tag:theconversation.com,2011:/ca/topics/world-breastfeeding-week-3507/articlesWorld Breastfeeding Week – The Conversation2020-08-06T06:48:51Ztag:theconversation.com,2011:article/1439892020-08-06T06:48:51Z2020-08-06T06:48:51ZCOVID-19 pandemic shows why infant formula donations are dangerous and how breastfeeding protects infants<figure><img src="https://images.theconversation.com/files/351212/original/file-20200805-503-n1ev2y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding is important at all times, but even more so in emergencies. </span> <span class="attribution"><a class="source" href="https://www.pexels.com/id-id/foto/cinta-kasih-rasa-sayang-tempat-tidur-3279208/">Pexels/Jonathan Borba</a></span></figcaption></figure><p><em>This article is published to celebrate <a href="https://www.who.int/news-room/detail/31-07-2020-world-breastfeeding-week-2020-message">World Breastfeeding Week 1-7 August</a>.</em></p>
<p>When emergencies occur, including in the current COVID-19 pandemic, people want to help mothers and babies. Sometimes they respond by making donations of infant formula. Baby milk companies can see emergencies as an opportunity to use <a href="https://www.opendemocracy.net/en/5050/infant-formula-companies-are-exploiting-covid-19-pandemic/">donations to market their products</a>.</p>
<p>Donations of infant formula in emergencies always <a href="https://www.worldnutritionjournal.org/index.php/wn/article/view/584">cause harm</a> because they reduce breastfeeding, increase rates of infection, and place infants in a food insecure situation. </p>
<p>After the <a href="https://www.ennonline.net/fex/34/special">Yogyakarta earthquake in 2006</a>, for instance, donations of infant formula doubled rates of <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/donated-breast-milk-substitutes-and-incidence-of-diarrhoea-among-infants-and-young-children-after-the-may-2006-earthquake-in-yogyakarta-and-central-java/7BC8079D2591050A0C25258EF2FAAF01">diarrhoea in babies</a>. The poorest families are worst affected. </p>
<p>During the COVID-19 pandemic all over the world, well-meaning donations from individuals and organisations have been harming infants. Infant formula manufacturers have sought to mislead parents and health workers about the safety of <a href="http://www.babymilkaction.org/archives/24341">breastfeeding during COVID-19</a> and <a href="https://twitter.com/DrKarleenG/status/1285404262814511106">have distributed infant formula against the WHO International Code</a>.</p>
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<p>The <a href="https://www.who.int/nutrition/publications/emergencies/operationalguidance-2017/en/">Infant and Young Child Feeding in Emergencies Operational Guidance</a> and the World Health Organization (WHO) state that breastfeeding is the safest and sustainable food source, and formula feeding should only be done when breastfeeding is not possible and with caution. </p>
<p>In normal situations, WHO only <a href="https://apps.who.int/iris/bitstream/handle/10665/69938/WHO_FCH_CAH_09.01_eng.pdf;jsessionid=E6DDD0E74718D61F15D764CB84765C41?sequence=1">recommends</a> infant formula when there are specific medical indications such as babies with galactosemia or with maple urine syrup disease.</p>
<p>WHO has said that <a href="https://www.who.int/news-room/detail/27-05-2020-countries-failing-to-stop-harmful-marketing-of-breast-milk-substitutes-warn-who-and-unicef">countries must act</a> to stop donations of infant formula in emergencies.</p>
<h2>Breastfeeding benefits in emergency situation</h2>
<p>Breastfeeding is important at all times, but even more so in emergencies. </p>
<p>Breastfeeding provides babies with safe food and water, and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901024-7/fulltext">protection from infection</a>. It also helps mothers who are stressed to bond with and provide good care to their babies. </p>
<p>Without breastfeeding, the ability of infants to fight infection is reduced, and formula-fed babies are more likely to need hospital treatment and, when conditions are poor, even to die. </p>
<p>It is for these reasons that <a href="https://www.who.int/publications/i/item/clinical-management-of-covid-19">WHO has said that women who are infected with COVID-19 should have</a> skin-to-skin contact with their babies after birth, keep their babies close to them day and night, and breastfeed.</p>
<h2>Infection rates are low when breastfed</h2>
<p>When babies are infected with COVID-19, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15422">they rarely become seriously ill and many have no symptoms at all</a>. Even babies who are born prematurely <a href="https://www.thelancet.com/pdfs/journals/lanchi/PIIS2352-4642(20)30140-1.pdf">may not suffer serious illness</a> when infected with COVID-19. </p>
<p>There is now also research showing that babies are at little risk of infection with COVID-19 if they are kept with their mothers and breastfed. <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30235-2/fulltext">Research from New York</a> found that of 116 breastfed babies whose mothers had COVID-19 none became ill. </p>
<p>In another study, 666 babies were born to mothers who had COVID-19 and only 28 babies became infected. Babies who were breastfed were not more likely to be infected than those who <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.16362">were formula fed</a> and it was concluded that separating babies from their mothers does not reduce infection rates. <a href="https://europepmc.org/article/ppr/ppr141432">Antibodies</a> to COVID-19 have been found in breastmilk which would help babies to fight COVID-19. </p>
<h2>Mothers have faced challenges in breastfeeding their babies in the pandemic</h2>
<p>Some government and medical organisation policies have said that mothers and babies should be separated and breastfeeding not allowed. These policies have been made without considering the importance of breastfeeding in protecting babies and have been <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.13033">criticised</a>.</p>
<p>Some organisations have now recognised their error and are reversing their recommendations and now support breastfeeding. As time goes on, it is becoming even clearer that even when mothers have COVID-19 they should be encouraged and supported to have skin-to-skin contact, to keep their babies close by them, and to breastfeed. </p>
<p>Other challenges that mothers have faced include the ongoing impact of the pandemic on health services. Pregnant women are having fewer health checks, many are having to give birth without a support partner. After the baby is born, face-to-face support for breastfeeding has been reduced. Grandmothers may not be able to visit and help their daughters with caring for the baby. </p>
<p>These challenges are happening in rich and poor countries. </p>
<p><a href="https://www.medrxiv.org/content/10.1101/2020.07.18.20152256v1.full.pdf">Australian research</a> found that many mothers found this situation very difficult and were stressed and anxious. When they experienced problems with breastfeeding they were reluctant to go to clinics because of fear of infection or were unable to seek support because services were shut. They often just wanted to have someone to talk to. </p>
<p>In response to the pandemic, some mothers placed a greater importance on breastfeeding because it could help protect their babies from infections including COVID-19. They also saw breastfeeding as protective because it was a secure food supply so they did not have to worry about whether they could buy infant formula. </p>
<p>The Australian Breastfeeding Association found that many women contacted their breastfeeding counsellors for <a href="https://www.who.int/maternal_child_adolescent/documents/who_chs_cah_98_14/en/#:%7E:text=This%20potentially%20life%2Dsaving%20measure%20is%20called%20relactation.&text='Relactation%3A%20A%20review%20of%20experience,wish%20to%20re%2Destablishing%20breastfeeding.">assistance with restarting</a> <a href="https://www.youtube.com/watch?v=V-EJ-T_KVcU">breastfeeding</a> because of the pandemic. Counsellors were also able to reassure mothers that it was usual for babies to want to feed more frequently in unsettled times and that stress has no impact on milk supply. </p>
<h2>Let’s support breastfeeding mothers to protect their babies health</h2>
<p><a href="https://worldbreastfeedingweek.org/">World Breastfeeding Week is celebrated every 1-7 August</a>, and this year’s theme is “Support Breastfeeding for a Healthier Planet”. This reminds us that breastfeeding protects not only the health of mothers and babies but also of the planet. </p>
