This so-called babycare grant is really a "milk grant" and has been so recognised by almost every observer in T&T. The PM seems to have a bee in her bonnet about milk for babies. It's not the first time she has tried this. It's old-time condescending charity at its worst and actually quite embarrassing. Flinging money in isolation at needy moms to buy milk and possibly diapers and baby wipes is simply not seen any anywhere any more. It's simplistic and simply does not work. It does not help mothers. It does not help their children. So I am not going to deal with the PM's rationalisation of the grant, ie the woman who stole a tin of milk in 2007. Is this how we make decisions that will cost up to $120 million of taxpayers' money? I am not going to deal with the dependency syndrome that this baby handout might well emphasise. I am not touching the topic of possibly encouraging the birth rate to go up and fathers to stop support. I am also unclear if this grant is for the period 2014-2015 only or if it will continue and if so for how long? Have the economics been worked out? Is it sustainable?
If for only the next year, then it is quite simply an election gimmick to encourage mothers to vote for the Government. Milk grants should always be part of a carefully planned, comprehensive programme of assistance to needy mothers and children, like the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) which is a federal assistance programme of the Food and Nutrition Service of the United States Department of Agriculture (USDA) for healthcare and nutrition of lowincome pregnant women, breastfeeding women, and infants and children under the age of five. Notice it includes pregnant women and breastfeeding women as well as children under the age of five. Applicants to the WIC programme must meet eligibility requirements in four areas: (1) categorical, (2) residential, (3) income and (4) nutrition risk and during the course of their WIC experience must repeatedly satisfy these criteria to remain in the programme. Other programmes like nutrition classes that moms must take are built into WIC. WIC is also considered an opportunity for referrals for preventative health care services, eg infant immunisations, prenatal care, contraception etc. Breastfeeding must be part of any such programme because of the likelihood that giving formula or milk to mothers will decrease breastfeeding rates, even though WIC is supposed to go out of its way to encourage mom to breastfeed. Beginning in 1993, USDA introduced an enhanced food package for breastfeeding mothers who forego the infant formula food package. Still, as Urban Institute researchers concluded in 1994: "It is not clear whether WIC promotes or hinders breastfeeding."
Practical observation on the ground leaves little doubt, however, that WIC does contribute to less breastfeeding. Formula and whole-milk feeding are associated, in the short term, with infectious diseases like gastroenteritis, respiratory tract infections especially ear infections and its sequel, hearing loss which affects school learning, urinary tract disease, necrotising enterocolitis, etc, and in the long term with obesity and chronic non-communicable diseases, diabetes and arteriosclerotic cardiovascular disease–a priority in T&T and one which the Minister of Health has repeatedly alluded to in terms of health disability, emotional stress and economic liability to the Treasury. Handing over formula or milk to mothers plays into this scenario. The recent announcement that the MoH has increased the annual subvention for an NGO promoting breastfeeding to $250,000 shows that the Government, or at least the Ministry of Health, understands this. Dr Khan has rightly stressed that, "Breastfeeding is one of the few things, if started very early and continued, will decrease the likelihood of non-communicable diseases as the child grows older." What might have been a better idea to do with the $120 million? Ideas abound and simply need to be thrashed out. The life of a child can be conveniently classified into three stages: prenatal; intra-natal– ie labour and delivery–and postnatal. Prenatal ideas include using the money to pay mothers not to become pregnant, paying for more contraceptive services, improving antenatal services in the Health Centres (despite the excellent job the Public Health Nurses do, antenatal services are in a mess and have not changed since the colonial days).
After some of the stories we have heard over the last year, labour and delivery services obviously need improving. That includes the social services but involves training of more midwives and obstetricians. The postnatal era is such a vast one and there is so much to be done. All of the hospital neonatal units need upgrading of staff and equipment. A dedicated lowbirthweight/ premature/neonatal problem register to track and support these high-risk infants from birth into adulthood, paying special attention to their education, is needed. Early childhood education for all children from birth to three years, the critical age and not three to five or five onwards, should be the emphasis. The money could be used to set up a proper WIC-type of service. Not to mention for the umpteenth time the much-needed National Centre for Children with Disabilities that Families in Action and I have been talking about since 2004. So many ideas. It's a shame that the people in the know, including apparently the technocrats at the MoH, and the doctors and social workers who daily fight up with the problems of needy mothers, were not consulted.