Pregnant_womanBreastfeeding also benefits society by reducing health care costs, raising the social and earning potential of adults who were breastfed, and reducing waste from packaging and conserving the large quantities of water used to make formula milks.

Two recent reviews published in the prestigious global health journal, The Lancet, confirm breastfeeding as a once-in-a-lifetime investment we can make in health, wellbeing, human capital and the environment.

But although breastfeeding is natural to human life, that doesn’t mean it is easy. Breastfeeding is a bit like sex. Biologically we are all capable of it, but it takes a lot of love and support for two people to get it right. Women need help and support to breastfeed.

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 – starting breastfeeding immediately after birth, exclusive breastfeeding in the first six months of life, and continued breastfeeding until the child is a toddler.

Why breast is best

Breastfed babies are four times less likely to die in the first six months of life. This applies in both low-income and high-income settings. Breast milk naturally inoculates the baby against disease because, through breastfeeding, the mother’s immune system kick-starts the baby’s ability to resist illness. This protects babies from respiratory infections and cuts diarrhoea episodes by half.

Breastfeeding not only saves the lives of infants, but also boosts their health and intelligence, and reduces their rate of behavioural problems in childhood. Breastfed babies are less likely to be obese, which means they are at lower risk of adult diabetes and cardiovascular disease.

Breastfed adults have IQs on average 2.6 points above those who were not breastfed. Long-term studies show that these IQ gains translate into increased earnings in adulthood.

A recent South African study found that breastfed babies are better behaved in middle childhood.

Breastfeeding is also good for mothers. It is a natural contraceptive because it interrupts the menstrual cycle, and it protects women against breast and ovarian cancer.

The broader economic argument for breastfeeding rests on three legs. Firstly, society gains from the increased intelligence of breastfed babies and their enhanced earnings as adults. A one-point increase in IQ is associated with a 12% increase in hourly earnings in high-income countries and 16% in low- and middle-income countries. To put this in perspective, it is an R800 a month increase on a monthly salary of R5 000!

In addition, millions of Rands can be saved as breastfed babies need less treatment for infectious illnesses in childhood. Lastly, breastmilk is environmentally friendly. It requires no processing and wasteful packaging and would save water. More than 4 000 litres of our precious water is needed to produce just one kg of formula powder.

What are the barriers?

With all these benefits, why don’t more women breastfeed for longer? For one, their confidence is undermined by commercial messages that formula feeding is less hassle and that mothers can be assured of how much milk their baby is drinking.

Baby formula manufacturers also insists that breastmilk substitutes are just as good as breastmilk but this is simply not true. While many supplements are added to formula milks to improve their nutritional value, a mother’s breastmilk is the perfect nutrient and transfers generations of disease resistance to her baby. Moreover, a women’s breastmilk is uniquely adapted to her baby, changing in energy composition as the baby develops and even in response to whether her child is a boy or a girl, according to research. Nothing that the contents of a tin can do!

South Africa signed up to the International Code of Marketing of Breastmilk Substitutes in 1981, but implemented only aspects of the code on a voluntary basis. But new regulations under the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No.54 of 1972) were published in December 2012 aimed at preventing commercial pressure by the infant feeding industry, so that all parents receive independent and objective information about infant feeding, and that all mothers who wish to breastfeed are supported.

Another barrier to breastfeeding is lack of advice and support to women and their partners at the crucial time of delivery and just after. This is where the 10 Steps of the Baby-Friendly Hospital Initiative come in. These requirements of hospitals and clinics were designed to protect, promote and support breastfeeding at this important time in the life of a mother and baby.

Ten Steps to success

South Africa adopted the World Health Organisation’s Ten Steps in 1995, but in 2012 renamed it the Mother-Baby Friendly Initiative (MBFI), to stress support for mothers and babies and to assert the continued importance of exclusive breastfeeding by HIV-positive women on antiretroviral treatment.

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within a half-hour of birth and have skin-to-skin contact, unhurried, for an hour.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breast milk unless medically indicated.
  7. Practice rooming-in – allow mothers and infants to remain together – 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Although roll out of the Ten Steps was initially slow, by 2011 the Department of Health reported that 44 percent of public hospitals were accredited. This figure apparently rose to 70% by 2014.

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 Tshwane Declaration of Support for Breastfeeding in South Africa. The declaration committed South Africa to ensuring that all public and private hospitals and health facilities would be accredited as Baby-Friendly by 2015 and that steps would be taken to ensure that mothers would continue to receive support once discharged in their homes and communities.

But 2015 has come and gone and there seems to be no national system for monitoring progress on accreditation or adherence to the 10 Steps. We also have little with which we can monitor whether breastfeeding rates increase in response to implementation, and little has been done to make communities more baby-friendly. We did what we, as South Africans, do well – pledged the best of intentions without putting in place practical steps to ensure that we realise them.

We have to become more mother and baby friendly. More businesses and government departments must provide spaces for women to breastfeed. No woman should be made to feel embarrassed if she breastfeeds in public, and more of us must step forward to defend her when needed.

Every women and her family preparing for delivery of a baby must be prepared, before the baby is born, to know the value of, and how to breastfeed. They must feel empowered to ask if the hospital they’re going to is accredited as baby and mother friendly.

Fathers and other family members must help the mother to insist that the hospital give effect to each of the 10 steps. And, as members of the public, we must support women and their families to demand and get all the help they need to be able to breastfeed their babies and give them the best start in life. – Health-e News.

* Professor Linda Richter is Director of the DST-NRF Centre of Excellence in Human Development at the University of the Witwatersrand, and one of the co-authors of The Lancet series on breastfeeding.