Walking into a local clinic in Malawi you will be faced with images calling for men to take a more active role in the health of children and mothers. Some of the messages boldly challenge what we consider to be normal, explicitly stating: “Exclusive breastfeeding is a husband’s responsibility.”

Breast milk contains nutrients that are essential for a child’s growth and development. In rural areas where women have little money and limited access to clean water to prepare formula, breast milk is a cheap and safe option. But it is also by far the better option for other reasons. The World Health Organisation estimates that around 220 000 children could be saved every year with exclusive breastfeeding. Yet less than half of children under six months are exclusively breastfed.

Because exclusive breastfeeding is often misunderstood, it is important to define what it really means. The English Oxford Dictionary defines exclusive as excluding or not admitting other things. Exclusive breastfeeding, therefore, means that the infant receives only breast milk with no other liquids, food or even water – except for oral rehydration solution, or drops/syrups of vitamins, minerals or medicine. Exclusive breastfeeding is recommended from the moment the child is born and through the first six months of life. To ensure that exclusive breastfeeding is fully sustained for the first six months of the child’s life, it is recommended that:

• it is initiated within the first hour of life;
• the infant only receives breast milk without any additional food or drink –  not even water
• the infant is breastfed as often as they want, day and night (on demand); and
• no feeding bottles, teats or pacifiers are used.

So what do men have to do with it?

Breastfeeding is not only time-consuming, but also requires a lot of physical energy. Stress, fatigue and anxiety can reduce the amount of milk a woman produces. In both rural and urban areas, women are often overburdened with family responsibilities such as cooking and cleaning. For women employed outside the home, there is the added stress and pressure on their time which requires additional support in taking care of the new addition. Studies show that when men have information on exclusive breastfeeding they can support women by helping with housework, looking after children and even providing the much-needed continuous emotional and physical support as a skilled assistant or a partner.

Society, tradition and culture can prevent men from providing this support. Although times are changing, and more men are taking up family responsibilities – a cooking dad is still not considered the norm. Government policies and laws worsen men’s ability to support. Recently, President Cyril Ramaphosa signed an act into law that entitles men to 10 days of paternity leave. Women are allowed four months. Yet exclusive breastfeeding is recommended for six months.

How do we reconcile this?

Insufficient maternity leave presents challenges for exclusive breastfeeding. It also perpetuates gender inequality. After a woman gives birth, society expects her to take responsibility for looking after the child. Maternity leave reinforces the idea that only women can look after children. Absence from the workforce creates discrimination in terms of the wage gap and career progression. Society should promote equal sharing of childcare responsibilities. One way to do this is to pass legislation on shared parental leave. For example, the UK offers up to 50 weeks of leave and up to 37 weeks of pay between both parents.

Our study of men’s involvement in maternal and child nutrition in Malawi shows that men can and are taking an active role in cooking, cleaning and looking after children. Working with traditional leaders is essential to overcome cultural beliefs concerning the different roles men and women play.

Some men might be reluctant to become involved in “women’s work”, but legislation and policy cannot be implemented in isolation. Advocacy using male role models is also needed. Imagine a famous soccer player or a political leader taking an active role in the first year of their child’s life. What kind of message would this send to other men throughout the country?

Breastfeeding is a shared responsibility between parents. Children’s health and well-being could be improved by addressing gender inequalities. Our leaders need to support both parents to play an active role in children’s lives.

Dr Elizabeth Mkandawire is the Coordinator for the United Nations Academic Impact Hub on SDG 2 at the University of Pretoria. Her research focuses on gender and food security and nutrition policy.

Dr Nokuthula Vilakazi is a Programme Coordinator at Future Africa, University of Pretoria. Her research focuses on food security and nutrition.