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How Breastfeeding Saves Lives…and How You Can Help

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Annie Urban on her blog, PhD in Parenting. We appreciate her permission to repost it here.

830,000 newborn deaths could be prevented if babies were breastfed within the first hour.

1.4 million child deaths could be prevented if optimal breastfeeding practices were followed (exclusive breastfeeding for the first 6 months and continued breastfeeding until at least 2 years).

Vilma, 20, breastfeeds her youngest child, Alderico (10 months), in their one room home in an urban slum in Paranaque City, Metro Manila, The Philippines on 18 January 2013. Vilma had raised her first 3 children on formula and had to cut down on food for her family to afford it. Both John Ashley, 4, and Justin, 3, are malnourished and stunted, and after losing one of her children, she now breastfeeds her youngest, Alderico. Image Credit: Suzanne Lee / Save the Children (Used With Permission).

Overcoming Barriers to Breastfeeding Will Save Children’s Lives

Source: Save the Children, Superfood for Babies — How Overcoming Barriers to Breastfeeding Will Save Children’s Lives (2013).A new research report released by Save the Children today underscores the importance of breastfeeding in saving babies’ lives.

In developing countries, malnutrition is still a significant problem — it was the cause of one third of the 7 million child deaths in 2010. According to the Save the Children report, breastfeeding is “the closest thing there is to a ‘silver bullet’ in the fight against malnutrition and newborn deaths.” Although child mortality rates are decreasing overall, a greater proportion of deaths now occur during the first month.

The Save the Children report points out that breastfeeding could prevent a higher proportion of child deaths than any other intervention, including mosquito nets, vitamins, vaccines, clean delivery, water and sanitation, and more.  

Yet breastfeeding rates globally have remained stagnantly below 40% for the last 20 years. While progress has been made in some countries, there are other areas (especially in east Asia and the Pacific) where the rates are starting to fall with potentially disastrous consequences for babies’ lives.

Why aren’t more babies breastfed globally?

The report by Save the Children identifies four main barries to breastfeeding globally (which align well with the types of barriers and challenges I’ve spoken about on this blog over the years). They are:

  1. Community and Cultural Pressures: Bad advice, denying newborn colustrum or giving other foods or liquids before starting breastfeeding, pressure from other family members (many women are not free to make their own decisions about how to feed their child).
  2. Health Worker Shortage: One third of infants are born without a skilled birth attendant present, making it difficult to ensure mothers have good breastfeeding support in the first hours after birth.
  3. Lack of Maternity Legislation: Mothers often need to return to work  shortly after giving birth, cannot take their children with them, and do not have breastfeeding / pumping friendly workplaces.
  4. Big Formula: The marketing activities of formula companies continue to violate the WHO Code of Marketing of Breastmilk Substitutes, resulting in unnecessary and improper use of formula.  Legislation doesn’t exist or isn’t enforced, leaving mothers and babies vulnerable to predatory marketing practices.

What Needs to Change?

To help overcome these barriers and ensure that more mothers are able to breastfeed their babies, Save the Children is asking world leaders, international institutions and multinational companies to implement the following four recommendations:

  1. Fund projects that will help overcome harmful practices and tackle breastfeeding taboos by focusing on changing the power and gender dynamics so that young women are empowered to make their own decisions about how to feed their babies.
  2. Ensure sufficient resources and infrastructure are in place to allow a skilled health worker to be present  at every birth.
  3. Governments should introduce nationwide breastfeeding-friendly policies and legislation focused on maternity leave, financial protection for mothers on maternity leave, and employer support of breastfeeding women in the workplace.
  4. Improving breast-milk substitute industry (primarily the infant formula industry) practices through a combination of changes within the industry and better national regulation of marketing practices.

Image credit: Caroline Trutmann / Save the Children (Used With Permission).

The First Hour

What struck me the post reading the report were the figures on the estimated deaths that could be prevented through breastfeeding within an hour of birth. I’ve long known that it is a best practice, but looking at the significance of that seemingly little factor compared with all other interventions, amazed me.

Here is what the research said (from page 4 of the Save the Children report) :

Save the Children estimates that 830,000 infant deaths in developing countries could be prevented if every baby were given breast milk, and only breast milk, in the first hour. Using two studies from Ghana and Nepal, we calculated the effect that increasing the current rate of early initiation to 100% would have if all other factors remained the same. Infants who are not breastfed within an hour are 86.5% more likely to die during the neonatal period – the first 28 days of life – than those who are breastfed.