<p>Formula feeding contributes to <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-019-0243-8">water and plastic pollution, land and waterways degradation as well as greenhouse gas emission such as methane (CH4), nitrous oxide (N2O) and carbon dioxide (CO2)</a>. In a world where natural as well as human made emergencies are ever increasing, we must support mothers to breastfeed so that they can protect their babies and protect the planet.</p><img src="https://counter.theconversation.com/content/143989/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andini Pramono menerima dana dari Lembaga Pengelola Dana Pendidikan dari Pemerintah Indonesia. Andini berafiliasi dengan Asosiasi Ibu Menyusui Indonesia (AIMI). </span></em></p><p class="fine-print"><em><span>Karleen Gribble tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>WHO has said that countries must act to stop donations of infant formula in emergencies.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityAndini Pramono, PhD Candidate in Health Services Research and Policy Department, Research School of Population Health, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1213332019-08-06T15:11:34Z2019-08-06T15:11:34ZSix ways the world has empowered and enabled breastfeeding<figure><img src="https://images.theconversation.com/files/286765/original/file-20190802-117881-hd0b65.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-breastfeeding-her-newborn-baby-beside-628630097?src=y3YDVRuiHydKAhGA631m0Q-1-22&studio=1">mrvirgin/Shutterstock</a></span></figcaption></figure><p>In an ideal world, the value of breastfeeding would go uncontested, and mothers would be supported to do it in all places and spaces. But unfortunately this is not the case. Even in the UK, a country which is so progressive in other health areas, breastfeeding mothers do not receive <a href="https://theconversation.com/breastfeeding-five-ways-it-can-be-encouraged-responsibly-82666">the support they need</a> to naturally feed their babies and <a href="https://www.stokesentinel.co.uk/news/stoke-on-trent-news/leave-breasts-alone-mums-turn-3166499">cuts to support services</a> are still being made. </p>
<p>Elsewhere in the world, things are very different, however. As this year’s <a href="https://worldbreastfeedingweek.org">World Breastfeeding Week</a> focuses on empowering and enabling breastfeeding, here are some of the ways that countries have <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jhn.12496">invested in public health</a>, changed the culture of their society and increased breastfeeding rates.</p>
<h2>1. Sweden’s maternity leave policies</h2>
<p>Want more women to breastfeed? Protect their time to do so. Women in Sweden can take <a href="https://www.yourlivingcity.com/stockholm/work-money/maternity-paternity-leave-sweden/">up to 15 months maternity leave at 80% pay</a>. This means that they can breastfeed and take care of their babies well beyond the period exclusive breastfeeding is recommended for (six months) without having to worry to about how to pay their bills and keep a roof over their family’s heads. By comparison, women in the UK are entitled to just six weeks’ leave at 90% pay before <a href="https://www.gov.uk/employers-maternity-pay-leave">it falls to £148 a week</a> – unless they have additional occupational pay. This has led to one in six mothers with a baby over four months old giving returning to work as a <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">reason for stopping breastfeeding</a>, and is reflected by the fact that just 34% of babies receive any breastmilk at six months old in the UK, compared to 62% in Sweden. Of course, things are <a href="https://www.washingtonpost.com/gdpr-consent/?destination=%2fnews%2fwonk%2fwp%2f2018%2f02%2f05%2fthe-worlds-richest-countries-guarantee-mothers-more-than-a-year-of-paid-maternity-leave-the-u-s-guarantees-them-nothing%2f%3f">even worse in the US</a> where statutory maternity pay is non-existent. </p>
<h2>2. Kenya’s workplace support</h2>
<p>Kenya identified that exclusive breastfeeding rates were falling partly because women were returning to work. So it created the <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/bills/2017/BreastfeedingMothersBill_2017.pdf">breastfeeding mothers bill</a> that supported breastfeeding in the workplace. This bill requires all workplaces to offer paid breaks and a private comfortable place with a lockable door. They must also provide a fridge to store milk, a power socket, a sink, and a table and chair. If employers don’t do this they can be fined or even imprisoned. </p>
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<a href="https://theconversation.com/lessons-from-kenya-on-how-to-boost-breastfeeding-rates-121059">Lessons from Kenya on how to boost breastfeeding rates</a>
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<h2>3. Bangladesh’s ban on formula marketing</h2>
<p>The <a href="https://www.who.int/nutrition/publications/code_english.pdf">international code of marketing of breast milk substitutes</a> was developed in the 1980s to protect families from unscrupulous marketing of formula milk. It does not limit formula milk – which can be vital for those mothers who are unable to breastfeed – but <a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">prevents the industry from trying to push their products</a>. Research has shown <a href="https://www.ncbi.nlm.nih.gov/pubmed/10796281">that promotion of formula milk reduces breastfeeding rates</a> so while the products are still available, in those countries following the code they are not allowed to be promoted in any form. </p>
<p>In 2017, Bangladesh became one of only 35 out of 194 countries who have <a href="https://apps.who.int/iris/bitstream/handle/10665/272649/9789241565592-eng.pdf?ua=1&fbclid=IwAR21hMnKeK5E9MttXgCxF7zzqoT71vIOFZOpFU-Zwt-KwQiZF2-5rhxCv5o">fully adopted the code</a> meaning that no formula milk, foods for babies under six months, teats or bottles can now be promoted in the country.</p>
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Read more:
<a href="https://theconversation.com/26-years-ago-the-uk-signed-up-to-formula-milk-advertising-rules-so-why-isnt-it-law-yet-74794">26 years ago the UK signed up to formula milk advertising rules – so why isn't it law yet?</a>
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<img alt="" src="https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Several countries have implemented simple solutions that have effectively improved breastfeeding rates.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/peaceful-loving-young-african-mother-sitting-1440379625?src=zCk5DaxMdhGUHBAHETZdTQ-1-38&studio=1">SeventyFour/Shutterstock</a></span>
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<h2>4. Croatia’s 100% adoption of baby-friendly hospitals</h2>
<p>Research has shown that babies born in <a href="https://www.who.int/nutrition/topics/bfhi/en/">baby-friendly hospitals</a> – an initiative set up by UNICEF and the World Health Organization in 1991 – <a href="https://www.ncbi.nlm.nih.gov/pubmed/26924775">are more likely to be breastfed</a>. To help protect breastfeeding, hospitals that have gained this accreditation <a href="https://www.unicef.org/newsline/tenstps.htm">follow ten steps</a> such as staff training, support after birth, keeping mum and baby together, and continued support in the community after discharge. </p>
<p>In Croatia, things weren’t always perfect – manufacturers had managed to get formula promotion into hospital bags meaning that no hospital met the criteria. But <a href="https://journals.sagepub.com/doi/full/10.1177/0890334417703367">things have been turned around</a>, and now all facilities in the country are accredited as baby friendly, and the steps are integrated into national policies, strategies and plans. </p>
<h2>5. Brazil’s human milk banks</h2>
<p>Donor human milk banks are lifesaving for premature babies who cannot receive their own mother’s milk, particularly just after birth. <a href="https://www.huffpost.com/entry/delaying-breastfeeding-increases-risk-of-newborn-death-by-80-un_n_579b65ebe4b0e2e15eb57fab?utm_hp_ref=impact">According to UNICEF</a>, delaying breastfeeding by between two and 23 hours after birth increases a baby’s risk of dying in its first month by 40%. If breastfeeding is delayed by 24 hours or more, this risk increases to 80%.</p>
<p>Brazil has invested heavily in donor milk provision as part of its strategy to improve breastfeeding rates. They now have <a href="https://brightthemag.com/the-surprisingly-simple-way-to-save-babies-lives-65c1806f4f60">around 230 of the 550 milk banks worldwide)</a> and more than 170,000 babies received donor milk in 2015. Not only has this investment meant more babies get donor milk, but this strategy helps improve the perception of the importance of breastmilk too. </p>
