Healthcare Assignment: Lactation in Newly Arrived Refugee Mothers

Question

Task: This healthcare assignment will be a 1500 word individual report (excluding references) on the specific vulnerable group you have been assigned. The report needs to be structured as per Assessment Criteria below.

1. Comprehensive identification of the health, nutrition and related social issues faced by the vulnerable group that you have been assigned to investigate and a critical review of the key aspects that need to be addressed.
2. Demonstrated ability to clarify the impact of the food environment and practices that enhance or worsen the vulnerabilities of the population being investigated, and the ability to clarify how policy or regulation might be strengthened or changed to support better health in the population being investigated.

3. Critical discussion around evidence based approaches to address the issues identified for the vulnerable group being investigated inclusive of the potential strengths and weaknesses of the approach/s reviewed.
4. Analyze the nutritional needs and influences on food choices for population groups across the lifespan.
5. Examine how population health is affected by food and nutrition systems and policies.

6. Critique Australian and global food and nutrition dietary and health patterns within an evidence-based framework.
7. Effectively communicate nutrition principles using a variety of approaches.

Answer

Introduction
Breastfeeding is an important factor impacting the development of a child after birth. According to the World Health Organisation (WHO) guidelines considered in the healthcare assignment, a child has to be breast-fed for the first six months after birth as the exclusive food source and breastfeeding should continue up to 2 years of age along with other complementary foods for providing the child with proper nutrition.

The custom of breastfeeding often depends on the cultural aspects and also is directly linked with the quality and quantity of nutrition available for the lactating mother. In this report, the factors impacting lactation in refugee mothers, policies that regulate the nutrition habit in their population, the general diet pattern in Australia and various factors affecting them have been discussed accordingly in an evidence-based manner.

Identifying health, nutrition and related social issues in lactating refugee mothers and critical review of key aspects
Since the past few decades, there has been a significant increase in the refugee problem due to rising violence and political disruption all across the world. Simultaneously the socio-economic conditions of the refugees, as well as that of the countries giving shelter, have worsened resulting in unhealthy living arrangements, malnutrition, infant mortality and so on.

Malnutrition has a greater negative effect on lactating mothers, stunting their children's development (Wfpusa.org 2021). It is a vicious cycle that affects both the mother and the newborn negatively and creates a long-term impact.

Apart from the economicbackgroundalso affects breastfeeding as the breastfeeding rate in Syrian refugee mothers is found to be lower by one research despite their educational background.Eidelman(2020) attributed this finding to the experience of war, violence by Syrian mothers for reducing their nursing behaviour (BayramDeger, Ertem and Cifci 2020, p. 172).

The presence of social stigma regarding breastfeeding in refugee mothers as they lack privacy.Another research highlights the difficulties faced by lactating African refugee mothers in Australia (Hauck et al. 2020, p. 2). The mothers were discouraged to breastfeed in public places due to a lack of awareness.

Another aspect of breastfeeding newborns is the employment status of the mother. In some cases, mothers switch to infant formula for feeding as they return to the workplace.

In Australia, refugees mainly came from South East Asia and Middle East, cultural factors of exclusive breastfeeding for the new born babies for first four months are very important. However, nutritional issues are faced by the refugees, other side, cultural factor of inability of produce breast milk in inheritance is a common belief.

Food environment and practices impactingof lactating refugee mothers
The intake of fermented food products, yoghurt is proven to be nutritionally helping lactating mothers. It also prevents the development of "lactation mastitis" (Eidelman 2020, p.1).

In Asian countries, breastfeeding is inherited as a part of native culture and practiced in the postnatal period enthusiastically. This is also seen in South-East Asian refugees in the United States.

However, the knowledge regarding breastfeeding also impacts the situation. Migrant mothers are often unaware of the benefits of colostrum or the first yellow milk in immunity building in the child and the solutions to the physiological problems related to breastfeeding like reduction in milk are also unknown to them. These also work as barriers to the issue.Organisations like World Food Program USA, the United Nations play a major role in addressing health-related situations among other aspects in refugee camps across the world. Breastfeeding mothers have medical Needs and in life-saving treatment can strengthens the mothers’ life, it is however, present in Australia. Local authorities can arrange nutritional foods so that the mothers can produce the milk for their babies and reuniting the refugee members owing to refugee displacement can also make mentally satisfied the mothers. This guidance includes both counselling of the mothers as well as supply of nutritional supplements to ensure healthy food habits.