The study in Ghana found that 16% of neonatal deaths could be prevented if all infants were breastfed within 24 hours of birth, and 22% if breastfeeding started within the first hour of life. The study in Nepal found that an infant given breast milk within an hour of birth is up to three times more likely to survive than one breastfed a day later. Infants who are not breastfed until they are two days old are more than four times more likely to die.

My son wasn’t breastfed within the first hour. I don’t remember exactly when I first nursed him, but it certainly wasn’t immediately and once I did, he didn’t latch. He was born at 7:30am and I didn’t get to see a lactation consultant until sometime the next afternoon (i.e. around 32 hours later) despite the fact that he wasn’t latching on at all. If I could change one thing about hospital practices here in Canada, it would be to ensure that all moms who are planning to breastfeed are encouraged to nurse in that first hour and that they are referred to a lactation consultant immediately if things are not working. I shouldn’t have had to wait that long to get professional help. I shouldn’t have had nurses with insufficient training in lactation pushing formula on my child before I’d had a chance to see a lactation consultant. I shouldn’t have had to see the pediatrician (who only did her rounds once per day) before getting a referral to the lactation consultant.

Globally, if I could change one thing it would be to ensure that all mothers have access to a skilled birth attendant who is trained in breastfeeding best practices, whether they are delivering their baby at home, at a birth centre, or at a hospital.

As I’ve said before, moms don’t need more pressure to breastfeed. But they do to be empowered and supported in their feeding choices. At the moment, that still isn’t happening. In some cases, that means moms cannot meet their own breastfeeding goals. In other cases, especially in the developing world, it is still an issue of life or death.

What Can You Do To Help?

If you want to help save babies lives and ensure mothers are empowered in their feeding choices, you can:

  • Sign the petition calling on Nestlé and Danone to change the way they market infant formulato comply with the WHO Code of Marketing of Breastmilk Substitutes.
  • Donate to Save the Children’s No Child Born to Die campaign to help tackle malnutrition and overcome the global shortage of health workers.
  • Write to your local hospital, member of provincial parliament, and health minister, asking them to ensure that all mothers who are planning to breastfeed are encouraged to breastfeed within the first hour of birth and that they have immediate access to lactation consultants if they are having any difficulty.
  • Read the Save the Children report to educate yourself and so that you can educate others about the issue of breastfeeding globally. Some of the statistics on breastfeeding in countries around the world are staggering and fascinating.
  • Encourage companies you work for or buy from to sign on to the C.A.R.E-WHO Alliancecoordinated by Best for Babes, demonstrating their committment to caring about moms and babies and complying with the WHO Code.
  • Blog, Tweet, Facebook or otherwise share the Save the Children report or this blog post.

What do you think needs to change to increase breastfeeding rates globally?


The Best and Worst Places in the Industrialized World for Breastfeeding Support

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Canadian RN and IBCLC Fleur Bickford on her blog Nurtured Child and she has graciously allowed us to republish it here.  You will have the opportunity to hear Fleur speak at this year’s ILCA Conference on the topic “Social Media as a Means to Protect, Promote and Support Breastfeeding”.

Written by Fleur Bickford

Photo via Save the Children

Every year, the non-profit organization and registered charity Save the Children looks at the health status, nutrition, education, economic well-being and political participation of women around the world to come up with their annual State of the World’s Mothers report. Along with providing rankings for 165 countries around the world, each report has a different theme.

This year, the report focuses on the critical impact of nutrition in the first 1000 days of life, starting with pregnancy. The report also contains an Infant and Toddler Early Feeding Score for 73 developing countries and a Breastfeeding Policy Scorecard which looks at breastfeeding practices, support and policies for 36 industrialized countries. You can read more about the best and worst places in the world to be a mother and the Infant and Toddler Early Feeding Score in this companion blog post.

The Breastfeeding Policy Scorecard for Developed Countries is new this year, and it provides an interesting look at support for breastfeeding in the industrialized world. Rankings are based on maternity leave laws, right to daily nursing breaks, percentage of hospitals that are baby friendly, state of policy support for the International Code of Marketing of Breastmilk Substitutes and breastfeeding practices. Of the 36 countries listed, Norway ranks first with a score of 9.2 and the USA ranks last with a score of 4.2. Canada ranks 31st with a score of 5.4.

