The majority of mothers in low-income communities in South Africa face many barriers such as high levels of stress which is believed to undermine their ability to produce breast milk of acceptable quality and quantity. This trend has seen South Africa slip down the rankings on the continent with the lowest rate of exclusive breastfeeding (EBF) in Africa.

Breast milk is the ideal food for infants as it is one of the most effective ways to ensure child health. The milk produced by mothers is safe, clean, and contains antibodies that help protect against many common childhood illnesses.

The World Health Organisation (WHO) and UNICEF have recommended that breastfeeding begins within the first hour of birth and that babies be breastfed exclusively for the first 6 months of life. However, globally 3 in 5 children are not breastfed in the first hour of life. And according to WHO, only 41% of infants under 6 months of age are fed only breast milk.

South Africa well off 2025 target

Together, WHO and UNICEF set exclusive breastfeeding as one of the global nutrition targets meaning countries would have to reach 50% by 2025. Dr Chantell Witten, a registered dietician and lecturer at the University of the Free State, says South Africa won’t meet this target.

A community-based mixed-methods study by Witten and her team examines the rate of EBF discontinuation and the psychosocial barriers and enablers of EBF in low-income townships. The study collected data on socio-demographics, the Edinburgh Postnatal Depression Scale, and the Breastfeeding Self-Efficacy Scale Short from 159 mothers.

Stress the No 1 barrier

The study found a low rate of exclusive breastfeeding and a high rate of mixed feeding. Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks while mixed feeding with infant formula increased from 17% to 30.6%. Food feeding went up from 3.1% to 54.2%. These statistics duplicate the national trends. The qualitative data revealed that the majority of mothers in low-income communities face many barriers such as high levels of stress. This is believed to undermine their ability to produce enough breast milk and quality milk for their infants.

According to Witten, women’s decisions around breastfeeding are influenced by several factors such as home, family and social environments, finances and cultural factors. Culture often gets in the way of the mother’s intentions to breastfeed her infant as recommended, especially for women living in poverty. In 2017, almost 20% of South African households reported that they had inadequate access to food.

“The North West province, where I did my study, had the highest proportion of food-insecure households at 63%,” said Witten.

Difficult home situations

The study revealed that the majority of the mothers were unmarried (84.9%), living with family (69.2%), and unemployed (74.2%). BMC reported that most new mothers live with their families rather than their partners or spouses. In some cases, these families already struggle with poverty. This increases stress levels and takes a toll on the mother’s mental health.

Witten’s study found that nearly 45% of mothers had clinical signs of distress. According to WHO, about 13% of mothers experience clinical depression after childbirth, better known as postpartum or postnatal depression. Mothers are more likely to stop breastfeeding within three months if they experience high levels of postpartum depression. Researchers have shown that stress in mothers increases corticosteroids in breast milk.

Too many people in family medicine still feel the need to preach and shame about the superiority of exclusive breastfeeding without understanding context in peoples’ lives. Let’s normalize that “fed is best.” https://t.co/20SfrAnGRB

— Jason Ricco (@RiccoMD) October 31, 2021

“Mothers feared that the stress they experienced could be passed on to their infants through breastfeeding. This made them reluctant to pass on their stress to their infants. Their decision to seek alternative feeding is a protective action to spare their infants their negative stress,” Witten concluded. – Health-e News