Breastfeeding

Before 1900, most mothers breastfed their infants. Breastfeeding rates declined sharply worldwide after 1920, when evaporated cow's milk and infant formula became widely available. These were promoted as being more convenient for mothers and more nutritious than human milk. Breastfeeding rates began rising again in the late 1950s and early 1960s.

BENEFITS OF BREASTFEEDING

Breastfeeding, or lactation, is, in fact, the ideal method of feeding and nurturing infants. Most health organizations recommend infants be exclusively breastfed during the first four to six months of life, but ideally through the first year. Premature infants also benefit from their mothers' milk. In developing countries, breastfeeding up to age two, with appropriate supplementary solid foods, maintains good nutritional status and prevents diarrhea.

Benefits of Breastfeeding

Human milk contains the right balance of nutrients for human growth and development. It is low in total protein and high in carbohydrates , making it more digestible and less stressful on the immature kidneys. In addition, each mammal produces milk that is nutritionally and immunologically tailored for its young. In rare cases, such as galactosemia and phenylketonuria , some infants cannot metabolize human milk or other milk products. A significant benefit of human milk is that it contains many immunologic agents that protect the infant against bacteria , viruses , and parasites . Breastfeeding also provides many benefits for the mother.

Breastfeeding Trends

Despite the many benefits of breastfeeding, only 64 percent of mothers in the United States initiate breastfeeding, with 29 percent still breastfeeding six months after birth. The U.S. goals for 2000 were to increase to 75 percent the proportion of women who initiate breastfeeding, and to increase to 50 percent the proportion of women who breastfeed for five to six months. In the United States, ethnic minorities are less likely to breastfeed than their white counterparts.

Based on a 2001 report by the World Health Organization (WHO), 35 percent of infants worldwide are exclusively breastfed (no other food or drink, not even water) for the first four months of life. Rates are very low in a number of African countries, especially Nigeria, Central African Republic, and Niger. Some countries, such as Benin, Mali, Zambia, and Zimbabwe have had small increases, due mainly to breastfeeding campaigns, baby-friendly hospitals, and the commitment of trained breastfeeding counselors. In Southeast Asia, the exclusive breastfeeding rate, though low, has increased. Breast-feeding rates are also low in many European countries, especially France, Italy, Netherlands, Spain, Switzerland, and the United Kingdom. Sweden, however, has a rate of 98 percent, the highest level in the world.

An increase in breastfeeding could save the lives of millions of children a year worldwide. However, the aggressive marketing campaigns by infant formula companies and the promotion of infant formula by health professionals combine to discourage breastfeeding. Other factors that determine whether a woman will breastfeed include:

• The father's preference for a specific feeding method
• Whether the mother was breastfed as an infant
• Social support
• Whether relatives and/or friends breastfeed
• Whether the mother gets help with household chores
• The mother's need to work
• Hospital policies

Physiology of Breastfeeding

During pregnancy, the body increases its production of a hormone called prolactin, which stimulates the breast to make milk. Suckling by the infant stimulates the release of prolactin. The size of the breasts is not a factor in milk production. Oxytocin, another hormone, allows the breast tissue to "let down" or release milk from the milk ducts to the nipples.

Colostrum, the first milk produced, has all the nutrients a newborn infant needs. It also contains many substances to protect against infections. The body produces colostrum for several days until the "mature milk" comes in. Mature milk adjusts to the baby's needs for the rest of the time the infant is breastfed.

Nutritional Needs of the Mother

Milk production requires about 800 calories a day. The Recommended Dietary Allowances for calories during breastfeeding is 500 more calories a day than is required by a nonpregnant woman. Nutritional requirements do not change significantly from pregnancy, with the exception of decreases in folate and iron , and increases in vitamin A, vitamin C, niacin , and zinc . The diet can be the same as during pregnancy, plus an additional glass of milk. Women who are on medication should check with their physicians, since most drugs are absorbed in breast milk.

Weaning

The decision to wean should be based on the desires and needs of the mother and child. Weaning should be gradual. Women returning to work can pump and store their milk for later use. Solid foods should be given based on the age and developmental stage of the child. In some countries, many toddlers become malnourished because they are given too many high carbohydrate foods, such as cassava, potatoes, and other root vegetables, too early. These foods are filling, but they are low in protein and other nutrients essential for growth and development.

Breast Implants and Breast Reduction

Many women with breast implants breastfeed successfully, though it is not known whether the health of the infant is affected by breast implants.

Human milk contains nutrients and antibodies that keep babies healthy. Although it is considered the ideal feeding method for infants, 36 percent of mothers in the United States do not breastfeed at all.

[Photograph by Jim Trois. Photo Researchers, Inc. Reproduced by permission.]

Who Should Not Breastfeed?

Women with HIV/AIDS, hepatitis , cancer , and other conditions where the immune system may be compromised should not breastfeed. A case-by-case assessment should be made with women exposed to certain environmental toxins and those who use illicit drugs.

Policies and Recommendations

A woman's ability to breastfeed for the optimal recommended time depends on the support she receives from her family, health care providers, and the workplace. Health care institutions should adopt policies and initiatives that include:

• A written breastfeeding policy
• A breastfeeding education program
• Rooming-in of mother and child
• Breastfeeding on demand
• Limited use of pacifiers, water, and formula

With the increased number of women in the workforce, employers can do a lot to support and encourage breastfeeding, such as providing adequate breaks; flexible hours; job sharing ; part-time work; refrigerators for storage of breast milk; and on-site child care.

A public health campaign can greatly increase the initiation and duration of breastfeeding. These campaigns should target all social groups, including men, future parents, grandparents, health care providers, and employers. In addition, culturally appropriate programs and materials should be available. Breastfeeding saves lives and money, and it benefits all of society.

SEE ALSO Beikost ; Infant Nutrition ; Mastitis ; Pregnancy .

Delores C. S. James

Bibliography

James, Delores C.; Jackson, Robert T.; and Probart, Claudia K. (1994). "Factors Affecting Breastfeeding Prevalence and Duration among International Students." Journal of the American Dietetic Association 94(2):194–196.

Worthington-Roberts, Bonnie S., and Rodwell-Williams, Sue (1993). Nutrition in Pregnancy and Lactation, 6th edition. Madison, WI: Brown & Benchmark.

U.S. Department of Health and Human Services, Office on Women's Health (2000). HHS Blueprint for Action on Breastfeeding. Washington, DC: U.S. Government Printing Office.

Internet Resources

American Academy of Pediatrics. "A Woman's Guide to Breastfeeding." Available from <http://www.aap.org/>

Ryan, A. S. (1997). "The Resurgence of Breastfeeding in the United States." Pediatrics (online). Available from <http://www.pediatrics.org>

UNICEF. "Breastfeeding and Complementary Feeding." Available from <http://www.childinfo.org/>

World Health Organization. "Global Databank on Breastfeeding." Available from <http://www.who.int/nut>