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Breastfeeding advances society

- Delia du Toit

Breastfed babies are healthier and smarter than formula-fed babies yet these benefits still do not translate into policy and practice.

Breastmilk makes the world healthier, smarter, and more equal. These were the findings of The Lancet Series on Breastfeeding (2016), the most in-depth analysis to date into the health and economic benefits of breastfeeding, which Professor Linda Richter in the DST/NRF Centre of Excellence (CoE) in Human Development at Wits co-authored.

“The deaths of 823 000 children and 20 000 mothers each year could be averted through universal breastfeeding, along with economic savings of US$300 billion. [Breastfeeding results in] fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers,” reads the Lancet report. 

Keeping abreast of policy 

However, exclusive breastfeeding (EBF) remains the exception rather than the norm in South Africa, says Wits Lecturer Sara Nieuwoudt, who coordinates the Social and Behaviour Change Communication field of study in the Wits School of Public Health. Nieuwoudt was the lead author on the Infant feeding practices in Soweto, South Africa: Implications for healthcare providers study (September 2018). 

“EBF is increasing, from less than 10% to about 32%, in large part due to the removal of free formula from public clinics and increased breastfeeding promotion by health workers. But our study suggests that some frontline health workers are still reluctant to abandon formula as an option for HIV-exposed infants,” says Nieuwoudt – this despite the 2011 Tshwane Declaration for the Promotion of Breastfeeding, which made breastfeeding promotion national healthcare policy. 

Although the Tshwane Declaration was an important step, it hasn’t even begun to scratch the surface of the challenge to increase breastfeeding uptake, says Patricia Martin-Wiesner, attorney, senior policy analyst and author of a breastfeeding policy review commissioned by the CoE in Human Development. 

“The problem can be seen in the enormity of the gap between EBF and other feeding practices in South Africa: 25% of children are not breastfed at all, 45% are fed using a bottle, and nearly 20% of mothers introduce solid food in the first month of the child’s life. Solid food is not recommended for the first six months of life,” says Martin-Wiesner.

Breastfeeding advances society. © Curiosity | 

Working women breastfeeding 

The results of the South African workplaces surveyed for the policy review were in stark relief to policy goals. In most instances, there was an absence of informal or formal policies to support breastfeeding when mothers return to work. 

“What struck me was the big knowledge vacuum in the corporate and NGO sector on the responsibilities created by law – internationally and nationally – to provide a supportive environment by providing breastfeeding breaks and a hygienic space to do so,” says Martin-Wiesner. 

“Many businesses are not doing much because they don’t know they have to. There is no education on or monitoring of the Code of Good Practice on the Protection of Employees During Pregnancy and After Birth of a Child law, which is part of the national Basic Conditions of Employment Act. Similarly, women do not know about it and so do not use it to enforce their rights through our labour protection framework and structures. There is also a reluctance to incur the costs and possible inconvenience of providing a supportive workplace.” 

Nieuwoudt says breastfeeding is often seen as a “women’s issue” instead of the countrywide developmental issue that it is. This perception makes it hard to mobilise the private sector, trade, and labour to support breastfeeding proactively. “Resources are hard to secure for health promotion. The formula industry, which has a commercial interest in pushing their products, actively undermines efforts to make breastfeeding the norm. And many women simply don’t feel comfortable breastfeeding in public spaces at present.” 

Breast is best for health and the pocket 

One of the first steps towards improvement would be for workplaces to recognise the economic benefits of supporting EBF. While the cost is relatively small – one only needs a clean and private space for pumping – breastfeeding support is a sound financial investment. 

“The biggest reason why women give up breastfeeding is because they have to go back to work where there is little, if any, support. If companies support breastfeeding, jobs can be saved rather than lost,” says Martin-Wiesner. 

Should companies support breastfeeding, new mothers (in whom the company has already invested) will come back to work and be motivated and loyal. Mothers will also not take as much leave for sick children suffering from common problems associated with bottle-feeding. 

“In the longer term, it contributes to healthy early childhood development, which is the bedrock of sustainable social and economic development. Indeed, for the most vulnerable and marginalised babies, breastfeeding is recognised as one of the key equalisers to afford them equal opportunities to develop to their full potential and ultimately escape the traps of poverty.” 

At a family-level, breastfeeding saves time and money compared to formula feeding. Breastfed infants are sick less, particularly in contexts like South Africa where access to clean water and sanitation remains an issue for many households. This translates into fewer sick leave days, higher productivity for working mothers, and fewer burdens on the health system. 

In addition to lower infant mortality, breastfed infants enjoy fewer diarrhoeal and respiratory illnesses, because breastmilk contains healthy bacteria, antibodies and nutrients that are not in formula. If a mother is using antiretrovirals, the risk of transmitting HIV through breastfeeding is less than 1%. 

But simply passing new laws won’t be enough. Resolving the problem requires a nationwide response at a policy, resource and system-level, from trade and industry, labour, the corporate sector, and the health sector. Breastfeeding support must not be seen as a health issue, but as a development issue that concerns the entire country. 

  • Delia du Toit is a freelance journalist.
  • This article first appeared in Curiosity, a research magazine produced by Wits Communications and the Research Office.
  • Read more in the sixth issue, themed: #HungerGames where our researchers and academics unpack the latest research on food security, food science, food politics and governance, nutrition and food-related issues such as obesity, diets, breastfeeding, and body image.