Optimal breastfeeding and why we need more of itby Jennifer Bowden
Increasing this country’s breastfeeding rates could greatly improve health and reduce healthcare costs.
In 2009, fewer than 20% of Vietnamese babies were exclusively breastfed until the age of six months, as recommended by the World Health Organisation. Many mothers were convinced they couldn’t produce enough milk, says environmental journalist Jennifer Grayson, who researched the situation in Vietnam for her book Unlatched: The Evolution of Breastfeeding and the Making of a Controversy. “Because of formula advertising, women had come to believe the combination of breastmilk and formula was the best nutrition for their baby.”
Other contributing factors to Vietnam’s low rates were the easy availability of artificial formula and lack of support from healthcare workers and older family members.
Lack of family support is also an issue in other countries. In a recent British study, most mothers with infants reported feeling satisfied with their chosen feeding method, whether breastfeeding or using artificial formula. However, among breastfeeding mums, 54% felt the need to defend their feeding choice, 38% felt stigmatised and 15% felt guilty. The family environment contributed significantly to those feelings.
In Vietnam, several key changes enabled mothers to exclusively breastfeed babies to at least the age of six months, says Grayson. The Government increased paid maternity leave from four to six months and Alive & Thrive – a large-scale initiative aimed at saving lives and promoting healthy growth through better breastfeeding and complementary feeding practices – was introduced, with support from the Bill & Melinda Gates Foundation.
Alive & Thrive worked with Vietnam’s Ministry of Health and Unicef to advocate for funding to improve infant and young child feeding, educate healthcare workers and create social franchises to offer counselling and support for breastfeeding in local communities. The programme also developed breastfeeding promotional campaigns, which reached millions of mothers. As a result, exclusive breastfeeding rates rose from 26% to 48% in just one year in those regions. In areas with both mass-media campaigns and social-support franchises, exclusive breastfeeding rates (to six months) rose from 19% to 62% between 2010 and 2013.
In New Zealand in 2014, just 25% of babies were exclusively or fully breastfed at six months, a significant drop from the 80% of two-week-old babies exclusively breastfed that year.
Increasing our breastfeeding rates could significantly improve health and reduce healthcare costs. US researchers analysed the benefits of optimal breastfeeding (exclusive breastfeeding until six months, with continued breastfeeding for at least a year) and found that for every three women optimally breastfeeding, one infant middle-ear infection is prevented, and for each 95 women breastfeeding, one child is saved from hospitalisation for a lower-respiratory-tract infection.
The number of women needed to optimally breastfeed to prevent one case of maternal hypertension is 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented.
Says Grayson, “A lot of people are recognising how important [breastfeeding] is, but there isn’t the support in society for women to be able to successfully breastfeed. You’ve got this real conflict: on one hand, we are starting to recognise how important it is, and on the other, mothers can’t do what they know they’re supposed to do, so there’s a lot of guilt.”
New Zealand’s Baby Friendly Community Initiative aims to improve community support for breastfeeding through a programme that educates and requires service providers, such as GPs and midwives, to protect and support breastfeeding past that two-week mark. It’s not mandatory, so it may not be high on the agenda of our busy NGOs and primary-care health providers, irrespective of the long-term health and cost benefits of optimal breastfeeding.
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