Browsing and breastfeeding. Credit: Pinot Dita from Flickr.
Breastmilk is the optimal nutrition for an infant in the first 6 months of life. It promotes healthy child development and growth and prevents diseases in adulthood. Especially in resource-poor settings in which formula feeding is not affordable, feasible or sustainable, breastfeeding is often the only option to ensure child survival and health.
A recent Lancet paper recommends breastfeeding promotion as one of the 10 evidence-based core interventions to address child undernutrition. Increasing breastfeeding rates is on the agenda of more and more Ministries of Health and Family Welfare, international agencies and non-governmental organisations that work on improving child health. At community-level, lactation counsellors and breastfeeding peer support groups have become a common feature in many places. Since 1991, the World Alliance for Breastfeeding Action, a global network of organisations and individuals, has been organising the annual World Breastfeeding Week to raise international awareness, from 1-7th August.
So why, despite all these efforts, are only 36% of all infants worldwide breastfed for the recommended first 6 month of their lives? Why do so few women breastfeed or discontinue breastfeeding early? What prevents mums from giving their children the best nutritional start possible?
The reasons for low breastfeeding rates in almost every country in the world are complex and multi-dimensional. If we want to be serious about increasing breastfeeding rates, we need to do much more than simply raising awareness and providing individual-level breastfeeding support to mums.
The unmet challenges of work and breastfeeding
The topic of this year’s World Breastfeeding Week is on how to support women to better combine breastfeeding and work. The International Labour Organisation’s maternity protection from 2000 paved the way for women to claim their right to breastfeed and work. Paid maternity allowance in line with the breastfeeding targets, flexible working hours with sufficient break times to allow mothers to nurse or express breastmilk and supportive workplace environments are some of the measures that are currently mooted to help nursing women.
While all of these can be supportive for nursing mothers, they are only the tip of the iceberg. The majority of working women (especially in low and middle income countries) are not eligible or are excluded from these supportive measures, for example because they work in the informal sector without any legislative or social protection mechanisms such as maternity leave, or are self-employed.
The realities of work life including long working hours, work-related stress (especially in the context of high levels of unemployment and constant fears of being ‘laid off’ or made redundant), crowded and hazardous working conditions, lack of safe places at work to express and safely store breastmilk, unsupportive employers and long commutes add further and often insurmountable challenges for women.
We need to think more creatively and inclusively about breastfeeding at work. Legal protection is an important first step, but is only the beginning of creating an environment that enables breastfeeding at work.
The need for a supportive social environment
Breastfeeding might be natural but it is far from straightforward. A recent review estimates that up to 80% of mother-infant pairs encounter difficulties with breastfeeding. To exclusively breastfeed for 6 months is a huge commitment with regards to the mother’s time and energy. It requires determination and constant perseverance, both of which can be difficult for mothers who also shoulder most of the burden of caring for other children and/or household members, do household chores, work and still recover from (often traumatic) births.
Lactation experts, peer support and health visitors can help women to overcome some of these challenges. But they also inadvertently place all of the responsibility for breastfeeding on the mother alone, forgetting about the influences, needs and demands of her home environment and community setting.
Support and encouragement from relatives, partners and the wider community have been shown to be important for successful breastfeeding. In many cultures it used to be custom that new mothers and their babies stayed separate from their families for the first few months after birth and were well cared for by the entire community. This custom gave mother and child time and space to rest, bond and establish a good breastfeeding practice. Sadly, things have changed and mothers all over the world need to go back to their usual chores (or parts of their routine) shortly after birth. Lack of supportive social networks in nuclear family settings, anonymous and often isolated living conditions in urban metropoles and poverty add further challenges.
Breastfeeding does not take place in isolation but within a family and community. Hence, breastfeeding promotions needs to target the entire social environment of a mother and not only the mother to be effective.
There is no doubt that ‘breast is best’ for a baby. But to empower women to do what is best, we need to create an environment that truly supports and enables women to breastfeed.