Breastfeeding rates still low despite global education

Despite widespread awareness of the importance of breastfeeding to the human child, mothers in developed countries demonstrate low rates of compliance with global recommendations. Nursing past six months is the exception rather than the rule. Bottle-feeding infants has become normal. Exclusive and extensive breastfeeding has become a pastime primarily for the rich with some interesting exceptions. Nordic countries exhibit the overall highest European breastfeeding rate with England ranking lowest. UAE ruling class mothers exclusively breastfeed the longest among Arabs while Iraq suffers the lowest breastfeeding rates. US Whites and Native Americans are most likely to breastfeed while Blacks and Hispanics are the least likely.

Class plays a large role in decision to breastfeed, for far fewer women belonging to the routine and manual labor socio-economic group nurse beyond six weeks than is typical of professional women and full time mothers. Yet, religion and philosophy also affect women’s decision to breastfeed. In Singapore non-Malay Muslim women are 6.7 times more likely to breastfeed than Buddhist women although Malays have the lowest rate. Urban babies receive half the breast milk of rural babies. The youngest mothers tend to supplement with bottles from birth.

The World Health Organization and UNICEF work hard to promote breastfeeding worldwide, but their success is undermined by factors such as free infant formula distribution, hospital practices and lack of personal support. Breastfeeding is a learned skill requiring effort and focus. Good intentions are not always enough to establish lactation. “Baby-friendly hospital” initiatives in many countries have significantly increased breastfeeding but rates are still well below optimum health guidelines.

Almost all new mothers attempt breastfeeding but few continue for the recommended period. According to UNICEF the early introduction of bottle-feeding and complementary food leads to premature weaning, which is the primary cause of malnutrition in children under age two worldwide.

Many women give up nursing in favor of bottle-feeding out of a sense of powerless over the situation. These mothers often wanted very much to nurse their child, but they lost their chance. Hospitals fail to promote exclusive breastfeeding of newborns. Most new mothers receive free samples of formula because of multi-million dollar deals between hospitals and pharmaceutical companies and come home with their babies already addicted to the bottle. Coaxing a newborn child to breastfeed after he has been bottle-fed even just once or twice can be a big struggle. Success may be impossible without the aid of a midwife or lactation counselor because unfortunately even the older generation of mothers lack sufficient knowledge.

When newborns reject the breast, mothers typically try for a while, then give up and supply a bottle. This teaches the baby that refusing to nurse will be rewarded. Parents must exercise “tough love” by declining to give the baby a bottle even if it takes several hours or even days for the baby to nurse willingly. (If the baby gets dehydrated, do give him water with a cup or medicine dropper, but introducing a bottle creates “nipple confusion” which is disastrous for the mother-child relationship).

Some women give up on breastfeeding because the husband insists. This tragedy reveals a stripping away at women’s postnatal rights and sets a dangerous precedent. Nursing a baby is an exhausting and time-consuming job requiring family help, encouragement, and support especially from the father to enable mother and child to be together undisturbed as much as possible particularly during the first 40 days of the baby’s life.

Many women manage to make it through those hardest days in the beginning and then stop breastfeeding after a few weeks out of fear of insufficient milk supply. These mothers need to increase their consumption of calories and to get adequate rest. Under no circumstances should they give their baby a bottle because this will only decrease the supply of breastmilk. Sometimes it is actually the doctor’s advice to start feeding their babies solids before 6 months that leads to premature weaning. A mother needs to weigh the fun of spoon-feeding her infant against the risk of premature rejection of the breast.

Thus bottle-feeding rates remain high despite awareness that breastmilk alone contains all the nutrients, antibodies, hormones and immune factors that a baby needs.

“Encouraging exclusive breastfeeding has to become a high priority in all sectors of society,” said Dr. Mahendra Sheth, UNICEF Regional Health and Nutrition Adviser for the Middle East and North Africa. Exclusive breastfeeding for six months followed by complementary feeding between 6-9 months with continued breastfeeding through the first year could save an estimated 1.5 million lives annually.

Women receiving adequate advice can often prolong nursing even after returning to work outside the home. Premature infants particularly need breast milk for the best odds in life.

Pregnant women should read books on how to breastfeed and understand fully the necessary commitment to avoid making a tragic mistake to be remembered with regret.


Karin Friedemann is a Boston-based writer on Middle East affairs and US politics. She is Director of the Division on Muslim Civil Rights and Liberties for the National Association of Muslim American Women.