20 February 2012

Interventions So Simple They Are Complicated

Chlorine water filter and doser

It is so simple! Breastfeeding can improve the health of infants dramatically. Well, yes, that is true but the whole thing about it being simple is a bit of a problem. Karen Grepin shares a personal anecdote as to why: 
Honestly, if I hear another public health official (frequently male) allude to the fact that breastfeeding is among the simplest interventions available I think I am going to lose it. I can tell you from first hand experience, breastfeeding was among the most physically and emotionally challenging aspects of raising my own son. 
My son was born a week early by cesarean section due to the fact that he was breeched. This delivery likely delayed my own milk production and I spent four very distressed and agonizing days watching my son shrivel up because I was so hell bent on making breastfeeding work. The simple solution would have beee to supplement his feeding. The advice and support I received from the breastfeeding experts usually took the form of one counsellor telling me to only do Y and whatever I do don’t do X only to be followed up by another counsellor telling me to only to X and never to do Y. Oh, and I did I mention how painful it was? Picture cracked, bleeding and infected nipples and a whirlwind of hormones. Yeah. 
Most public health experts recommend mothers to “exclusively” breastfeed their children for 6 months. But that means that the mother can never very far from their baby this entire time. The fact that this might negatively impact a mother’s labor force participation or productivity seems completely ignored in these cost-effectiveness calculations. Simple in this case is leaving a bottle so that fathers, grandparents, and other care givers can share in the feeding of children.
Her larger argument, which is excellent, is that behavior change is really hard. There are plenty of simple solutions (don't smoke, drink less, eat fewer calories) that have health benefits but are not so easily executed. So, while the solution itself is seemingly simple the execution is not.

In learning about clean water last week, it became obvious how the most simple solution (aka chlorine) fails because it alters the flavor to the point that people do not want to drink the water and it requires the right amount to be used.  You can address without much trouble, but adding additional steps can mean the difference between people treating and not treating their water.

Photo Credit: White African