Fundamentally, breastfeeding is about infant feeding. However, it has also become – among other things – about gender and economic equality, commercial interests, poverty, non-communicable diseases and the overall health and well-being of both the mother and the child.

From a nutritional perspective, it should be a fairly straightforward case. The World Health Organization (WHO) celebrates World Breastfeeding Week1 every year from 1 to 7 August as a reminder of the importance of breast milk for the health and well-being of newborn babies. The antibodies present in breast milk are often referred to as “baby’s first vaccine”,2 and WHO recommends that breastfeeding is initiated within the first hour after birth and continued exclusively for the first six months. Breastfeeding also has long-term benefits for the child, as many studies have linked exclusive breastfeeding to a lower risk of obesity and type 2 diabetes, as well as higher cognitive performance3 later in life.

With such compelling evidence in favour of breastfeeding, why are fewer than one in three babies exclusively breastfed during the first six months of life? There are various reasons for this, including the information and options available to the family, which, in turn, are influenced by region and socioeconomic status.

Feeding infants is also big business, as was demonstrated during the 71st World Health Assembly in May 2018. The interests and lobbying power of the infant formula industry overcame science and best practice, and watered down a resolution aimed at encouraging breastfeeding in developing countries.4 Breast milk substitutes are a huge global business, and despite the code of conduct that regulates their marketing, aggressive marketing practices and misconceptions about the nutritional facts still abound. In low-income settings, for example, using unsafe water to prepare infant formula and feeding with unsterile bottles and teats presents a real risk for many mothers and babies.

At the same time, society, the labour market, public attitudes and, sometimes, even the law can be hostile towards breastfeeding mothers.

Traditionally male-dominated work environments and public places have been slow to accept breastfeeding as natural and normal. The overt sexualisation of the female body has led to public outrage towards mothers feeding their children on a park bench, in the corner of a café or in a shopping mall. Until recently, it was still illegal to breastfeed in public in certain US states,5 where mothers faced being accused of public indecency simply for nursing their child. Similarly, in most countries, an employer who provides facilities and breaks in the working day to allow mothers to breastfeed or pump breast milk in safe and sanitary conditions is still a rarity.

Economic factors can also lead mothers to cease or reduce breastfeeding. Without paid maternity leave, breastfeeding-friendly work places and flexible childcare arrangements, mothers may be unable to continue nursing when they return to work. In particular, in lower-income settings, mothers who are the primary or sole wage earner in their family face the stark choice between providing the best nutrition for their child, or maintaining their income level in order to feed and house themselves and the rest of the family. Furthermore, this often leads to the double disadvantage of having to spend money on breast milk substitutes – placing an additional financial burden on already limited resources.

Breastfeeding is a health and nutrition issue, but it is also an economic and gender equality issue. The right of the child to adequate nutrition should not depend on the income level of the mother, on commercial lobbying or on the absence of a supportive environment. Multisectoral action is required to shift public attitudes and common practices that currently prevent mothers from making a true and informed choice about feeding their babies. The focus should be on creating a society where public spaces, work places and the health system support women to breastfeed, and are fully inclusive towards breastfeeding mothers.

References

1  WHO, ‘Breastfeeding’, web pages.
2  WHO, ‘3 in 5 babies not breastfed in the first hour of life’, news release, 31 July 2018.
3  WHO, ‘Breastfeeding’, Facts in pictures news item, 20 February 2018.
4  Jacobs, Andrew, ‘Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials’, The New York Times, 8 July 2018.
5  Sampathkumar, Mythili, ‘Breastfeeding in public is finally legal in all 50 US states’, Independent, 24 July 2018.