<h2>6. Scotland’s integrated feeding teams</h2>
<p>Recognising the importance of supporting breastfeeding, Scotland has recently achieved <a href="https://www.unicef.org.uk/babyfriendly/scotland-celebrates-full-maternity-community-baby-friendly-accreditation">100% baby-friendly accreditation</a> for its maternity and community services as Baby Friendly. The country has also invested <a href="https://www.bbc.co.uk/news/uk-scotland-46035569">£2 million</a> (on top of the existing £2.3 million funding) into breastfeeding support, and £300,000 into <a href="https://www.snp.org/policies/pb-what-is-the-snp-scottish-government-doing-to-promote-breastfeeding/">donor human milk banks</a>. <a href="https://www.gov.scot/news/breastfeeding-support-strong/">Integrated infant feeding teams</a> have also been created which bring together maternity and health visiting, infant feeding teams and peer supporters, to provide consistent, joined up care so that mothers can access one visible team for a variety of different needs. </p>
<p>With so many countries seeing the value in breastfeeding support, it’s about time all women were genuinely empowered and enabled to breastfeed too.</p><img src="https://counter.theconversation.com/content/121333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.</span></em></p>So many other countries see the value in breastfeeding support but the UK is lagging behind.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/807552017-08-02T15:45:22Z2017-08-02T15:45:22ZWhy Kenya needs to adopt ‘milk banks’ to reduce infant deaths<figure><img src="https://images.theconversation.com/files/178434/original/file-20170717-6084-g7c4q8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The WHO recommends donor human milk as the next best infant feeding option.</span> <span class="attribution"><span class="source">Saul Martinez/Reuters</span></span></figcaption></figure><p>Mother’s milk has an enormous impact on <a href="http://www.who.int/mediacentre/commentaries/breastfeeding-in-emergencies/en/">child survival</a>. While in Kenya it has <a href="http://globalfinancingfacility.org/sites/gff_new/files/documents/Kenya%20RMNCAH%20Investment%20Framework_March%202016.pdf">improved</a> over the past decade, the number of children who die before five years remains significant. The rate has decreased from 115 per 1000 live births in 2003 to 52 in <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf">2014</a>. </p>
<p>Neighbours <a href="http://www.dhsprogram.com/pubs/pdf/FA66/FA66.pdf">Rwanda</a> (2008), <a href="http://www.nbs.go.tz/nbs/takwimu/census2012/Mortality_and_Health_Monograph.pdf">Tanzania</a> (2012) and <a href="https://www.weforum.org/agenda/2015/05/how-uganda-is-tackling-child-mortality/">Uganda</a> (2011) have recorded 50, 66 and 65 deaths per 1,000 live births for children below five years, respectively.</p>
<p>The main <a href="http://www.who.int/pmnch/media/press_materials/fs/fs_newborndealth_illness/en/">causes</a> of childhood deaths are infections, preterm births and lack of sufficient oxygen, or asphyxia.</p>
<p>Breastfeeding infants on breast milk alone until they are six months old has been shown to <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">reduce child mortality</a>. When mothers can’t provide their own milk, the next best alternative is donor milk from other women. Access to “human milk banks” gives vulnerable infants, without access to their mother’s own milk, a healthy start to life. </p>
<p>The milk bank concept was initiated in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009567/">Vienna</a> in 1909 and was preceded by a century old practice of <a href="http://www.encyclopedia.com/medicine/anatomy-and-physiology/anatomy-and-physiology/wet-nursing">wet nursing</a> – a mother breastfeeding another mother’s child. </p>
<p>Since then, over <a href="http://www.path.org/publications/files/MCHN_strengthen_hmb_frame_Jan2016.pdf">500 human milk</a> banks have been established in more than 37 countries globally in <a href="https://www.path.org/publications/files/MCHN_strengthen_hmb_frame_Jan2016.pdf">developed</a> and developing countries. The pioneer countries include Brazil, South Africa, India, Canada, Japan and France.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pubmed/24166053">effective human milk bank</a> provides safe, high quality donor milk where the human milk is collected, pasteurised, stored, and distributed to the recipients.</p>
<p>The World Health Organisation recommends <a href="http://www.mnhcicf.org/donated-human-milk-could-be-lifesaving-alternative-vulnerable-newborns-kenya">donated milk</a> as a lifesaving alternative for children with no access to their mother’s milk. </p>
<p>In our <a href="http://aphrc.org/post/publications/integrating-human-milk-banking-breastfeeding-promotion-newborn-care-kenya-ready">study</a> we interviewed about 900 mothers to assess attitudes on donation of breast milk, milk banking and use of donated milk. This is the first study done in Kenya and our findings showed that three out of every five mothers would feed their own children on donated breast milk.</p>
<h2>Improving child survival</h2>
<p>Kenya needs to pay more attention to saving newborns without access to their mother’s milk, who are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508468/">born before</a> their delivery date, have low birth weight, or are very ill, by giving them donated human milk. The newborn should also be given this <a href="http://journals.sagepub.com/doi/abs/10.1177/0148607116629676?journalCode=pena">milk</a> if the mother is sick, dies, is unavailable to breastfeed, or if she is on medication that restricts breastfeeding.</p>
<p>Studies show that sustained breastfeeding averts about <a href="https://www.ncbi.nlm.nih.gov/pubmed/26869575">820,000</a> child deaths across the world every year and reduces <a href="http://www.who.int/maternal_child_adolescent/topics/child/imci/en/">childhood illnesses</a> such as colds, infections and pneumonia.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969767/">Studies</a> also show that mother’s milk reduces the risk of infections in low-birth weight infants by 19% in first 28 days. Other studies note that it’s more protective than <a href="https://www.ncbi.nlm.nih.gov/pubmed/17943776">formula</a>.</p>
<p>About <a href="https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/35508/Karki_washington_0250O_15312.pdf?sequence=1&isAllowed=y">8%</a> of children are born too small and 12.3% too early in Kenya. Many of these babies are very vulnerable and have no access to their own mother’s milk and could potentially benefit from donor milk.</p>
<p>Mother’s milk has also been found to be more <a href="http://www.telegraph.co.uk/news/health/news/5688590/Breast-feeding-protects-babies-from-stomach-damage-study-finds.html">gentle</a> on infants’ stomachs and <a href="http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1519-38292011000100009">prevents diarrhoea</a>. Donated human milk is an economically viable method because it reduces these complications and also leads to a shorter stay in the newborn intensive care unit.</p>
<p>To ensure safety and quality of the donor human milk, internationally recognised <a href="https://www.ncbi.nlm.nih.gov/books/NBK66137/">practices</a> are observed like screening donors for diseases and infections.</p>
<p>No risks or adverse effects on donated human milk use have been published. However, some of the concerns raised include fear of HIV transmission in <a href="https://docslide.net/documents/acceptability-of-donated-breast-milk-in-a-resource-limited-south-african-setting.html">South Africa</a>, and cultural and religious beliefs against donating and use of donated milk in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25632719">Turkey</a>.</p>
<h2>The milk bank</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009567/">Human milk banks</a> receive, process, store and provide safe donations to infants who need it. Kenya does not have any policies that support the donation of human milk so we carried out an initial assessment in Nairobi County, between August and December 2016, to understand the feasibility and acceptability of human milk banking. </p>
<p>The <a href="http://aphrc.org/">Africa Population Health Research Center</a> in collaboration with the <a href="http://www.health.go.ke/">Ministry of Health</a> and <a href="https://www.path.org/">PATH</a> led the project at the community and health facility levels.</p>
