The Milk of Life: Breastfeeding in the Sultanate of Oman

By Um Yaqoob

Durga illustrationIt was 9 p.m. when the nurse wheeled me to my bed, one of six in the Omani hospital ward. After a full day of labor, I thought I would finally settle down with my sleeping newborn and get some rest.

The first few cries from the baby in the adjoining bed didn’t bother me. The mother responded quickly, and I was able to doze off. When he howled for the second, third, fourth, fifth, and then I-don’t-know-what-number time, the mother let out an audible “tsk” before she went to pick him up. Her nerves were beginning to fray. By 3 a.m., so were mine and those of the other four women on the ward. The later it got, the longer it took the woman to pick up her son. The nurse came to talk to her. “He wants to nurse,” she said.

“I keep feeding him. There is no milk.” The woman raised her voice, a heavy accent coloring her English. She was near to tears.

“There doesn’t need to be any milk. He just needs you.”

“I’m tired! I can’t keep getting up to nurse him! Please, can you give him a bottle?”

“No.” The answer was very firm. “Breastfeeding is not just about milk, Mother. Your breast is all that baby knows. He needs the colostrum that is there now. Even if you don’t feel it, it’s there.”

The mother moaned and fell back onto the bed. “I can’t stand any more of this.”

I felt sorry for her. I felt sorry for all of us. Her baby was keeping all the mothers, and our newborns, from getting our rest. Yet I imagined her nipples were sore by then, and her fatigue was aggravating her impatience with her baby’s need to suck.

The doctor came. “What’s wrong, Mother? Your baby won’t nurse?”

“He nurses! That’s the problem! That’s all he wants to do. He won’t sleep because he’s not getting any milk. Please, doctor, tell the nurse I need to give him a bottle.”

The doctor shook his head. “I cannot do that. Your baby is sick. He has a fever. That is why he won’t sleep. He needs what is coming from your breast now. It is the only medicine we have for him.”

She started to cry.

“You are a mother of five now. You know all of this. Please. You must feed your baby.” He picked up the whimpering baby and gave him to his mother. “Feed your baby, Mother.”

Finally, after several more wakings, the baby became quiet. He was quiet for so long, in fact, that I could not sleep in the sudden silence. Looking over to see what had calmed him, I saw that the woman had fallen asleep with the baby at her breast. Her arm was around him. If he awoke, what he needed was right in front of him.

Morning came just two hours later. Before the nurses had even come to change the beds, the occupants of bed number one had a visitor. A tall woman stood sternly over the mother and sick baby. The woman began to speak in excited Arabic.

“What is this the nurse is telling me? You were asking for a bottle for the baby?”

“He couldn’t sleep. He was hungry.”

The visitor shook her head. “Yes, he was hungry–hungry for his mother! Do you want to stay here for a month with a sick baby? Your other children are crying for you, and you are just lying here in the bed!”

“I cannot feed him anymore! I’m tired.”

“Give him to me, then. I have milk. I’ll nurse him.” The tall woman lifted the baby from his bassinet and sat down.
By now all of the other mothers, including me, were sitting up to watch the scene. The tall woman had the baby in position, ready to latch on, when the mother said, “Give him to me.”

“Why? You said he needs milk. Here is milk.” She drew the baby close again.

The mother reached for her child. “I’ll feed him.”

Slowly, her eyes set straight on the mother, the woman handed the baby over. “Feed him, then. No more talk about bottles. No nephew of mine will have a bottle before he has even left the hospital!” After a few minutes, satisfied the new mother would indeed devote herself to breastfeeding, the visitor left.

The mother scarcely put the baby down the rest of the day. He sucked at her breast even as she sat dozing in her chair, even as she ate her food. Except for an occasional fuss from the other babies, the ward was quiet.

Evening came, and with it arrived the doctor. “Well, Mother, I see your medicine worked. The fever is down, and if it stays down you can go home tomorrow.”

Relief flooded the woman’s face. “Alhamdu lillah [thanks be to God]!” she proclaimed. After the doctor left, I heard the woman sniffling. She was crying, kissing the baby, saying “Alhamdu lillah” over and over.

Before the Sultanate of Oman opened its eyes to the modern world, a great number of babies died of disease or dehydration, either at home or in what was the country’s only hospital. Many deaths were caused by bad water mixed with too little formula. Malnourished and dehydrated from diarrhea, the babies simply had no strength to fight other illnesses that came their way.

In 1970, a new leader took the reins of the country. Sultan Qaboos felt deeply for the plight of his people and immediately earmarked a large portion of the country’s modest oil wealth to setting up modern hospitals and clinics throughout the country. Along with this, a campaign of immunization and education about child health care was launched. Infant mortality rates fell. However, many children were still born sick or became ill in infancy from water-borne diseases. Oman’s Ministry of Health decided to fight back with tough medicine.

Today, when any woman, whether Omani or a foreigner, gives birth in an Omani hospital, the baby’s needs take precedence over the mother’s decision about whether or not to breastfeed in the first days. Unless there is a good reason for providing artificial nutrition, such as maternal illness or a sucking problem, no formula or bottle-fed supplementation is allowed. Nurses are instructed not to permit pacifiers in the crucial first days. The only food is colostrum, the only source of sucking satisfaction the breast. Only when a woman is discharged is the decision hers–bottle or breast–although she is strongly encouraged to nurse for as close to two years as she can, with solids not being introduced until the fifth month. As long as she is in the hospital, the rule is: breast only!

