The critical importance of promoting the value of breastfeeding globally, nationally, and at the community level can never be highlighted enough. According to UNICEF, the potential impact of optimal breastfeeding practices is especially important in developing country situations with a high burden of disease and low access to clean water and sanitation.
Dr. Yvonne Vaucher (MD, MPH, FAAP), the Immediate Past-President of San Diego County Breastfeeding Coalition and Professor of Pediatrics at UC San Diego, recently discussed the problems and progress of breastfeeding in developing countries at the Coalition’s general meeting.
Dr. Vaucher talked about the impact of suboptimal breastfeeding on survival in developing countries, pointing out that suboptimal breastfeeding is a major cause of childhood death worldwide. She cited a 2006 study published by Public Health Nutrition, saying that suboptimal breastfeeding is the number three cause of childhood death globally, second only to malnutrition which causes 3.75 million deaths per year, and unsafe water, sanitation and hygiene which lead to 1.73 million deaths per year.
“Suboptimal breastfeeding is responsible for 1.45 million deaths per year,” said Dr. Vaucher, “that is 4,000 deaths per day, 165 deaths per hour, or 3 deaths per minute.”
The same study showed that optimal breastfeeding up to two years of age in developing counties would prevent 13%, or 800,000 of all deaths in children under five years each year. Unfortunately, “there are too many factors resulting in suboptimal breastfeeding,” said Dr. Vaucher.
Those factors include: delayed initiation of breastfeeding, prelacteal feeds, supplementation with water, teas, animal milks, formula feeding, health provider misinformation, commercial promotion of formula, maternal C-section, illness, or death, and infant low birth weight or illness.
Dr. Vaucher believes that early and exclusive breastfeeding is a cultural issue. “Some cultures appreciate other liquids like teas and animal milks,” she said. “Others accept water as compatible with early breastfeeding. Some cultures prescribe early feeding of solids at four to five months, or believe that a fat baby is a healthy baby.”
Formula and breast milk supplements also contribute to the barriers to exclusive breastfeeding. In many developing countries, people believe that formula is “scientific” and “modern,” and symbolize economic and social success.
A risk of breastfeeding in developing countries is the transmission of infectious diseases such as HIV and Ebola. The New York Times reported in 2008 that “up to 48% of infant HIV in developing countries is from breastfeeding.” However, Dr. Vaucher said, “Protective factors including antibodies, cytokines, antiviral lipids, lactoferrin, and glucosoaminoglycans are also present in breast milk.”
There has also been a lot of discussion about Ebola. “The risk of transmission from mother to infant is very high based on close contact alone, not necessarily breastfeeding,” said Dr. Vaucher. “If possible, experts recommend to have anuninfected caretaker and alternative food source for infant.”
It is often assumed that breastfeeding is optimal in developing countries where it is the norm. This is a myth. There are actually many barriers to exclusive breastfeeding in developing countries. “The good news is,” said Dr. Vaucher, “breastfeeding rates in developing countries are no longer declining.”
She said that exclusive breastfeeding rates are improving in most developing countries, thank to increased government action to support and protect breastfeeding. Currently, world health organizations continue their breastfeeding initiatives in developing countries. Key components and interventions including controlling marketing of breast milk substitutes, and providing community-based counseling and support.
TO-WEN TSENG 曾多聞