<p>The study findings showed that breast milk donation and milk banking was a new concept to 74% of the women interviewed. But about 80% said they would donate their breast milk to a milk bank and about 60% would feed their children on donated milk.</p>
<p>The mothers described the donated milk as lifesaving. In the words of one:</p>
<blockquote>
<p>If it is a matter of life and death, it’s about saving the child. I will not sit and watch a baby die. In such a scenario, I will have a human heart to donate milk.</p>
</blockquote>
<p>Health workers said the use of donated milk was potentially an affordable solution, compared to the high cost of buying infant formula milk.</p>
<h2>Challenges and solutions</h2>
<p>There were concerns among the women interviewed about the use of donated milk due to personal, health, cultural and religious concerns.</p>
<p>One asked:</p>
<blockquote>
<p>What are you going to do with my milk? There are those bad stories of people taking other peoples hair, nails and other body parts for undisclosed uses.</p>
</blockquote>
<p>For the respondents who didn’t fully support the donation of milk, the main reason was the risk of transmitting diseases and conditions like HIV. But there are ways around these concerns. The safety of the donated milk can be ensured by:</p>
<ul>
<li><p>screening donors for infections and diseases;</p></li>
<li><p>teaching donors on hygiene;</p></li>
<li><p>sterilising the milk;</p></li>
<li><p>testing the milk for contamination; and</p></li>
<li><p>sterilising the equipment and ensuring hygiene during handling and storage.</p></li>
</ul>
<p>In addition, education and <a href="http://www.mnhcicf.org/donated-human-milk-could-be-lifesaving-alternative-vulnerable-newborns-kenya">awareness campaigns</a> in communities and among health workers can solve these concerns. These campaigns can be run through existing community health promotion programmes, religious institutions and trained health professionals.</p>
<p>The government should put in place national policies and allocate money to ensure infants have access to a safe, high quality, sustainable supply of donor milk. A good first step would be to establish a multi-sectoral team to look into setting up milk banks in Kenya.</p>
<p>In addition, the Kenyan government could borrow experiences from other countries where milk banks have been established such as <a href="https://sites.path.org/southafrica/human-milk-banking/">South Africa</a>.</p>
<p><em><a href="http://aphrc.org/post/team/milka-njeri">Milka Njeri</a>, a research assistant, contributed to this article</em></p><img src="https://counter.theconversation.com/content/80755/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Kimani-Murage receives funding from County Innovations Challenge Fund funded by DFID, through PATH. She is affiliated with the African Population and Health Research Center - APHRC. </span></em></p>Human milk banks play an important role in ensuring the safe supply of breast milk. This is made available to babies whose mothers are unable to breastfeed.Elizabeth Kimani-Murage, Research Scientist at the African Population and Health Research Center and Adjunct Assistant Professor, Brown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/806942017-07-19T18:21:57Z2017-07-19T18:21:57ZSouth Africa has made giant strides in breastfeeding. But it’s still taboo in public places<figure><img src="https://images.theconversation.com/files/178791/original/file-20170719-13586-12wkscb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/Adrees Latif</span></span></figcaption></figure><p>South Africa has a long history of promoting breastfeeding as an important part of promoting child health in the country. </p>
<p>Even during the height of <a href="https://www.ncbi.nlm.nih.gov/pubmed/3696214">apartheid</a>, the health fraternity acknowledged the need to keep breastfeeding at the forefront of children’s development. The first breastfeeding campaign was launched in <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Malan%20A%5BAuthor%5D&cauthor=true&cauthor_uid=3696214">October 1987</a>. Several other initiatives were launched in the years that followed. These have led to significant improved breastfeeding rates in the country. </p>
<p>The current government has been very active in protecting, promoting and supporting breastfeeding through an array of policies, programmes and legislation to improve the breastfeeding environment in South Africa. The country has some of the most progressive legislation to protect the breastfeeding from inappropriate marketing of breastmilk substitutes.</p>
<p>But South Africa hasn’t managed to clear the last hurdle – attitudes towards breastfeeding in public. Thirty years after breastfeeding was first championed, mothers can’t breastfeed in public without <a href="https://www.all4women.co.za/369211/lifestyle/inspiring/i-was-told-not-to-breastfeed-in-public">provoking angry responses</a>. On several occasions mothers have been humiliated and <a href="http://www.parent24.com/Baby/Breastfeeding/sa-mom-discriminated-for-breastfeeding-on-kulula-flight-20160728">stigmatised</a>. </p>
<p>In recent years, several countries have put legislation in place to protect breastfeeding at <a href="https://www.theguardian.com/world/2015/mar/19/brazil-law-breastfeeding-mothers-fine-sao-paulo">work and in public spaces</a>. For example, in Brazilian city Sao Paulo, businesses or organisations that prevent women from breastfeeding in public are fined. Others, like Vietnam, have invested in communication and education strategies to <a href="http://www.who.int/features/2016/Viet-Nam-breastfeeding-campaign/en/">improve breastfeeding culture</a>. The result is that women can breastfeed in public places without being victimised.</p>
<p>South African health authorities educate the public about breastfeeding. But without supportive legislation and strong behaviour change communication, breastfeeding in public will never be normalised. </p>
<h2>Breastfeeding successes</h2>
<p>Seven years ago the government made positive <a href="http://www.sajcn.co.za/index.php/SAJCN/article/view/586">policy changes towards breastfeeding</a> to encourage exclusive breastfeeding. Since then it has made several additional and significant policy shifts to promote and support longer duration of breastfeeding to 24 months, among HIV-negative and HIV-positive mothers. </p>
<p>In 2012 the health department stopped providing free infant formula to HIV positive mothers. This reversed an earlier policy that promoted the use of infant formula – an approach that had been pursued because of the transmission of HIV from mothers to children <a href="http://www.sahivsoc.org/FileUpload/Infant_feeding_FAQ_July_2011.pdf">through breastmilk</a>.</p>
<p>The reversal on formula milk approach was accompanied by a massive rollout of life-long anti-retrovirals for pregnant mothers. This makes breastfeeding in the context of HIV safer and lowers the risk of mother to child transmission of HIV through breastfeeding.</p>
<p>In the same year the department also <a href="http://webcache.googleusercontent.com/search?q=cache:Zgj5uXp_VosJ:www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-04-30-09-10-23/2015-04-30-09-11-35/category/207-regulations-labelling-and-advertising%3Fdownload%3D742:r991-guidelines-to-industry-and-health-care-personnel-may2014-1+&cd=1&hl=en&ct=clnk&gl=za">passed regulations</a>
that prohibit the marketing and promotion of products that undermined and displaced breastfeeding, like infant formula.</p>
<p>This was followed by a revised infant and young child feeding policy in line with the <a href="http://www.ennonline.net/whoguidelineshivandinfantfeeding2010">World Health Organisation’s recommendations</a> that countries have one public health infant feeding policy. </p>
<p>South Africa has also had phenomenal success in establishing human milk banking. In addition, more than 70% of public health facilities have been accredited as Mother-Baby-Friendly. These facilities are trained and offer a level of service that protects, promotes and supports breastfeeding with immediate initiation of breastfeeding, practice of skin-to-skin and rooming-in to keep mothers and babies together.</p>
<p>These facilities discourage bottle feeding and teach mothers cup feeding and how to express breastmilk for when they are not with their babies. All these practices improve breastfeeding and the mother’s milk supply.</p>
<h2>Breastfeeding practises</h2>
<p>But public breastfeeding is still frowned upon. Part of the problem seems to be that initiatives to promote breastfeeding have been restricted to the health system. </p>
<p>There is very little promotion and conversation in other sectors such as education, social development and in the justice system.
