Breastfeeding is a human right
... but does society truly enable women to
breastfeed?:
by Inka Barnett
Breast milk is the optimal nutrition for an infant in the first 6
months of life. It promotes healthy child development and growth and
prevents diseases in adulthood. Especially in resource-poor settings in
which formula feeding is not affordable, feasible or sustainable,
breastfeeding is often the only option to ensure child survival and
health.
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Browsing and
breastfeeding. Credit: Pinot Dita from Flickr |
A recent Lancet paper recommends breastfeeding promotion as one of
the 10 evidence-based core interventions to address child undernutrition.
Increasing breastfeeding rates is on the agenda of more and more
Ministries of Health and Family Welfare, international agencies and
non-governmental organisations that work on improving child health. At
community-level, lactation counsellors and breastfeeding peer support
groups have become a common feature in many places. Since 1991, the
World Alliance for Breastfeeding Action, a global network of
organisations and individuals, has been organising the annual World
Breastfeeding Week to raise international awareness, from 1-7th August.
So why, despite all these efforts, are only 36% of all infants
worldwide breastfed for the recommended first 6 month of their lives?
Why do so few women breastfeed or discontinue breastfeeding early? What
prevents mums from giving their children the best nutritional start
possible?
The reasons for low breastfeeding rates in almost every country in
the world are complex and multi-dimensional. If we want to be serious
about increasing breastfeeding rates, we need to do much more than
simply raising awareness and providing individual-level breastfeeding
support to mums.
Work and breastfeeding
The topic of this year's World Breastfeeding Week, was how to support
women to better combine breastfeeding and work. The International Labour
Organisation's maternity protection from 2000 paved the way for women to
claim their right to breastfeed and work. Paid maternity allowance in
line with the breastfeeding targets, flexible working hours with
sufficient break times to allow mothers to nurse or express breast milk
and supportive workplace environments are some of the measures that are
currently mooted to help nursing women.
While all of these can be supportive for nursing mothers, they are
only the tip of the iceberg. The majority of working women (especially
in low and middle income countries) are not eligible or are excluded
from these supportive measures, for example because they work in the
informal sector without any legislative or social protection mechanisms
such as maternity leave, or are self-employed.
The realities of work life including long working hours, work-related
stress (especially in the context of high levels of unemployment and
constant fears of being 'laid off' or made redundant), crowded and
hazardous working conditions, lack of safe places at work to express and
safely store breast milk, unsupportive employers and long commutes add
further and often insurmountable challenges for women.
We need to think more creatively and inclusively about breastfeeding
at work. Legal protection is an important first step, but is only the
beginning of creating an environment that enables breastfeeding at work.
Supportive social environment
Breastfeeding might be natural but it is far from straightforward. A
recent review estimates that up to 80% of mother-infant pairs encounter
difficulties with breastfeeding. To exclusively breastfeed for 6 months
is a huge commitment with regards to the mother's time and energy. It
requires determination and constant perseverance, both of which can be
difficult for mothers who also shoulder most of the burden of caring for
other children and/or household members, do household chores, work and
still recover from (often traumatic) births.
Lactation experts, peer support and health visitors can help women to
overcome some of these challenges. But they also inadvertently place all
of the responsibility for breastfeeding on the mother alone, forgetting
about the influences, needs and demands of her home environment and
community setting.
Support and encouragement from relatives, partners and the wider
community have been shown to be important for successful breastfeeding.
In many cultures it used to be custom that new mothers and their babies
stayed separate from their families for the first few months after birth
and were well cared for by the entire community. This custom gave mother
and child time and space to rest, bond and establish a good
breastfeeding practice.
Sadly, things have changed and mothers all over the world need to go
back to their usual chores (or parts of their routine) shortly after
birth. Lack of supportive social networks in nuclear family settings,
anonymous and often isolated living conditions in urban metropoles and
poverty add further challenges.
Breastfeeding does not take place in isolation but within a family
and community. Hence, breastfeeding promotions need to target the entire
social environment of a mother and not only the mother to be effective.
There is no doubt that 'breast is best' for a baby. But to empower women
to do what is best, we need to create an environment that truly supports
and enables women to breastfeed.
(Inka Barnett is a Research Fellow at the Institute of Development
Studies (IDS) in the University of Sussex. With a background in
nutrition and epidemiology, Dr Barnett's work focuses on the politics of
undernutrition, with a particular interest in breastfeeding. This
article was originally published in 50-50) |