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Use of traditional GALACTAGOGUES in breastfeeding support during emergencies - yes or no?

This question was posted the Infant and young child feeding interventions forum area and has 3 replies.

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Isabelle Modigell

IYCF-E Consultant

Frequent user

27 Feb 2022, 14:26

I am seeking opinions and experiences on the use of traditional galactagogues (milk-boosting foods, drinks or herbs traditionally taken by postpartum mothers) as part of breastfeeding support provided during humanitarian emergency responses.

IN YOUR OPINION: Are they unhelpful cultural beliefs that should be tackled because they distract from well proven methods to increase milk supply / erode mothers' confidence in their ability to successfully breastfeed their baby when the galactagogue in question is no longer available because of the emergency? OR are they valuable indigenous knowledge that we should work with, while also seeking to identify and correct the cause of low milk production and sharing that frequent breastfeeding/milk removal is vital to increasing milk production? Or do you have a different opinion altogether? 

I would be very interested to hear from you:

  • Do you look into traditional use of natural galactagogues during IYCF-E needs assessments and/or discuss these practices when training breastfeeding counsellors during emergencies?
     
  • In the emergency contexts you work in, are you aware of any foods, drinks or herbs (galactagogues) that are traditionally taken by new mothers to support breastmilk production? Is there any evidence to support their use?
     
    • If yes, has access to these traditional galactagogues been disrupted by the emergency, and what impact - if any -  have you seen this have on breastfeeding outcomes /  mothers' confidence in their ability to breastfeed their baby? 
       
  • If your approach has been to counsel mothers that galactagues are not important/recommended, how has this been received and what impact - if any - have you observed?
     
  • If your approach has been to facilitate access to traditional galactagogues, how did you do this, how was this received and what impact - if any - have you observed?

Your inputs will be used to inform Save the Children's IYCF-E Curriculum which will soon be made externally available to train IYCF-E programme planners, managers and advisers.

I look forward to hearing your thoughts!

Thank you,

Isabelle

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Background notes:

I was able to find one publication mentioning galactagogues in emergency contexts. Studying post-Earthquake Nepal,  De Young et al. (2018) identified jwano as a spice traditionally used to boost lactation in Nepalese mothers. When they asked one mother if she ate jwano soup to facilitate lactation, she responded by saying that there would be no other way to produce human milk: “If I don’t eat the soup [jwano], how can I make the milk?” The authors recommended that "the use of specific spices (jwano) to increase lactation should be considered in support and interventions during disaster recovery, even if the mechanism is partially through altering perceptions of low milk supply." Do you agree? 

A Cochrane Review published in 2020 concludes that: "Due to extremely limited, very low certainty evidence, we do not know whether galactagogues have any effect on proportion of mothers who continued breastfeeding at 3, 4 and 6 months....There is some evidence from subgroup analyses that natural galactagogues may benefit infant weight and milk volume in mothers with healthy, term infants, but due to substantial heterogeneity of the studies, imprecision of measurements and incomplete reporting, we are very uncertain about the magnitude of the effect....High‐quality RCTs on the efficacy and safety of galactagogues are urgently needed."

In their book "Making More Milk", Diane West and Lisa Marasco write that "in every country and culture, nursing mothers have taken special foods or herbs to bring in a strong supply or boost a lagging one. These traditional practices are supported by centuries of experience and continue to be passed on from one generation to the next. Scientific support for traditional knowledge has lagged, and skeptical professionals have argued "there is no research" or "there is no evidence that galactagogues work" but that simply isn't true...........the quality of new research continues to improve, so stay tuned for updates on "where's the evidence?"

West & Marasco go on to identify herbs such as chamomile which can help with relaxation, supporting the letdown reflex that can be inhibited by stress (as seen during emergencies). 

Please share publications you think may be of interest, particularly any covering emergency contexts. 