Evidence from other countries show that breastfeeding improves if the interventions are delivered through a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/abstract">multi-pronged approach</a>. Where there have been successes, governments have ensured that breastfeeding is supported in and by:</p>
<ul>
<li><p>the health system and the services that are offered, </p></li>
<li><p>the family and community, and</p></li>
<li><p>the workplace</p></li>
</ul>
<p>While South Africa has <a href="http://www.labour.gov.za/DOL/legislation/codes-of-good-ractise/Basic%20Conditions%20of%20Employment/code-of-good-practice-on-pregnancy">provisions</a> under the Basic Conditions of Employment Act, very few employers have made effort to protect or support mothers in their work environment. </p>
<p>Last year, the Department of Health unveiled its National Breastfeeding Campaign which is built around the question: </p>
<blockquote>
<p>Why do communities not support mothers to breastfeed? </p>
</blockquote>
<p>This is an important question because it goes to the heart of the challenge South Africa still faces. Society remains averse to mothers breastfeeding their babies in public spaces, even though breastmilk is universally recognised as being a lifesaving <a href="http://www.savethechildren.org.uk/resources/online-library/superfood-babies">super food for babies</a>.</p>
<p>If breastfeeding is part of our African culture, why are people offended and disturbed when a mother breastfeeds her baby? If it is part of the natural order of loving and caring for children, why do people shame, humiliate and stigmatise breastfeeding mothers?</p>
<p>But it’s not enough for the health department to pose the question. Collectively, we need to come up with answers, and take action. </p>
<p>South Africa can take a lead from <a href="https://www.ncbi.nlm.nih.gov/pubmed/27780198">Vietnam and Bangladesh</a> who have benefited enormously from large-scale interventions. Both countries have combined intensive inter-personal counselling with mass media campaigns. </p>
<p>South Africa has antenatal care counselling for mothers at clinics but has not yet invested in the promotion of breastfeeding. Such campaigns are not unfamiliar in the country. It has done exceptionally well in campaigns such as <a href="https://www.arrivealive.co.za/">Arrive Alive</a> and the <a href="http://www.knowmystatus.org/">HIV know your status</a> campaign .</p>
<p>But until the resistance of communities towards breastfeeding is fully understood, there will not be a shift in embracing it and South Africa will continue to carry the high burden of infant death and disease.</p><img src="https://counter.theconversation.com/content/80694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chantell Witten is affiliated with the South African Civil Society for Women's. Adolescents' and Children's Health (SACSoWACH)</span></em></p>South African health authorities educate the public about breastfeeding but without supportive legislation and strong communication, it will never be normalised.Chantell Witten, Lecturer and PhD candidate, North-West UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/635502016-08-05T14:58:40Z2016-08-05T14:58:40ZTraumatic breastfeeding experiences are the reason we must continue to promote it<figure><img src="https://images.theconversation.com/files/133155/original/image-20160804-466-1i6c6nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's not all sunshine and roses for some mums.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-301455563/stock-photo-mother-holding-her-crying-little-son-in-studio.html?src=7IxJ0dyhYy-BiDVgEKrUyA-1-0">Shutterstock/Konstantin Tronin</a></span></figcaption></figure><p><a href="http://worldbreastfeedingweek.org">World Breastfeeding Week</a> was designed to promote, protect and encourage breastfeeding. To celebrate the marvel of women nourishing a whole new tiny person. To highlight why we need to invest in our new mothers, babies and the future. </p>
<p>Yet for many mums, this week sends a chill straight through their core. It makes them want to shout and throw things because breastfeeding certainly isn’t something to celebrate for them. </p>
<p>For far too many women, any mention of breastfeeding reminds them of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738467/">pain</a>, <a href="https://bfmed.wordpress.com/2013/05/30/breastfeeding-and-depression-its-complicated/">anxiety</a> and a <a href="https://www.breastfeedingnetwork.org.uk/crisis-in-bf/">lack of support</a>. It reminds them of their determination to do what had been promised to them as simple, enjoyable and the right way to feed their baby. Determination which slowly turned to desperation when it didn’t work for them. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babe in arms.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-281210201/stock-photo-happy-baby-in-the-mothers-breast.html?src=n_8bJP6qeNiu3YXOJTZ79g-1-21">Shutterstock/Luca Elvira</a></span>
</figcaption>
</figure>
<p>It reminds mothers of the heartbreak they felt as they stopped breastfeeding <a href="http://www.herfamily.ie/parenthood/5-mums-stopping-breastfeeding-ready-no-one-listened/227281">before they were anywhere near ready</a> – it wasn’t just about the promised health benefits but the feeling that their body wasn’t doing what it was meant to do, and the fact they just really wanted to do it. </p>
<p>All the pain, regret and anger that mothers feel is the reason we need to shout so loudly about breastfeeding. This hurt comes from women being so badly let down by a society that does not protect breastfeeding. Because, while there are many mums and babies who experience health problems that stop them from breastfeeding, there are even more who would breastfeed if the right support was in place. </p>
<p>We need to change this attitude, and one of the best ways we can do that is by drawing attention to its importance. Because although it might not seem like it to some, breastfeeding has become the underdog in a society that might shout about its importance but actually works rather hard <a href="https://blogs.unicef.org.uk/2016/04/11/breastfeeding-call-to-action/">to undermine it</a>. </p>
<h2>Breaking down barriers</h2>
<p>Britain has ended up in a situation where, despite the <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/">known health</a> and <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Financial-benefits/">economic benefits of breastfeeding</a>, rates are abysmal. In fact they’re <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/The-Lancet-Increasing-breastfeeding-worldwide-could-prevent-over-800000-child-deaths-every-year/">the lowest in the world</a>. More importantly, 80% of mothers who stop breastfeeding in the first six weeks <a href="http://digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">are not ready to do so</a>, and stop because breastfeeding has become seemingly impossible for them. </p>
<p>Breastfeeding should not be so difficult for so many and should only be impossible for a <a href="https://bfmed.wordpress.com/2012/10/15/how-often-does-breastfeeding-just-not-work/">very, very small minority of mothers</a>. However, while society appears to promote breastfeeding, there are actually <a href="https://blogs.unicef.org.uk/2016/07/07/removing-barriers-breastfeeding-uk/">numerous barriers</a> ranging from formula milk adverts to a lack of community support, that ultimately make breastfeeding feel impossible. </p>
<p>Society <a href="http://online.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">does not understand</a> what it is like to breastfeed. Women are given information that damages breastfeeding such as babies <a href="http://www.dailymail.co.uk/health/article-2084874/Study-finds-babies-fed-formula-milk-easier-to-sleep.html">should sleep through the night</a>, rather than wake to feed, for example. Some think misunderstand studies, and come to believe that breastfeeding causes things that are actually <a href="https://www.theguardian.com/lifeandstyle/2012/jan/10/breastfeeding-babies-temperamental-study">just normal baby behaviour</a> and that formula is the solution. Others believe self-styled experts who make money out of telling mothers that their baby should be in a routine – despite research showing that strict routines are actually <a href="http://www.swansea.ac.uk/humanandhealthsciences/news-and-events/latest-research/newresearchsuggestsearlyparentingroutinesmayharmbreastfeeding.php">incompatible with or discourage breastfeeding</a>. </p>
