Fostering breastfeeding

Promoting the exclusive breastfeeding of infants by their mother, especially in the early months after birth (say the first 4 to 6 months) as an alternative to the use of artificial or commercial milk-formula bottle feeding. This involves printing, posters, promulgating slogans, organizing groups, training mothers and organizing political and economic pressure against manufactures of artificial formulas, including ending supply of free and low-cost infant formula to maternity institutions. Fostering national action on this issue.

Although alternatives to mother's breast feeding have always been available (i.e. wet-nursing), promoting breast feeding as a strategy has only become widely important in the present century, stimulated by the ubiquitous availability of artificial infant formulas, powdered and tin milk and also by the changing role definitions and requirements of women.

It is estimated that only 25 percent of the world's infants breastfeed exclusively for the first four months, thereby receiving protection against diarrhoeal diseases, ARI and other illnesses associated with inadequate child nutrition. It is estimated that if more infants were breastfed exclusively as recommended, an additional 1.5 million infant deaths, caused each year by diarrhoea, and ARI alone, would be prevented. In addition, breastfeeding has a major influence on the interval between births. In Asia and Africa, it is believed that breastfeeding averts an average of four potential births per women.

What began as a campaign among middle-class women in Europe and North America for a return to breast feeding has now become a global effort supported by the World Health Organization to promote the benefits of breast feeding and call attention to the nutritional and hygienic dangers inherent in the use of commercially prepared formulas, especially in the third world. As of September 1993, nearly 700 hospitals in developing and industrialized countries have been designated "baby-friendly" by implementing the "Ten steps to successful breastfeeding" recommended by UNICEF and WHO, and by stopping the distribution of free and low-cost supplies of breastmilk substitutes. The broad strategy of the baby-friendly-hospital initiative is to minimize and, where possible, eliminate the obstacles that societies have placed in the way of successful breastfeeding. So far, 19 industrialized countries have set up national authorities to supervise the baby-friendly programme, and over 250 hospitals are moving to implement the "ten steps". In the developing world, most governments have begun the baby-friendly campaign by selecting influential hospitals and maternity centres to pioneer the scheme. In total, nearly 14,000 maternity units in 125 countries are now involved. The World Summit for Children goal is that by the year 2000, all women should be empowered to practise exclusive breastfeeding and all infants should be fed exclusively on breastmilk from birth to four to six months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods up to two years of age and beyond.

Only 11 industrialized countries have taken some action to end distribution of free or low-cost breastmilk substitutes. All but two of 72 developing countries where free and low-cost distribution was the norm, have taken government action to end the practice. Another 52 developing countries where breastmilk substitutes have not taken hold, have been encouraged to take preventive action. NGOs involved in promoting breastfeeding include: Public Interest International; International Baby Food Action Network (IFBAN); La Leche League International (LLLI); International Code Documentation Centre; International Lactation Consultant Organization; World Alliance for Breastfeeding Action (WABA). WABA is coordinating efforts supporting the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. World Breastfeeding week is observed in August each year.

Several related benefits are claimed to result from breast feeding; including: (1) Improved nutrition for the infant, especially where unboiled water or contaminated bottles and nipples increase the chances of dysentery, tuberculosis and other diseases; (2) Enhanced "bonding" of the infant and mother contributes to the psychological sense of security and well-being for both; (3) The hormone stimulated by breast feeding aid the female body in recovering from pregnancy and child birth; (4) The milk released during the first few days of lactation, called colostrum, is rich in essential amino acids and also contains proteins which convey immunity to some infections from mother to young; (5) Nursing may also be used as a means of contraception. Recent studies indicate that lactation tends to delay the return of ovulation and thus fertility), although the effect is also influenced by other nutritional factors; (6) Early discontinuation of breast feeding, especially in economically limited situations where the infant is weaned to a high-starch, low protein diet, has been found by WHO to be related to the occurrence of Kwashiorkor, a nutritional disease of protein deficiency.

Some women who, for whatever reason, are unable to breast feed their babies are subjected to psychological guilt and feelings of inadequacy by the current strident promotion of breast feeding. This sense of inadequacy may pervade and influence other parental behaviour.