A global scorecard that analysed economic and societal factors that influence breastfeeding has shown no country in the world is fully compliant in delivering policies and programs that support and promote the practice. This could be the reason why the scorecard also found only 40% of countries are achieving the accepted World Health Organization (WHO) recommendation that babies be exclusively breastfed to six months of age.World Health Organization. Infant and young child feeding 2017.
Handed down in August as part of World Breastfeeding Week , the Global Breastfeeding Scorecard measured how countries are meeting breastfeeding practices and their level of investment in broad breastfeeding policies and programs. The scorecard was developed by the Global Breastfeeding Collective – a partnership of 20 international agencies and non-government organisations led by UNICEF and the WHO.
International breastfeeding guidelines
The WHO’s accepted guidelines are that breastfeeding should be initiated within the first hour of birth and continued exclusively until a baby is six months of age. The guidelines also recommend that breastfeeding continue up to two years of age or beyond, together with complementary foods introduced to a baby’s diet at six months.
In Australia, the National Health and Medical Research Council also recommends exclusively breastfeeding up to six months, and introducing complementary foods at six months in addition to breastfeeding up to 12 months, and beyond for as long mum and baby desire.
Scorecard results – breastfeeding practices
The scorecard found only 40% of babies under six months are exclusively breastfed, with just 23 of the 194 countries analysed reaching rates above 60% for exclusive breastfeeding to six months.
Australia was not one of the countries that reached above 60%. And many countries, including some high-income countries, don’t have any data about their country’s breastfeeding practices.
What does our data say?
Statistics from Australia’s 2010 National Infant Feeding Survey show 96% of Aussie mums initiate breastfeeding of children aged 0–2 years, with 39% continuing to exclusively breastfed up to three months of age, and 15% exclusively breastfeeding up to six months.
Whether a mum breastfeeds or not can depend on her physiology, knowledge, attitudes and beliefs.Wen L, Baur L, Rissel C, Alperstein G, Simpson J. Intention to breastfeed and awareness of health recommendations: findings from first-time mothers in southwest Sydney, Australia. 2017 Socio-economic factors can also influence whether a new mother will breastfeed or not. Young mums under the age of 25 years, from a low socio-economic background with minimal education have reduced rates of breastfeeding.Garden F, Hector D, Eyeson-Annan M, Webb K: Breastfeeding in New South Wales: Population Health Survey 2003-2004. Sydney; NSW Centre for Public Health Nutrition, University of Sydney, and Population Health Division, NSW Department of Health, 2007 In contrast, according to the 2010 National Infant Feeding Survey, mothers more likely to initiate and continue high-intensity breastfeeding for longer are those aged 35 years and older with higher education and incomes, and whose infants do not regularly use dummies.
Of mums who do breastfeed, approximately 94% say they do so because of the nutritional benefit for their baby, and 64% say it helps them bond with their bub. About 38% of Aussie mothers say they don’t breastfeed due to past unsuccessful experiences, and 26% say infant formula provides the same benefits as breast milk.
Many mothers experience difficulties including mastitis, breast pain, too much or too little milk, infection and psychological issues such as postnatal depression, which can all affect whether breastfeeding is possible. The Australian Breastfeeding Association (ABA) states if breastfeeding doesn’t work out and a mother is unable to breastfeed for as long as she intends or at all, many mothers feel a deep sense of guilt. However, there are options available if mums don’t or aren’t able to breastfeed. In some cases, expressing breast milk may be an option. In other cases, mothers may use donor milk or infant formula to feed their babies.
It’s not just mum’s responsibility
On the surface it may seem like the decision to breastfeed is an individual one made by each new mother. However, breastfeeding is not the sole responsibility of a mother but rather a collective societal responsibility to create an environment that promotes breastfeeding.Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al. Why invest, and what it will take to improve breastfeeding practices?. The Lancet. 2016;387(10017):491-504.
The WHO states that while it is a mother’s choice to breastfeed, her decision is influenced by economic, environmental, political and social aspects. And the Global Breastfeeding Scorecard is an important reminder that governments and communities have a role to play in creating supportive, protective environments that promote the practice. Research shows that countries can improve breastfeeding rates if interventions, policies and programs are scaled up.Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al. Why invest, and what it will take to improve breastfeeding practices?. The Lancet. 2016;387(10017):491-504.
Scorecard results – policy and program investment
Worldwide investment in policies and programs that support breastfeeding are poor, with the results showing only 6% of governments invest at least $5 per newborn.
The results also show just:
- 21% of countries have implemented, legislated and enforced the International code of marketing of breast milk substitutes.
- 12% of governments have paid family leave legislation and workplace breastfeeding policies.