<h2>Invest in breast</h2>
<p>Rather than protecting breastfeeding, the government doesn’t invest properly in the services, support and expertise that would actually enable mothers to breastfeed – despite reports finding it could actually <a href="https://www.theguardian.com/lifeandstyle/2012/oct/18/increase-breastfeeding-nhs-savings-unicef">save the NHS money</a>. Instead, <a href="http://www.nursingtimes.net/news/news-topics/public-health/warning-of-uk-breastfeeding-crisis-amid-budget-cuts/7002416.fullarticle">cuts to services</a> take away essential volunteer groups and funding of breastfeeding specialists. What should be an easily fixable issue gets turned into months of suffering. </p>
<p>Though <a href="http://www.telegraph.co.uk/news/uknews/1570179/Clampdown-on-milk-firms-targeting-newborns.html">no longer allowed</a> to advertise to mothers of babies under six months, the multi-billion formula milk industry <a href="http://www.telegraph.co.uk/women/mother-tongue/11697178/Breastfeeding-Formula-industry-has-hijacked-breastfeeding-for-profit.html">still dominates</a>. Some might argue that the world doesn’t need a week celebrating breastfeeding but in reality, every week is world formula feeding week. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breastfeeding in public should be the norm.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-333965063/stock-photo-thessaloniki-greece-november-1-2015-mother-breastfeeding-her-baby-on-the-6th-nationwide-public-breastfeeding-in-celebration-of-world-breastfeeding-week.html?src=n_8bJP6qeNiu3YXOJTZ79g-9-92">Ververidis Vasilis / Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Mothering is not <a href="http://www.nhs.uk/news/2014/09September/Pages/Mums-feel-shame-about-how-they-feed-their-babies.aspx">valued or supported</a>. Instead <a href="http://www.dailymail.co.uk/femail/article-2090277/How-I-banished-baby-belly-Celebrity-mums-ping-shape-weeks-easy-real-women-regain-figures-One-mother-shares-diary-.html">weight loss is celebrated</a>, tips on reviving your sex life are published, and the focus is on “getting your life back” post-pregnancy. Celebrities are <a href="http://www.instyle.com/celebrity/celebrity-moms/star-bodies-after-baby">snapped back in their jeans</a> and out partying a week after having a baby. “Normal” mothers meanwhile are <a href="http://www.mirror.co.uk/news/uk-news/mum-left-humiliated-after-being-7945539">ridiculed and criticised</a> for simply trying to feed their hungry baby in public. </p>
<p>The simple truth is that we set women up to fail. Most breastfeeding problems are created by a society that is not breastfeeding friendly: the actions of others are <a href="https://blogs.unicef.org.uk/2016/07/07/removing-barriers-breastfeeding-uk/">responsible for poor breastfeeding rates</a> and the trauma of mothers. And we must change this.</p>
<p>If as a society we encouraged breastfeeding, properly supported women and the government cracked down on the way in which formula is promoted, there might not be this level of problem. </p>
<p>Ultimately if we did all of this then there would be no need to shout about breastfeeding and no need for special events. Because it would just be normal. Just how babies are fed.</p>
<p>In the words of the <a href="https://act.unicef.org.uk/ea-action/action?ea.client.id=375&ea.campaign.id=52979&ea.tracking.id=g8yt4l55">UNICEF Baby Friendly Initiative Call to Action</a>: “It’s time to change the conversation.” We need to keep speaking out about breastfeeding and direct our trauma into action, until everyone who can plays their part in creating a supportive environment for new mothers.</p><img src="https://counter.theconversation.com/content/63550/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC. </span></em></p>Negative breastfeeding experiences can make special drives to encourage it all too painful for some.Amy Brown, Associate professor of child public health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/633092016-08-01T15:45:42Z2016-08-01T15:45:42ZWhy breastfeeding in South Africa still needs champions<figure><img src="https://images.theconversation.com/files/132642/original/image-20160801-17201-1ob85zp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><a href="http://www.sciencedirect.com/science/article/pii/S0140673615010247">Breastfeeding</a> has been proven to protect the health of mothers and babies. It naturally inoculates babies against disease because the mother’s immune system kick starts the baby’s ability to resist illness. This applies in both low-income and high-income settings.</p>
<p>For mothers, breastfeeding is also good. It is a natural contraceptive because it interrupts the menstrual cycle, and it protects women against <a href="http://www.sciencedirect.com/science/article/pii/S0140673615010247">breast and ovarian cancer</a>.</p>
<p>Despite all these benefits, only <a href="http://www.who.int/nutrition/global-target-2025/infographic_breastfeeding.pdf?ua=1">38% of babies</a> are exclusively breastfed across the world. </p>
<p>A number of <a href="http://www.sciencedirect.com/science/article/pii/S0140673615010442">initiatives</a> have been put in place to turn this situation around. One of these is the <a href="http://www.unicef.org/programme/breastfeeding/baby.htm">Baby-Friendly Hospital Initiative</a>, a UNICEF and World Health Organisation scheme launched in 1991. The idea was to make sure that all maternity wards, whether free standing or in a hospital, became centres of breastfeeding support.</p>
<p>Since its launch, more than <a href="http://www.who.int/nutrition/topics/bfhi/en/">152 countries</a> have signed up to the initiative. And by 2012 more than 21 300 facilities were designated baby friendly. This is close to 30% of all facilities worldwide and 31% of facilities in low and middle income countries. </p>
<p>But of the 152 countries, only 18 have reported setting up a <a href="http://online.liebertpub.com/doi/full/10.1089/bfm.2012.0066">government committee</a> to direct and enforce the initiative. </p>
<p>South Africa, despite its <a href="http://sajcn.co.za/index.php/SAJCN/article/view/756/1144">bold commitments to improve breastfeeding</a>, has not reported to the World Health Organisation. It still does not have national data to monitor breastfeeding rates to ensure that its policies are being effective. </p>
<p>And unless the country creates structures that ensure facilities become mother and baby friendly, breastfeeding rates in the country are unlikely to improve. </p>
<h2>What it means to be baby friendly</h2>
<p>The 10 Steps of the Baby-Friendly Hospital Initiative is a proven strategy to provide this support at the critical time of delivery and just after. It increases all aspects of breastfeeding – initiation of breastfeeding immediately after birth, exclusive breastfeeding in the first six months of life, and continued breastfeeding until the child is a toddler.</p>
<p>Its success is evident in countries like <a href="http://www.unicef.org/infobycountry/cuba_53057.html">Cuba</a> where, as a result of most of country’s 56 hospitals and maternity facilities being baby-friendly, the rate of exclusive breastfeeding at four months almost tripled in six years from 25% in 1990 to 72% in 1996. This success is related to government commitment and ongoing monitoring. </p>
<p>No official data has been released, but South Africa’s National Department of Health claims that the country has accredited 70% of its public hospital as baby friendly. The fact that 30% are not accredited indicates that there is no uniform system and no concerted push for accreditation. </p>
<p>There is also no information readily available on the accreditation of private facilities. </p>