Karleen Gribble

Normal user

28 Feb 2022, 00:49

Hi Isabelle,

Traditional galactogogues are everywhere. In my view they mostly have no impact (or at most they have a negligible impact). What I have seen is the effort spent trying to get or not having the traditional galactogogue have a really negative impact on breastfeeding. Women can also rely on the galactogogue to make more milk rather than the core practice of milk removal/breast emtying. What I've also seen in emergency responders bring their own traditional galactogogue into a situation- which is totally pointless and again detracts. And finally, I've seen mothers who have been provided with their traditional galactogogue (milk is a common one- which presents it's own issues) feel more confident and able to breastfeed. So it's complex! I don't think that we should be reinforcing that galactogogues are necessary to breastfeed but neither is it appropriate or helpful to tell women that these substances are likely useless if she strongly believes that they are. The way I approach it in breastfeeding counselling when mothers are very keen on the galactogogue is to try to put it in context- give her information about how lactation works and the paramount importance of milk removal in driving milk production. If she has access to her traditional galactogogue I will provide her with empathy about how  that must give her confidence but may also say something to provide her with a way of being OK if it's not available, some anticipatory guidance. For example, I might talk about how milk for example is a nutritious food and that it can give mothers energy which helps them to care for their child and so if milk is not available at some time in the future, other food can fill that gap and breastmilk production will continue just fine so long as she keeps breastfeeding her baby. If she does not have her galactogogue available and is anxious about it, I will again provide empathy and might provide some information about how different galactogogues are used in different places and again depending on what is available suggest that a food that she does have access to might be able to fill that gap- while again emphasising the importance of frequent breastfeeding in driving milk production. You might find some info in the following paper helpful- it's about prelacteal feeds rather than galactogogues but it provides an example of adjusting a traditional belief to improve health outcomes. I think there's some relevance here. Dörnemann J, Kelly AH. ‘It is me who eats, to nourish him’: a mixed-method study of breastfeeding in post-earthquake Haiti. Maternal and Child Nutrition (2013) 9(1):74-89. doi: 10.1111/j.1740-8709.2012.00428.x.

I hope this is helpful.

Rukhsana Haider

TAHN Foundation

Normal user

28 Feb 2022, 05:28

Hi Karleen and Isabelle,

You have posted good questions and responses!

The use of "natural" galactogogues is common and culturally acceptable in many countries during normal circumstances too. Some women (my close family members too) swear by the ones that have proved helpful in increasing their milk production, black cumin (kali jeera) being one of them. Generally we are empathetic during counselling, and do not actively discourage the use of the natural galactogogues. As you will agree, there may be a psychological effect - mother feeling better since she is actually taking something to increase her milk production, and as long as she continues to breastfeed exclusively, we are happy! However, I must confess that I do feel rather uncomfortable when mothers are prescribed "chemical" galactogogues, as I seen/ heard some rather worrying side-effects. There is another risk - mothers often tend to continue these medicines for a longer duration than what has been advised. In emergency settings, I would think that one needs to be even more careful, since access to knowledgeable health professionals is scarce. 

Best wishes

Rukhsana

Lenka Blanarova

Senior Nutrition Assessment Coordinator

Normal user

1 Mar 2022, 06:52

Dear Isabelle,

within nutrition causal analyses Link NCA we tend to document galactogogues and prelacteal feeds, which are shared with us during the qualitative inquiry. Most of recent Link NCA studies include a mention of these to a various degree, depending on how much the community relies on these foods/liquids to boost the breastmilk production and/or supplement breastmilk for various reasons. However, within our work we do not attempt to prove whether cited galactogogues or prelacteal feeds have a positive or negative effect on the health of a mother or that of her child (such question would be referred for further research beyond our scope of work) but rather explain why they seek them. From what I have seen across multiple contexts, mothers usually deploy these practices with the best interest of a child in their mind while some may be more useful/nuisible than others so I would say that all need to be considered within the context, in which they are used.

In case you would like to get more info on documented galactogues and prelacteal feeds from Link NCA studies, my colleague Carine Magen coded all Link NCA studies in NVivo last year and so we should be able to extract relevant data for you rather easily. 

Kindest regards,

Lenka

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