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Why More Mothers Don’t Breastfeed Their Babies

From barely regulated marketing to a lack of healthcare services, there are many factors that make it difficult for mothers in developing countries to breastfeed their babies. The solution, say experts, requires more than just saying “breast is best.”

Written by Christine Chung Published on Read time Approx. 5 minutes
Hong kong breastfeeding
About a hundred mothers with their babies attend a breastfeeding flash mob in Hong Kong to promote the practice and urge the government to establish policy to protect the right of breastfeeding mothers in public place, June 14, 2014. AP/Kin Cheung

Around the world, medical professionals recommend breastfeeding babies exclusively for their first six months. But despite the overwhelming evidence of its benefits, breastfeeding is not the norm. Globally, nearly two out of three infants are not exclusively breastfed for the recommended six months – a rate that has remained steady for the past two decades.

According to UNICEF, breastfeeding has “profound impact on a child’s survival, health, nutrition and development.” Research shows that breast milk provides all of the nutrients, vitamins and minerals an infant needs in its first six months. The act of breastfeeding has been shown to stimulate the proper growth of a baby’s mouth and jaw and, later in life, can have a positive effect on behavior and speech, as well as lower the risk of chronic conditions such as obesity, high blood pressure and childhood leukemia. A series in the Lancet suggested that the deaths of 823,000 children and 20,000 mothers each year could be averted through universal breastfeeding.

Even with all the benefits associated with breast milk, many women are bottle feeding their babies. For some, medical and living issues make breastfeeding impossible. But for others, say health experts, the choice to turn to the bottle is influenced by a number of factors – from marketing to lack of healthcare services – that make it difficult for women to get the best out of breastfeeding.

Breastfeeding advocates blame baby formula companies, which they accuse of skirting marketing legislation to promote their products in low- and middle-income countries. Breast milk substitute is “a big business with massive profits,” says Mike Brady, campaigns and networking coordinator for Baby Milk Action. The breast milk substitute industry reports annual sales of almost $45 billion worldwide, projected to rise by over 55 percent to $70 billion by 2019.

In the 1970s, baby formula companies – labeled “baby killers” by critics – suffered a backlash against the way they pitched their products. The boycott of Nestle that began in 1977 highlighted the marketing practices that were misleading women around the world into buying breastmilk substitutes and bottle feeding, often to the detriment of their babies.

In 1981, the World Health Assembly responded by adopting the International Code of Marketing of Breast-milk Substitutes, which calls for no promotion to the public or healthcare workers and the provision of clear information on the benefits of breastfeeding over formula.

But as birth rates fall and breastfeeding gains popularity in the United States and other developed countries, baby formula manufacturers have shifted their focus to low- and middle-income countries. In 2008, China overtook the U.S. as the world’s largest formula market. According to the Lancet’s rer, only 37 percent of children younger than six months of age are exclusively breastfed in low- and middle-income countries.

Critics argue that formula companies targeting these countries find ways around the marketing code to push their products onto populations who don’t need or can’t afford them. “Marketing by the infant feeding industry and the availability of formula, including through the distribution of free samples, result in increased bottle feeding,” says the World Health Organization (WHO). “Formula advertisements portray it as good as or better than breast milk or present it as a lifestyle choice rather than a decision with health and economic consequences.”

Women & Girls Hub contacted Nestle and Danone, the two top breast milk substitute companies, for comment. “Breast milk is the best nutrition for infants,” said Nestle in a statement. “We support the World Health Organization’s (WHO) recommendation of six months exclusive breastfeeding, followed by the introduction of adequate nutritious complementary foods along with sustained breastfeeding up to two years of age and beyond.” Danone did not respond to the requests.

Experts acknowledge that commercial influences are only part of the reason so many women choose formula over breast milk. There are health conditions that can affect infants, such as classic galactosemia or phenylketonuria, that may prevent some women from breastfeeding temporarily or permanently. Mothers can also suffer from severe illness or certain health problems, including mastitis, hepatitis infections and substance use, that can stop them from breastfeeding. However, the Lancet Breastfeeding Series Group reports, “Women’s work is a leading motive for not breastfeeding or early weaning.”

What would it take for women around the world to breastfeed exclusively in the first six months of their babies’ lives? “It’s not an issue of persuasion but empowerment,” says Brady of Baby Milk Action.

Many women know breastfeeding would be beneficial but face barriers, including repressive social attitudes, weak policies on mother’s rights and lack of healthcare services, according to medical experts. The 2016 Global Nutrition Report says almost one-fifth of all countries have no data on maternity protection policies, “suggesting a huge legislation gap,” while nearly 70 percent with data don’t provide for nursing or childcare facilities at the workplace.

Another challenge, say health experts, is that many women don’t deliver in health facilities or receive any assistance before, during or after childbirth.

Nosa Orobaton, former chief of party of USAID’s Targeted States High Impact Project in Nigeria, says one of key advantages of increasing women’s access to healthcare would be that they can get important counseling, including about the benefits of breast milk. “To introduce breastfeeding exclusively for six months, promoting this is not enough,” Orobaton says. “Women need to understand that breast milk acts as a vaccine. The antibodies that are transferred act as a first line of defense for babies.”

There have been some promising efforts to boost breastfeeding numbers, says Brady, including the Baby-Friendly Hospital Initiative that UNICEF and WHO launched in 1991, which encourages all maternity facilities to become centers of breastfeeding support. To be designated baby-friendly, a maternity facility cannot accept free or low-cost breast milk substitutes, feeding bottles or teats, and has to implement 10 specific steps to support successful breastfeeding. More than 15,000 facilities in 134 countries have been awarded Baby-Friendly status. Other efforts, Brady says, include peer or community health volunteer support groups and the World Breastfeeding Trends Initiative, which assesses the state of breastfeeding in 75 countries.

To bring the breastfeeding rate up to its recommended level, the WHO wants governments to promote lactation-friendly employment conditions, make it easier for women to get access to health services that support them and their families in breastfeeding, and disseminate information, as well as regulate the baby formula industry.

The idea, says the WHO, is to “create a new normal where women are supported in their decisions to breastfeed – at home, work and in the community.”

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