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Using Local Customs to Champion Breastfeeding in Tajikistan
Dr. Ranogul educating community health teams in Khuroson District
On most weeknights in Tajikistan’s Khatlon region, mothers bring their children to Dr. Ranogul Khusanova’s home seeking treatment or advice. Using her medical training as a pediatrician and nutritionist and knowledge of local culture, Dr. Ranogul provides mothers with useful advice on nutrition and breastfeeding.
She plays a critical role because of breastmilk’s importance for infants. It contains all the nutrients most infants need, protects against diarrhea and other common childhood illnesses such as pneumonia, and may also have longer-term health benefits for the mother and child. The World Health Organization (WHO) recommends early initiation of breastfeeding within one hour of birth and introduction of safe, nutritious, solid foods at six months combined with continued breastfeeding up to two years of age or beyond. The WHO also recommends that infants get exclusively breastfed for the first six months of life to achieve optimal growth, development, and health.
In Tajikistan, only 36 percent of infants aged 0-6 months are exclusively breastfed. This represents a steep drop off; close to 95 percent of infants in the country are exclusively breastfed during their first month. Several factors are responsible for the decline, including: a mother’s belief that breast milk is not enough to satisfy hunger; a lack of understanding that suboptimal breastfeeding leads to poor milk production; conflicting advice about the sufficiency of breast milk to satiate hunger, quench thirst, or soothe children in the heat; lack of social support from families to enable mothers to rest; lack of help with chores to enable sufficient breastfeeding; conflicting encouragement from family and some health providers to feed children animal milk and/or formula; and lack of awareness of the negative consequences of feeding cow’s milk/other animal’s milk too early. 
“Traditionally, mother's milk was valued as sacred in Tajikistan,” said Dr. Ranogul. “My mother raised all 10 of her children exclusively with breastmilk, but today that is very uncommon. This is what worries me as a woman, pediatrician, and nutritionist. Children who are not breastfed exclusively in their first six months may experience health issues in their future.”
As one of the country’s few nutritionists, Dr. Ranogul was aware of these breastfeeding challenges but struggled to stay up to date on new developments in evidence-based medicine. Due to financial constraints, she was unable to travel to participate in technical refresher courses offered by the Postgraduate Institute for Advanced Training of Medical Worker of Tajikistan.
The United States Agency for International Development (USAID) filled the gap. In July 2017, Dr. Ranogul participated in a two-day USAID-sponsored training on Nutrition for Children Under 2. The sessions provided new, scientifically validated data on the importance of exclusive breastfeeding, breast milk content, complementary feeding, and WHO protocols for intensive feeding. This experience inspired her to learn English so she could take other training to stay current on global best health practices.
Dr. Ranogul facilitating a training for the HMHB team.
Armed with these critical nutrition messages and intent on reaching more people with them, Dr. Ranogul joined USAID’s Abt-led Healthy Mother, Healthy Baby (HMHB) Activity as a nutrition specialist in March 2021. Now she collaborates with international experts to adapt cutting-edge practices to the local Tajik context and foster sustainable nutrition solutions. Uniquely familiar with the Khatlon region and the challenges of reaching ethnic minorities and other vulnerable groups, she used her trusted role in the community to design and lead a social behavior change campaign called Breastfeeding Beyond the First 40 Days.
“I have known Dr. Ranogul since childhood because my mother brought me to her,” said Ms. Hosiyat, a mother and neighbor of Dr. Ranogul. “I now have two children, and I am very grateful for her care and advice. Thanks to her, all the mothers in our village know how to properly care for their children, especially when they are sick. She also taught me that eating nutritious foods can prevent many health problems for both children and adults."
HMHB works to scale evidence-based public health practices such as exclusive breastfeeding to improve the health of mothers and babies in 12 districts of the Khatlon region. It uses social and behavior change (SBC) to creatively reach moms and families so they can improve nutrition and maternal and child health. In particular, for the upcoming campaign: Breastfeeding Beyond the First 40 Days, Dr. Ranogul worked with global SBC experts from the HMHB subpartner, Changeable, and devised a culturally sensitive approach to encourage moms to exclusively breastfeed children until a child is six months old. The goal: a return to the traditional Tajik saying: Mother's milk is the sap of my soul. It is cure for all the pain. Hundreds of dry and fresh foods for the baby. The breast milk, however, is the best.
 Much of the data indicates that while formula is widely available in the market in many places, accessibility is limited due to its high cost.
Reproductive, Maternal, Newborn and Child Health (RMNCH) in South & Central Asia