Critical discussion around evidence-based approaches to address the issues for the lactating refugee mothers
The refugee crisis is declared to be a global humanitarian crisis pushing millions of people to unsanitary, unhygienic conditions and malnutrition. To discuss the intervention of global organisations in this issue, this report uses the instance of the United Nations’ assistance to the Rohingya refugees residing in Cox’s Bazar in Bangladesh.

The United Nations World Food Programme assists the refugee mothers and children by providing them with customised rations, education about nutrition, health and hygiene and counselling for the lactating mothers.
Breastfeeding is encouraged by the U.N nutritionists as a source of nutrition and immunity. In absence of a lactating mother, wet nursing is arranged to ensure the children's growth (Azad et al. 2019). Strength of this approach in this regard is to make the community overcome social stigma about breastfeeding in public. For that reason, not only the young mothers but also the fathers and grandparents are counselled. The mothers are also helped by building corners specific for breastfeeding in the U.N food outlets and centres for nutrition.

UNHCR (UN Refugee Agency) has taken the framework of action which starts with advocating the mothers in refugee camps to consider the influence of relevant managers in camp for Infant and Young Child Feeding (IYCF). The camp management needs to mobilise the resources for IYCF as it incorporates the strategies and proposals ensuring activities in all sectors (Unhcr.com 2021). Weakness of this, despite the efforts, the whole scenario is quite challenging. The trauma, related to forceful migration is overwhelming and requires a long-term supply of aids to return to normalcy, if at all possible. In this situation, overcoming social, cultural and economic barriers is excruciatingly difficult and cannot be done overnight. Strength is of this framework; the availability of nurses changes all the time as they switch shelters. Therefore, despite the international and host government efforts, the task of encouraging lactating immigrant mothers and the use of wet nurses to provide the children with the necessary diet remains elusive.

Policies can be strengthened to improve the population health
Government regulations and guidelines regarding nutrition sources play a vital role in the food choices of a population and thereby its health. The Australian Dietary Guidelines (NHMRC 2015) outlines five guidelines for maintaining proper weight, drinking plenty amount of fluid, eating plenty of vegetables, pulses, fruits, lean meats, tofu, limiting the intake of high-calorie foods, sugary drinks and encourages to develop an active lifestyle for preventing obesity and related issues. It also supports breastfeeding by lactating mothers and emphasises cutting down pre-cooked food items. The global population is generally influenced by scientific facts to form a diet plan, but the increasing spread of misinformation regarding nutrition has a negative effect on food choice. It leads to the development of unhealthy food habits giving rise to diseases.

Analysing the nutritional needs and influences on food choices for lactatingmothers’ role of nutritional policies
In connection with the above discussion of breastfeeding practices as a healthy habit in lactating refugee mothers, this report also emphasises the broader issue of choice of diet plans and its implications in human health across the world.

Food Standards Agency (FSA) defines food choice as "the selection of foods for consumption, which results from the competing, reinforcing, and interacting influences of a variety of factors". Choice of food is a significant factor in regulating not only the health of an individual, his or her family, community but also has its effect on a global level (HaghighianRoudsari et al. 2017, p. 241). It is influenced by various aspects of an individual or a population, discussed as follows.

The food choice of a population is determined by its socio-cultural and temporal variables.
The socio-cultural variables include ethnicity, demographics like sex, age, economical condition, marital status, urbanisation, the prevalence of diseases like type 2 diabetes, education, occupation, income, marital status, and geography mediated by individuals' attitudes and beliefs, religion, social status and so on (HaghighianRoudsari et al. 2017, p. 241).

Australian and global food and nutrition dietary and health patterns
The current evidence-based framework for nutrition and its drawbacks are discussed followingly (Neale and Tapsel 2019, p. 2).