<p>Hospitals and clinics are considered “baby-friendly” when they don’t accept free or low-cost breastmilk substitutes, feeding bottles or teats, and implement 10 specific steps to support successful breastfeeding.</p>
<p>The ten steps include:</p>
<ul>
<li><p>a written breastfeeding policy which all health care staff know about and are trained in</p></li>
<li><p>informing pregnant women of the benefits and management of breastfeeding</p></li>
<li><p>helping mothers initiate breastfeeding within one half-hour of birth and showing them how to breastfeed and maintain lactation</p></li>
<li><p>giving newborn infants no food or drink other than breastmilk, unless medically indicated.</p></li>
<li><p>not giving infants artificial teats or pacifiers.</p></li>
</ul>
<p>All these steps help a new mother to breastfeed her baby. This in turn protects babies from respiratory infections and cuts diarrhoea episodes by half. As a result, breastfed babies are four times less likely to die in the first six months of life. </p>
<p>Breastfeeding also boosts babies’ health and intelligence and reduces their rate of <a href="http://eprints.soton.ac.uk/393881/">behavioural problems in childhood</a>. Breastfed babies are less likely to be obese which means they are at lower risk of adult <a href="http://www.sciencedirect.com/science/article/pii/S0140673615010247">diabetes and cardiovascular disease</a>. </p>
<h2>No full commitment</h2>
<p>The 10 steps initiative was adopted by South Africa in 1995. In 2012 it was renamed the <a href="http://www.kznhealth.gov.za/babyfriendly.htm">Mother-Baby Friendly Initiative</a> to stress support for mothers and babies and to assert the continued importance of exclusive breastfeeding by HIV positive women on antiretroviral treatment.</p>
<p>Roll out was initially slow. But by 2011 the Department of Health reported that 44% of public hospitals were accredited. This figure is alleged to have risen to 70% by 2014 but no official update report of the programme has been released by local health authorities.</p>
<p>New impetus was given to the initiative in August 2011 when participants at a national consultative meeting, including the Minister, Deputy Minister of Health and provincial health heads and managers, adopted the <a href="http://www.sajcn.co.za/index.php/SAJCN/article/viewFile/586/820">Tshwane Declaration of Support for Breastfeeding in South Africa</a>. </p>
<p>The declaration committed South Africa to ensuring that all public and private hospitals and health facilities would be accredited as Baby-Friendly by 2015. Steps would be taken to ensure that once discharged, mothers would continue to receive support to breastfeed in their homes and communities.</p>
<p>But 2015 has come and gone and there is seemingly as yet no national system for requiring compliance, monitoring progress on accreditation or adherence to the 10 steps. South Africa also has few tools with which it can monitor whether breastfeeding rates increase in response to implementation. And little has been done to make communities more baby-friendly. </p>
<p>Although health authorities have pledged the best of intentions, they still have to put in place practical steps to ensure that the country can realise them.</p>
<h2>What needs to be done</h2>
<p>To follow up the bold commitments and ensure that they are implemented in South Africa, every hospital should be required to be mother and baby friendly. They should be inspected periodically to ensure compliance. </p>
<p>In addition, health authorities should collect national data to monitor breastfeeding rates to ensure that the policies are effective. </p>
<p>On top of this, South Africa needs to become more mother and baby friendly. More businesses and government departments must provide spaces for women to breastfeed.</p>
<p>And campaigns are needed to ensure that every women and her family know the value of breastfeeding, and how to breastfeed, before the baby is born. They must feel empowered to ask if the hospital they’re going to is accredited as baby and mother friendly.</p><img src="https://counter.theconversation.com/content/63309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linda M. Richter has received funding for research related to this article from the National Research Foundation, UNICEF and the EU funded Programme for Sustainable Pro-Poor Policies (PSPPD) in the Presidency.</span></em></p>South Africa, despite its bold commitments to improve breastfeeding, does not have national data to monitor breastfeeding rates to ensure that its policies are being effective.Linda M. Richter, Director, DST-NRF Centre of Excellence in Human Development, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/165142013-08-01T04:33:17Z2013-08-01T04:33:17ZBreastfeeding improves IQ – now have we got your attention?<figure><img src="https://images.theconversation.com/files/28472/original/pzgzvzy5-1375324677.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New research shows breastfeeding leads to improved language receptiveness at age three.</span> <span class="attribution"><span class="source">Tom & Katrien/Flickr</span></span></figcaption></figure><p><a href="http://archpedi.jamanetwork.com/article.aspx?articleid=1720224">Research published in JAMA Pediatrics</a> this week shows a causal relationship between breastfeeding and higher IQ by the time a child is seven years old. Put simply, longer breastfeeding appears to make for smarter children.</p>
<p>This is just another piece of scientific proof of the wonders of breastfeeding. Its benefits for <a href="http://www.ncbi.nlm.nih.gov/pubmed/20450531">gut development</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/22103307">immunity</a> have been widely reported, but studies looking at breastfeeding’s effects on brain development have so far been poorly designed, showing only weak positive effects.</p>
<p>The new research shows breastfeeding leads to improved language receptiveness at age three. And higher verbal and non-verbal IQ at school age.</p>
<h2>The research</h2>
<p>This is a well-designed observational study and the latest in a line of <a href="http://www.ncbi.nlm.nih.gov/pubmed/11242425">countless other studies</a> showing benefits for the “long-term” breastfed baby, compared to formula feeding or short-term breastfeeding.</p>
<p>And it’s a vast improvement on previous studies because the authors have adjusted their results for factors that are known to influence child intelligence. Maternal intelligence, for instance, and the developmental stimulation received in the home environment. In other words, the authors have independently examined the effects of breastfeeding on child intelligence.</p>
<p>The study didn’t simply compare babies who were “ever” breastfed to those who were “never” breastfed. The author asked whether babies were being breastfed at six months and 12 months, thereby accounting for the effects of partial versus exclusive breastfeeding.</p>
<p>At age three, the children had a 0.58-point increase in language comprehension (listening and understanding what is communicated) tests for every additional month of breastfeeding. </p>
<p>By the age of seven, every additional month of breastfeeding resulted in a 0.35-point increase in verbal intelligence (ability to analyse information and solve problems using language-based reasoning) score and a 0.29-point increase in non-verbal intelligence (ability to analyse information and solve problems using visual, or hands-on reasoning) score.</p>
<h2>Definitely worthwhile</h2>
<p>It may seem obvious that providing our young with the nutrition that has evolved over thousands of years to support their growth and development will result in greater brain function, immune function, and so on.</p>
<p>But studies like these are important because the majority of the population is not heeding their results. In the latest <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4810.0.55.001">Australian Bureau of Statistics Report</a> (2003) – 87% of infants were breastfed at birth, but this had fallen to 48% six months later and 23% by the time they were a year old.</p>