- 14% of countries have more than half of their births take place in facilities with the Baby-friendly Hospital Initiative.
- 61% of countries have primary healthcare facilities and 50% have community facilities that provide Infant and Young Child Feeding (IYCF) breastfeeding counselling and support.
- 40% of countries have monitoring systems in place that assess their programs and policies, and 48% had collected breastfeeding data over the last five years.
Overall, of the 194 countries analysed, only six achieved the minimum standard in more than half of the seven analysed indicators. These countries were Armenia, Cuba, The Gambia, Guatemala, Nepal and Vietnam.
How did we score?
Using a traffic light system, the scorecard did not give Australia any green lights in any of the seven areas. We scored a yellow light (just less than green) for having 20% of births occur in Baby Friendly Hospitals and Maternities. We were given an amber light (just less than yellow) for Australia’s paid parental leave scheme. A red light was given for our voluntary agreement (the MAIF Agreement) for the international marketing code for breast milk substitutes.
The Lancet Breastfeeding Series reports universal breastfeeding in line with recommendations could avoid the deaths of 823,000 children and 20,000 mothers.Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al. Why invest, and what it will take to improve breastfeeding practices?. The Lancet. 2016;387(10017):491-504.
There are a myriad of health, developmental and cognitive benefits for bubs who are breastfed.Horta BL, Bahl R, Martinés JC, Victora CG: Evidence on the long-term effects of breastfeeding: Systematic reviews and meta-analysis. World Health Organization Geneva, Switzerland, 2007 Breast milk has protective nutrients, including proteins, lysozymes, prolactin, macrophages, free fatty acids and nucleotides, some of which are not found in infant formula. And breastfeeding can be crucial in preventing mortality from gastrointestinal infections and pneumonia in the first six months of life.Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al. Why invest, and what it will take to improve breastfeeding practices?. The Lancet. 2016;387(10017):491-504.
When a newborn’s immune system is still developing, breastfeeding offers immunoprotection. Research also indicates that breastfeeding can help reduce a child’s risk or severity of a number of conditions in infancy and later life, including physiological reflux, urinary tract infection, type 1 and 2 diabetes, asthma, Sudden Infant Death Syndrome (SIDS), cardiovascular disease and bowel disease.
Benefits to mothers who breastfeed include quicker recovery from childbirth and decreased risk of developing breast and ovarian cancers.
Apart from the health benefits, breastfeeding lowers the costs associated with morbidity and medical treatment of childhood disorders. It is also suggested that breastfeeding improves a child’s educational, and therefore their adult earning, potential. There are also reduced environmental costs associated with breastfeeding. As a natural, renewable source, there is no pollution or unnecessary packaging, unlike breast milk substitutes which have an ecological footprint associated with manufacturing and distribution.Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al. Why invest, and what it will take to improve breastfeeding practices?. The Lancet. 2016;387(10017):491-504.
In short, breastfeeding can help develop healthier and better educated children, and more sustainable communities.
What can we do to improve?
Given that 85% of Australian babies aren’t exclusively breastfed to six months in line with the accepted guidelines, perhaps more can be done to encourage and support Aussie mums, whilst also showing empathy and compassion to any breastfeeding issues that they may encounter. Australia is developing a new national breastfeeding strategy that will incorporate recent research on effective breastfeeding strategies to address the barriers to mums initiating and maintaining breastfeeding. Stakeholder consultation is currently underway and a draft strategy is due to be submitted for approval to the Australian Health Ministers’ Advisory Council this year.
The right political leadership and level of funding is key in implementing policies and programs that support breastfeeding. These, in turn, can make a world of difference in helping to ensure mums can breastfeed confidently and bubs get the best possible start in life.
References [ + ]
|1.||⇪||World Health Organization. Infant and young child feeding 2017.|
|2.||⇪||Wen L, Baur L, Rissel C, Alperstein G, Simpson J. Intention to breastfeed and awareness of health recommendations: findings from first-time mothers in southwest Sydney, Australia. 2017|
|3.||⇪||Garden F, Hector D, Eyeson-Annan M, Webb K: Breastfeeding in New South Wales: Population Health Survey 2003-2004. Sydney; NSW Centre for Public Health Nutrition, University of Sydney, and Population Health Division, NSW Department of Health, 2007|
|4.||⇪abcde||Rollins N, Bhandari N, Hajeebhoy N, Horton S, Lutter C, Martines J et al. Why invest, and what it will take to improve breastfeeding practices?. The Lancet. 2016;387(10017):491-504.|
|5.||⇪||Horta BL, Bahl R, Martinés JC, Victora CG: Evidence on the long-term effects of breastfeeding: Systematic reviews and meta-analysis. World Health Organization Geneva, Switzerland, 2007|