This may seem severe and unfair to mothers who do not wish to breastfeed, but few health specialists doubt that this breastfeeding program is helping to cut down on infant illnesses and deaths.

When Sukayna al-Ghaithy visits a friend with a newborn, she will “ooh” and “aah” only for the first few minutes. Then comes the inevitable question: “You are breastfeeding, my love, aren’t you?”

To those women who answer “yes,” Sukayna offers full support and encouragement. Those who answer “no” also receive encouragement, but of a different kind: “You must at least try!” she counsels. “It is your baby’s right.” If the baby starts to cry for any reason, Sukayna will smile with wide eyes and say, “See? She wants you!”

This is Sukayna’s job, whether she’s on or off duty. An Omani national and a former midwife, she now works with UNICEF and the World Health Organization to bring the breastfeeding program into the most remote parts of the nation. Sukayna has seen many babies sick with the types of illnesses, such as jaundice and dysentery, that breastfeeding can alleviate or prevent. It is because of this that she feels so strongly about the program. She feels that it saves lives–many lives–through antibody protection of the infant, cleanliness of the milk, and calorie content.

More than this, however, Sukayna feels deeply about breastfeeding because of her Muslim beliefs. “The Qur’an tells us to feed our babies two full years. For a Muslim, it’s an act of worship to nurse a baby,” she says. Indeed, a major reason for the program’s success is that it appeals to the Omanis’ conservative Islamic faith; in addition, the message is delivered to them by someone who understands their religious sentiments.

Another reason is the obvious physical results. Dr. M. V. Joseph, director of the program, stops short of saying that breastfeeding alone has reduced infant mortality, but he sees a clear connection between improved health care and the encouragement of extended nursing. “Particularly when we look at the diarrheal diseases, we can say that breastfeeding has contributed significantly to improving the health of many Omani children,” he says.

Perhaps none of this would work if the mothers did not receive so much support. Although most Omani women do not work outside of the home, those who do are allowed long maternity leaves to establish a firm nursing relationship; once back at work, they are given time during the day to go home and feed their babies. Employers are generally compliant, and even those mothers who work far from their homes find that they can continue breastfeeding well through the first year with minimal supplementation with formula.

Women are also eager to nurse in the early months because of breastfeeding’s contraceptive effects. In a society where large families are common and contraception is not widely practiced, most women are aware that exclusive nursing can delay the return of menstruation and will breastfeed for that reason alone.

Breastfeeding support groups are a tremendous component of the program’s success. These groups operate at the grassroots level, with volunteers serving their own villages and neighborhoods to bring the program’s message to all new mothers and their families. Professionals like Sukayna travel throughout the country to educate the volunteers, but most of the work is done by familiar faces within the communities.

Volunteers share their own experiences as breastfeeding mothers and add to it the wisdom of women who never used a bottle for feeding. As one woman commented, “In one village that I came across, an elderly woman knew a lot more about proper positioning of the baby for breastfeeding than I did.”1 Volunteers operate through daily neighborhood women’s gatherings as well as poster campaigns in clinics, well-illustrated and culturally sensitive pamphlets, and home visits.

In addition to helping babies and mothers, the breastfeeding program has added a new dimension to the lives of the many Omani women who volunteer in the support groups. Such women speak of feeling that they’re a vital part of their community, that they serve an important function. “Now I am not just one of many,” one volunteer says. “I stand out, I’m special. I’m a unique individual with something to offer.”2 Another speaks of the satisfaction of becoming close to the children: “Touching children, becoming intimate with the world of children, is a delicious experience, and we may offer help to this beautiful new world.”3 One woman sums up the feelings expressed by many: “Before, we knew only ten households and never visited the others. But now the circle has widened.”4

These pioneers–volunteers, mothers, and their babies–have achieved a remarkable goal, but there remain many battles to fight. One of them is the lingering impression among many women of previous generations that bottle feeding is more “modern” and thus “better.” These older women seem more experienced and their advice is respected, so a new mother is likely to accept the idea that babies need supplementation with formula and water or even that they need no breastmilk at all.

There is also a reluctance to use a backup form of birth control, so many women become pregnant before they’ve finished nursing a baby for a full two years. This is due to ambivalence on the part of both men and women, combined with an ignorance of the limited birth control permitted by Islamic law (for instance, to allow a woman to breastfeed an infant or to allow the mother to recover from giving birth). Furthermore, many older mothers are reluctant to take the advice of younger women, whom they see as inexperienced and naïve.

Obviously, further education and encouragement is needed, but roots have taken hold in a very Omani way. Says one volunteer, “We’re now like the palm tree, which has roots in the ground and cannot be uprooted.”5

NOTES

1. The Circle Has Widened: Community Support Group Volunteers in the Sultanate of Oman (Muscat, Oman: Ministry of Health and UNICEF, 1999), 12.

2. Ibid., 8.

3. Ibid., 8.

4. Ibid., 11.

5. Ibid., 17.

For more information about breastfeeding in other cultures, see the following article in a past issue of Mothering: “The Politics of Infant Formula,” no. 60.

Um Yaqoob is an American Muslim who has lived in Oman since 1993. She and her husband, Yousuf Al-Mohamed, have five children: Nassima (10), Yaqoob (9), Zainab (5), Ayah (3), and Yahya (10 months). The three older children are homeschooled in Arabic, using the curriculum of the Omani schools.

Published: Issue 106, May/June 2001