Breastfeeding without borders

Kelli breastfeeds her son, Olivier. Photo: Kelli Cappelier.

The village traditional midwife and my work counterpart, Sané, and I walked to the hut where a mother was holding her malnourished child. The child is crying without tears, and the skin stays when pinched – marasmus, a form of severe malnutrition, as I learned during my three-month Peace Corps training just outside of Bamako, Mali. I’d been in the village for one week, prepared with only three months of intensive training in public health.

I asked the mother if the infant was still breastfeeding. “No, she got sick with diarrhea. She would no longer latch, so my supply stopped,” she answered with hopelessness in her voice. I noticed the village drank well water that was not clean, and traditionally mothers gave their newborn water from birth as they waited for their milk to come in, which was likely the culprit of this baby’s diarrhea.

This was the only case of marasmus I experienced in my four years living in Mali, where kwashiorkor (a form of malnutrition due to a lack of protein) was much more commonly seen in the area I was posted, but this always stuck with me. I still think about that child and the mother’s hopelessness and sadness. Traditionally, Malian mothers do not give their children colostrum, which is the yellowish, sticky breastmilk that arrives after pregnancy and is recommended by the World Health Organization to begin within the first hour after birth. They believe colostrum is just water and not enough for the child, so it is always supplemented with water, which is unnecessary and can be harmful to a newborn’s fragile immune system.

Working alongside the village traditional midwife in rural western Mali, we made frequent house calls to new mothers. Breastfeeding was often the primary challenge mothers grappled with in the early days of motherhood, similar to many other mothers around the world. Helping mothers improve breastfeeding was a primary focus for Sané, and I was there to help support her in that effort, but it resulted in an experience of great value for me personally and professionally. Observing and learning the value of breastfeeding in this context was the beginning of me becoming a breastfeeding advocate.

Fast forward 15 years, here I am with a 2.5 year old son and still breastfeeding. In the field of global health, I knew successfully meeting one’s breastfeeding “goals” while striving for a “work/life” balance would be a complex dance. What I did not anticipate was just how much thought and strategy it takes to successfully breastfeed. I always committed to myself and my son that as long as he was interested, I had a goal of breastfeeding for two years.  

When I first returned to work after my four months of maternity leave, I was fortunate to enter into a supportive environment where I had a well-equipped mother’s room available in my office, supportive “mom-colleagues” to exchange with, and I could carve out time in my calendar to pump as needed. I am also a firm believer in normalizing the reality of breastfeeding and pumping and I probably talk about it more often than some are comfortable with. While there are some who may raise their eyebrows at breastfeeding a toddler, it is a feat I am very proud of and do not hide. Reaching this point in my breastfeeding journey is in large part the result of having a supportive and flexible work environment that so many women do not have the luxury of receiving from their employers or colleagues.

 In my role, I travel (mostly long distances) up to 30% of my time. Traveling while pumping, I could never bring myself to “pump and dump.” I wanted to secure my supply, especially in the second year of breastfeeding, while also not wasting a drop of all the work that went into expressing it! When I embarked on my first trip when my son was 10 months old, I went to Ghana for a four-day trip that consisted of me being in the country for less than 48 hours. As I tried to strategize how best to pump and travel with breastmilk, I had difficulty finding resources applicable for my line of work. I found resources either specific to traveling domestically in the US, or to countries where one can access dry ice or mail services. But my work travel is 90% in sub-Saharan Africa, travel which usually takes about 24 hours. Sanitation is not always available, and pumping is not always culturally supported or understood. So through trial and error, successes and failures, and sometimes pleasant surprises, I managed to come up with a system that worked and enabled me to bring home all of my expressed milk (e.g., who knew that London Heathrow airport is so friendly to breastfeeding moms, with clean nursing rooms and an allowance of two liters of milk through security?!).

In my travels, I have enjoyed the experience and process of breastfeeding and pumping around the world. While I have experienced more frustration, overall, there tends to be much more support in the world than judgement. The frustrating experiences became an opportunity to learn and educate, and embrace the support and pleasant surprises that come on this journey. For example, the power of the “sisterhood” stretches far and wide. Women speak a language that transcends borders and motherhood can bring you together in powerful ways, even if you don’t speak the same language. It’s a beautiful thing.

When working and traveling as a breastfeeding mom, I always felt a sense of anxiety. I felt like my mind never rested, and I constantly watched the clock for my next pump session.  We’re all doing the best we can and surmounting significant barriers while juggling so many things, but an enabling environment on so many levels is critical to the success of a woman’s breastfeeding journey.

Moms – you are doing amazing and you’ve got this.

Families and friends – you are the best support a mom has in her breastfeeding journey, and we thank you for that.

Colleagues and work environments – you help us meet our goals the best we can, despite the inconvenience it can bring to scheduling meetings, etc., your support and patience means more than you can know!

If you are a traveling momma, especially working in global health, see more here for strategies to pump and bring home your milk in uncertain environments.

To all of us – let’s make sure that no baby loses the protective health benefits of breastfeeding due to lack of support. The scene in Mali still fills me with motivation because I know that we can prevent this suffering to create the enabling environment mothers need to care for their children.