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Exclusive breast-feeding for the first six months is optimal, says the World Health Organisation.
But few women are able to fulfil this ideal and in South Africa, only 8 percent of babies are exclusively breast-fed for six months, for many reasons, says midwife and lactation specialist, Tina Otte.
“Employment conditions, cultural and social constraints and a lack of education and awareness around child nutrition make it difficult for moms to breast-feed exclusively and for prolonged periods of time,” she says.
Over the past decade, the government has put in place a number of programmes to improve breast-feeding rates, including the adoption of the South African code of ethics for the marketing of breast-milk substitutes, the baby-friendly hospital initiative and the breast-milk banking initiative.
The National Health Council has also committed to re-engineering primary health care to improve breast-feeding rates.
In a further drive to promote breast-feeding up to two years, the Department of Health recently published draft regulations on foodstuffs for infants and young children. This promotes exclusive breast-feeding for the first six months of life, through regulation of the promotion of breast-milk substitutes and accessories.
It also aims to regulate the use of commercial complementary foods introduced after a baby reaches six months of age.
In South Africa, 49 percent of babies aged six to nine months are fed both breast milk and complementary foods, with 31 percent breast-fed up to two years.
Otte says because working mothers are only entitled to four months paid maternity leave under the Basic Conditions of Employment Act, it limits their ability to exclusively breast-feed for the first six months.
There is also a lack of social support for breast-feeding both in the workplace and in public.
Some mothers may also experience health complications after birth which may prevent them from breast-feeding.
“Even within the home, mothers need physical, as well as emotional support when breast-feeding, highlighting the need for family members to understand the importance of breast-feeding,” says Otte.
Against this backdrop, the health-care professional (HCP) plays an integral role in encouraging breast-feeding and educating mothers about its benefits. Most mothers rely on advice and information from their HCPs.
The draft regulations propose a restriction on communication between infant food manufacturers and HCPs regarding the various products and ingredient benefits.
This may severely limit the HCP’s ability to provide moms with the best and most adequate nutritional advice for babies.
Without access to information, says Otte, mothers may give babies nutritionally inadequate products like tea, rice milk, soya milk or whole milk.
“International case studies suggest that regulations must strike a balance between promoting exclusive and prolonged breast-feeding, while allowing moms full access to scientific information on breast-milk substitutes via their HCPs if it is to achieve a reduction in malnutrition.
“Promoting breast-feeding really starts before pregnancy,” says Otte. “Breast-feeding should be actively promoted, encouraged and protected at all times and the continued empowerment of HCPs is critical.”
Otte believes HCPs should be equipped and educated to support mothers with current scientific information relating to breast-milk substitutes and complementary foods.
She would like to see awareness and education programmes on a national basis.
Otte points to Madagascar as an example. In terms of regulations, the country enacted many of the provisions of the World Health Organisation’s (WHO) international code of marketing of breast-milk substitutes. It also launched a large-scale public awareness campaign programme educating mothers about breast-feeding.
The campaign reached 6.3 million people via interpersonal communications, community mobilisation events and local mass media. The results were phenomenal and Madagascar has one of the highest breast-feeding rates in the world, combined with a 61 percent reduction in its under-five child mortality rate since 1990.
However, despite a significant increase in its breast-feeding rates, Madagascar also has one of the highest percentages of stunted children at 49 percent because of a lack of education about the transition from breast-milk to complementary foods.
“When women don’t have access to information and are not educated, they may feed their babies unsuitable breast-milk substitutes like coffee creamers, which are nutritionally unsuitable,” says Otte.
She adds that if a woman decides not to breast-feed her baby, she should be able to access comprehensive and scientific information on infant feeding substitutes via her HCP.
“Mothers obtain information from a variety of sources, including their HCPs, but also from labels, articles and the media,” says Otte.
“It’s important that these sources portray the most up to date information so that mothers are empowered to make the best decisions to promote their babies’ good health and nutrition.”
These are some points proposed by the draft legislation:
* Labelling on formula containers is not to show illustrations, diagrams or graphics.
* Formula labels are not to provide any nutritional or health information.
* Bottle, teat and dummy labels must include a statement that cup feeding is safer for infants.
* Manufacturers may not sell, sample or advertise products in a health establishment.
* There may be no direct or indirect contact with the public through print media, TV, radio or the internet.
* No helpline details may be displayed on formula labels.
* Manufacturers may not pay for, donate or distribute educational material to health establishments.
* Media will be curtailed in their coverage of issues relating to bottle-feeding.