<p>The <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n56b_infant_feeding_guideline_summary.pdf">National Health and Medical Research Council</a> recommends exclusive breastfeeding for six months and for it to continue until at least 12 months. </p>
<p>The <a href="http://www.who.int/topics/breastfeeding/en/">World Health Organization</a> also recommends exclusive breastfeeding for up to six months and for it to continue alongside appropriate complementary foods until the child is two years old and beyond.</p>
<p>Our closest genetic relatives, primates (apes and chimpanzees), spend about 12% of their lifespan breastfeeding their young. That’s around four and a half years. If we spent the same proportion of our time breastfeeding, we would do so for nine years!</p>
<p>The average time we spend breastfeeding now is one year or about 1.5% of lifespan, which is comparable to what rodents do, even though their brains are significantly less evolved than ours.</p>
<p>One of the reasons women may not be breastfeeding for very long (even though they physically can) is because it is stigmatised. Breastfeeding is discouraged in some public places and some mothers fear the nosey citizen offended by the sight of it, who decides to comment.</p>
<p>Perhaps it’s time to replace television advertisements for infant formula with a national advertising campaign showing women breastfeeding to “normalise” the natural way to feed babies and toddlers.</p>
<p>Breastfeeding represents an incredible opportunity for the human brain (and the body, in general) to reach its full potential. Let’s give our young the best start in life that we can.</p><img src="https://counter.theconversation.com/content/16514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hayley Dickinson receives funding from Australian Research Council, National Health and Medical Research Council and Cerebral Palsy Research Alliance.</span></em></p>Research published in JAMA Pediatrics this week shows a causal relationship between breastfeeding and higher IQ by the time a child is seven years old. Put simply, longer breastfeeding appears to make…Hayley Dickinson, ARC Post-Doctoral Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/85582012-08-02T05:24:22Z2012-08-02T05:24:22ZExplainer: why mothers should breastfeed<figure><img src="https://images.theconversation.com/files/13723/original/3275mcbh-1343805265.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding is good for the health of both babies and their mothers.</span> <span class="attribution"><span class="source">Ozgur POYRAZOGLU</span></span></figcaption></figure><p>Breast milk is one of the most important components of infant care. It provides complete nutrition and helps to prevent and fight infections. And it’s also safer – in much of the world, artificial infant feed is dangerous because clean water, which is essential for mixing with the powder, may not be available.</p>
<p>The <a href="http://www.who.int/nutrition/topics/infantfeeding/en/index.html">World Health Organization (WHO)</a> and <a href="http://www.unicef.org/">UNICEF</a> recommend that infants be exclusively breastfed for six months and continue breastfeeding with the appropriate introduction of solids.</p>
<p>In Australia, although we have safe alternatives to breast milk and clean water to mix it with, we need to make mothers aware that breastfeeding needs to be the norm to protect their babies from infection. Babies are born with a relatively immature immune system that is supplemented with antibodies created by the mother in response to the environment that she and her baby share.</p>
<p>The risks of not breastfeeding include an <a href="http://www.bmj.com/content/336/7649/881">increased incidence</a> of respiratory and gastrointestinal infections in infancy. What’s more, people who have not been breastfed have a higher incidence of obesity, diabetes, high blood pressure and coeliac and Crohn’s disease.</p>
<p>Mothers who breastfeed also enhance their own health – <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/">breastfeeding has been linked</a> to a reduced incidence of breast and ovarian cancers, diabetes and cardiovascular disease. And, breastfeeding is environmentally-friendly – it doesn’t produce any additional waste from manufacturing or packaging. </p>
<p>Artificial infant feeds contain some components that are similar to breast milk but it’s impossible to mimic the vast array of live cells and other components of human milk that have important beneficial qualities. Nor can formula milk reflect or imitate the changing nature of breast milk over time. The amount and type of immune factors in breast milk change as babies grow and develop, and it even has a different composition if a baby is born prematurely. Indeed, an artificial infant feed that is largely the same as human milk simply doesn’t exist.</p>
<p>Breast milk introduces infants to flavours in foods that are thought to influence later eating habits. Research shows young children who have been breastfed eat a <a href="http://www.nutrociencia.com.br/upload_files/artigos_download/SHIM%20et%20al.,%202011.pdf">wider range of foods</a>.</p>
<p>Mothers need accurate and appropriate information to help guide them through any difficulty they have with breastfeeding. Many groups advocate for breastfeeding and provide resources to educate the broader community. Information for families can be found on websites of the <a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a>, <a href="http://raisingchildren.net.au/">Raising Children Network</a> and the <a href="http://www.babyfriendly.org.au/about-bfhi/">Baby Friendly Hospital Initiative</a>. </p>
<p>Some women begin breastfeeding when their babies are born but then stop soon afterwards for one reason or another, such as a lack of support, the need to return to work or the thought that they don’t have enough milk. Breast milk is difficult to measure and the focus on numbers in infant care with regular measures of weight gain probably doesn’t help these doubts.</p>
<p>It’s easy to measure volumes consumed when feeding artificially but monitoring the amount of breast milk an infant is getting is more reliant on indicators such as urine volume, stools, infant behaviour and growth. Most babies are able to grow and thrive on breast milk alone until they are six months old, with a neat system of supply and demand; the more frequently the baby feeds, the more milk the mother makes!</p>
<p>We need to support breastfeeding because it’s the optimal way to feed infants. We can do this by creating and maintaining ways to encourage mothers to breastfeed – but we also need to encourage them to continue breastfeeding until their child is two years of age or beyond.</p>
<p>Access to health-care professionals who are trained and committed to breastfeeding as well as increasing the community’s knowledge to support women who are doing so will be helpful. Breastfeeding should not be hidden away, young women who observe others successfully feeding will be more likely to choose to breastfeed themselves.</p>
<p>And having a strong culture of breastfeeding will mean there are lots of women around who have the wisdom of their own experience to share. Governments can help with legislation to protect and promote breastfeeding and by implementing the <a href="http://www.who.int/nutrition/topics/global_strategy/en/index.html">WHO and UNICEF global strategy</a> for infant and young child feeding.</p>
<p><br>
<em>See more <a href="https://theconversation.com/topics/explainer">Explainer articles</a> on The Conversation.</em></p><img src="https://counter.theconversation.com/content/8558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evelyn Volders is a volunteer dietitian for the Australian Breastfeeding Association and has previously written and evaluated materials for the Raising Children Network.</span></em></p>Breast milk is one of the most important components of infant care. It provides complete nutrition and helps to prevent and fight infections. And it’s also safer – in much of the world, artificial infant…Evelyn Volders, Adv APD, Senior Lecturer/Course Convenor in Nutrition and Dietetics, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.