• Systemic reviews- This helps in the integration of research data in a methodical way to form policies in nutrition. The drawback of this method is the dependency of guidelines on different research and large time requirements.
• Nutrient intake recommendations and dietary guidelines- They outline policies to intake necessary nutrition to reduce adverse health effects and chronic conditions. These policies become invalid, if not updated with time.
• Clinical practice guidelines- Used by clinicians. Also, require regular updates and a single central guideline to avoid contradictory opinions.
• Food standards and health claims- Used for marketing purpose of food products featuring their nutritional value. It requires to be externally monitored to limit advertisement of inaccurate nutritional information by the companies.

In order to use the nutritional principles effectively, the growing evidence-based framework should be closely monitored. The clinicians, academics and policymakers should form an efficient coalition to make the public aware of misinformation, pseudoscience and constantly update themselves as per the need of the hour.

Conclusion
Access to nutritious food is the most basic among all human rights. The global population health is impacted by the choice and sources of food available to the mass. Therefore, to ensure a constant supply of healthy dietary resources each national government has to make strict guidelines. Curbing the sale of high-calorie junk foods by levying high taxes and advertising their negative impacts on health is also to be done with utmost importance. This way, it is possible to encourage the general population to adopt a healthy active lifestyle and reduce the risk of obesity, diabetes, cardiac diseases and so on. Also, the nutrition in refugee camps across the world has to be more vigorously monitored and more intensified contributions by the international agencies are required to ameliorate the situation of the lactating mothers in the immigration shelters.

Reference List
Azad, F, Rifat, MA, Manir, MZ and Biva, NA 2019, ‘Breastfeeding support through wet nursing during nutritional emergency: A cross sectional study from Rohingya refugee camps in Bangladesh’, PloS one, vol. 14, no. 10, p.980.

BayramDe?er, V, Ertem, M and Çifçi, S 2020, ‘Comparison of the breastfeeding practices of refugee Syrian mothers and native Turkish mothers’, Breastfeeding Medicine, vol. 15, no. 3, pp. 170-175.

Eidelman, AI 2020, ‘Breastfeeding Practices: The Reality of the Syrian Refugee Population's Situation in Turkey’.

Gallegos, D, Vicca, N and Streiner, S 2015, ‘Breastfeeding beliefs and practices of African women living in Brisbane and Perth, Australia’, Maternal & child nutrition, vol. 11, no. 4, pp. 727-736.

HaghighianRoudsari, A, Vedadhir, A, Amiri, P, Kalantari, N, Omidvar, N, Eini-Zinab, H, & Hani Sadati, SM 2017, ‘Psycho-Socio-Cultural Determinants of Food Choice: A Qualitative Study on Adults in Social and Cultural Context of Iran’, Iranian journal of psychiatry, vol. 12, no. 4, pp. 241–250.

Hauck, YL, Kuliukas, L, Gallagher, L, Brady, V, Dykes, C and Rubertsson, C 2020, ‘Helpful and challenging aspects of breastfeeding in public for women living in Australia, Ireland and Sweden: a cross-sectional study’, International breastfeeding journal, vol. 15, pp. 1-14.

Marshall, S, Taki, S, Love, P, Kearney, M, Tam, N, Sabry, M, Kuswara, K, Laird, Y, Wen, LM and Rissel, C 2020, ‘Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia’, Women and Birth.

Neale, EP and Tapsell, LC 2019, ‘Perspective: the evidence-based framework in nutrition and dietetics: implementation, challenges, and future directions’, Advances in Nutrition, vol. 10, no. 1, pp. 1-8. Unhcr.org. 2021.IYCF activities. Available at: https://www.unhcr.org/5c0643d74.pdf [Accessed 22nd May 2021]

WFpusa.org 2021, Breastfeeding in Emergencies: The Struggles of New Mothers in the World’s Largest Refugee Camp, viewed 21 May 2021, https://www.wfpusa.org/articles/breastfeeding-in-emergencies-the-struggles-of-new-mothers-in-the-worlds-largest-refugee-camp/