Q:  Why is it important to exclusively breastfeed for the first six months?

Labbok: Breastfeeding has an extraordinary range of benefits. It has profound impact on a child’s survival, health, nutrition and development. It also contributes to child spacing and to maternal health. Breastfed children have at least six times greater chance of survival in the early months - breastfeeding drastically reduces deaths from acute respiratory infection and diarrhoea, two major child killers, as well as from other infectious diseases.

Breastmilk provides all of the micronutrients and nutrients an infant needs for growth for the first six months, while the interaction between the mother and child during breastfeeding has positive repercussions for life, in terms of reduced chronic disease, such as diabetes and cancers, as well as on behaviour, speech and how the child relates to other people. Finally, if an HIV-positive woman exclusively breastfeeds, the risk of the child being infected via breastfeeding is substantially reduced.

Q: Why is formula not an acceptable substitute?

Labbok: First, formula, at its best, only replaces most nutritional components of breastmilk. Breastmilk changes with the time of the day, the duration of suckling and the age of the child.  In addition, breastmilk carries passive factors that fight disease, and when breastfed, the infant gets active living cells from the mother that help combat disease. 

Further, in the first few months, it is hard for the baby’s gut to absorb foreign substances. If you give even one feeding of formula or other foods, you may be causing micro-injuries to the gut and it takes weeks for the baby to recover. In any case, you will disrupt the living cells and normal bacteria that inhabit the gut and support digestion. The act of breastfeeding itself stimulates proper growth of the mouth and jaw, and secretion of hormones for digestion and satiety.

Finally, there are hundreds of other factors in breastmilk that you cannot include in formula – everything from bifudus factor, which helps the gut grow and long chain fatty acids that help the brain grow, to hormones and enzymes that aid development. Studies have shown that breastfed infants do better on intelligence and behaviour tests into adulthood. There has never been a study that shows any advantage of formula feeding over breastfeeding.

 Q: What are the optimal feeding patterns and behaviours?

Labbok: The World Health Organization and UNICEF suggest six months exclusive breastfeeding with continued breastfeeding and complementary foods for two years and beyond. When complementary foods are introduced, the mother should breastfeed first, and then give small amounts of complementary foods.  These foods should be rich in micronutrients, especially iron, and be nutrient dense in terms of protein and energy components.

The introduction of complementary foods should be a deliberate and sustained process, as the infant’s stomach is small. This should start with one to three feeds a day in addition to breastfeeding, and increase to five feeds a day by the time the infant reaches one year of age. Between the breastfeeds and the complementary feeds, mothers of six-month-olds to two-year-olds should expect to be feeding the child up to 10-12 times a day, reducing gradually to five to seven times daily as the stomach grows. This period of sustained weaning is also important to the mother, because she also is undergoing transitions, returning calcium to her bones and restoring nutrients to her body.

Q: How does breastfeeding impact the mother’s health?

Labbok: Breastfeeding contributes to maternal health immediately postpartum (the period shortly after childbirth) because it helps the uterus contract more rapidly, thereby reducing blood loss. Many consider this the final stage of labour.  In the short term, breastfeeding delays her return to fertility and in the long term, it reduces cancers associated with female organs: breast cancer, uterine cancer and ovarian cancer. Women often feel very positive about breastfeeding, once it is well established, because they have higher levels of prolactin, a relaxing hormone, and oxytocin, a bonding hormone.

Q: How is UNICEF working to promote, protect and support breastfeeding?

Labbok: UNICEF has two active ongoing programmes: the Baby-Friendly Hospital Initiative (BFHI) and International Code of Marketing of Breastmilk Substitutes. While the rates of initial breastfeeding are high – over 90 per cent of women worldwide begin breastfeeding – the proportion who continue to breastfeed exclusively and who maintain  breastfeeding over time can fall rapidly in some settings.

The major problems are the societal and commercial pressure to stop. These pressures are too often worsened by inaccurate medical advice from health workers who lack proper skills and training in breastfeeding support.

To counteract the aggressive marketing and promotion by formula producers, UNICEF works with legislators and lawyers to support legislation of the Code in more countries. The BFHI, which was launched in 1991, has grown into a series of trainings and assessments, with the result that over 19,000 hospitals around the world have been designated baby-friendly. 

Social pressures are more complex and differ around the world. Women are striving to achieve maternity entitlements and other approaches to continue optimal feeding as a way of counterbalancing increasing pressures to return to work and separate from their infants.