Breast-feeding mothers and their babies outside a shopping centre. South Africa has a progressive attitude towards breast-feeding, but not to doing it in public. Picture: David Ritchie

As World Breastfeeding Week is observed, there is a need to deal with the poor attitudes towards public breast-feeding in South Africa, writes Chantell Witten.

South Africa has a long history of promoting breastfeeding as an important part of bolstering child health in the country.

Even during the height of apartheid, the health fraternity acknowledged the need to keep breast-feeding at the forefront of children’s development.

The first breast-feeding campaign was launched in October 1987. Several other initiatives were launched in the years that followed.

These have led to significantly improved breastfeeding rates in the country.

The government has been very active in protecting, promoting and supporting breast-feeding through an array of policies, programmes and legislation to improve the breast-feeding environment.

The country has some of the most progressive legislation to protect breast-feeding mothers from inappropriate marketing of breast milk substitutes.

But South Africa hasn’t managed to clear the last hurdle - attitudes towards breast-feeding in public.

Thirty years after breast-feeding was first championed, mothers can’t breast-feed in public without provoking angry responses.

On several occasions, mothers have been humiliated and stigmatised.

In recent years, several countries have put legislation in place to protect breast-feeding at work and in public spaces.

For example, in Brazil’s capital city Sao Paulo, businesses or organisations that prevent women from breast-feeding in public are fined. Others, like Vietnam, have invested in communication and education strategies to improve breast-feeding culture. The result is that women can breast-feed in public places without being victimised.

South African health authorities educate the public about breast-feeding. But without supportive legislation and strong behaviour change communication, breastfeeding in public will never be normalised.

Seven years ago, the government made positive policy changes to encourage exclusive breast-feeding.

Since then, it has made several additional and significant policy shifts to promote and support longer duration of breast-feeding to 24 months, among HIV-negative and HIV-positive mothers.

In 2012, the Health Department stopped providing free infant formula to HIV-positive mothers. This reversed an earlier policy that promoted the use of infant formula - an approach that had been pursued because of the transmission of HIV from mothers to children through breast milk.

The reversal on formula milk approach was accompanied by a massive rollout of life-long anti-retrovirals for pregnant mothers. This makes breast-feeding in the context of HIV safer and lowers the risk of mother-to-child transmission of HIV through breastfeeding.

In the same year, the department also passed regulations that prohibit the marketing and promotion of products that undermined and displaced breast-feeding, such as infant formula.

This was followed by a revised infant and young child-feeding policy in line with the World Health Organisation’s recommendations that countries have one public health infant feeding policy.

South Africa has also had phenomenal success in establishing human milk banking.

In addition, more than 70 percent of public health facilities have been accredited as mother-baby-friendly. These facilities are trained and offer a level of service that protects, promotes and supports breast-feeding with immediate initiation of breast-feeding, practice of skin-to-skin and rooming-in to keep mothers and babies together.

These facilities discourage bottle feeding and teach mothers cup feeding and how to express breast milk for when they are not with their babies.

All these practices improve breastfeeding and the mother’s milk supply.

But public breast-feeding is still frowned upon.

Part of the problem seems to be that initiatives to promote breast-feeding have been restricted to the health system.

There is very little promotion and conversation in other sectors such as education, social development and in the justice system. Evidence from other countries shows breast-feeding improves if the interventions are delivered through a multi-pronged approach.

Where there have been successes, governments have ensured that breast-feeding is supported in and by the health system and the services that are offered, the family and community and the workplace.

While South Africa has provisions under the Basic Conditions of Employment Act, few employers have made efforts to protect or support mothers in their work environment.

Last year, the Department of Health unveiled its national breast-feeding campaign, which is built around the question: why do communities not support mothers in breastfeeding?

This is an important question because it goes to the heart of the challenge South Africa still faces. Society remains averse to mothers breast-feeding their babies in public spaces, even though breast milk is universally recognised as being a lifesaving super food for babies.

If breastfeeding is part of our African culture, why are people offended and disturbed when a mother breast-feeds her baby? If it is part of the natural order of loving and caring for children, why do people shame, humiliate and stigmatise breastfeeding mothers?

But it’s not enough for the Health Department to pose the question. Collectively, we need to come up with answers and take action.

South Africa can take a lead from Vietnam and Bangladesh, which have benefited enormously from large-scale interventions. Both countries have combined intensive interpersonal counselling with mass-media campaigns.

South Africa has antenatal care counselling for mothers at clinics, but has not yet invested in the promotion of breast-feeding. Such campaigns are not unfamiliar in the country. It has done exceptionally well in campaigns such as Arrive Alive and the HIV Know Your Status campaign.

But until the resistance of communities towards breastfeeding is fully understood, there will not be a shift in embracing it and South Africa will continue to carry the high burden of infant death and disease. 

The Conversation

* Witten is a lecturer and PhD candidate at North-West University.

The Conversation