From the report, we see that Norway is doing a wonderful job of supporting breastfeeding

“Norway tops the Breastfeeding Policy Scorecard ranking. Norwegian mothers enjoy one of the most generous parental leave policies in the developed world. After giving birth, mothers can take up to 36 weeks off work with 100 percent of their pay, or they may opt for 46 weeks with 80 percent pay (or less if the leave period is shared with the father). In addition, Norwegian law provides for up to 12 months of additional child care leave,  whichcan be taken by both fathers and mothers. When they return to work, mothers have the right to nursing breaks as they need them. Nearly 80 percent of hospitals have been certified as “baby-friendly” and many provisions of the International Code of Marketing of Breast-milk Substitutes have been enacted into law. Breastfeeding practices in Norway reflect this supportive environment: 99 percent of babies there are breastfed initially and 70 percent are breastfed exclusively at 3 months.”

Compare this to the USA:

“The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country – and one of just a handful of countries worldwide – where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as “baby-friendly” and none of the provisions of the International Code of Marketing of Breast-milk Substitutes has been enacted into law. While 75 percent of American babies are initially breastfed, only 35 percent are being breastfed exclusively at 3 months.”

The differences between Norway and the United States is staggering (and Canada isn’t doing much better than the United States). For all the talk about “Breast is best”, North America is doing a very poor job of providing parents with the support they need to actually give their babies the “best”. Most mothers want to breastfeed. Breastfeeding initiation rates are high, but breastfeeding drops off rapidly in the early weeks after birth. This happens not because mothers don’t want to breastfeed anymore, but because they haven’t received the support they need to continue. Breastfeeding is natural, but it is also something that requires community support. Conditions during birth and the first 72hrs after birth are critical for establishing breastfeeding (hence the importance of hospitals being Baby Friendly) and it is important that mothers have sufficient time off of work to establish their breastfeeding relationship which encourages a longer duration of breastfeeding.

Although not specifically about breastfeeding, below are some other key points about the United States from the report that should really be cause for alarm:

In the United States, mothers face a 1 in 2,100 risk of maternal death – the highest of any industrialized nation. In fact, only three developed countries – Albania, Moldova and the Russian Federation – perform worse than the United States on this indicator. A woman in the U.S. is more than 7 times as likely as a woman in Ireland or Italy to die from a pregnancy- related cause and her risk of maternal death is 15 times that of a woman in Greece.

The U.S. under-5 mortality rate is 8 per 1,000 births. This is on par with rates in Bosnia and Herzegovina, Montenegro, Slovakia and Qatar. Forty countries performed better than the U.S. on this indicator. This means that a child in the U.S. is four times as likely as a child in Iceland to die before his or her 5th birthday.

The United States has the least generous maternity leave policy of any wealthy nation. It is the only developed country – and one of only a handful of countries in the world – that does not guarantee working mothers paid leave.

The United States is also lagging behind with regard to preschool enrollment and the political status of women. Performance in both areas places it among the bottom 10 in the developed world.”

An interesting (and again alarming!) point about Canada from the Save the Children Canada website:

“Norway’s under 5 mortality rate is half that of Canada (3 deaths per 1000 live births vs 6 deaths per 1000 live births).”

The risks of not breastfeeding are well documented, and there is plenty of research on the best ways to encourage breastfeeding duration and exclusivity. The statistics from this report for the countries at the top of the Breastfeeding Policy Scorecard show that interventions such as requiring hospitals to be Baby Friendly, providing adequate paid maternity leave and supporting the International Code of Marketing of Breastmilk Substitutes DO work. This report should be a wake-up call for the countries at the bottom of the scorecard!

Below is the full list of where the 36 countries placed on the Breastfeeding Policy Scorecard. For the full details, and to see the score for each country, please refer to section 1:43 of the full report:

  1. Norway
  2. Slovenia
  3. Sweden
  4. Luxembourg
  5. Austria
  6. Lithuania
  7. Latvia
  8. Czech Republic
  9. Netherlands
  10. Germany
  11. Estonia
  12. Poland
  13. Portugal
  14. France
  15. Belgium
  16. Ireland
  17. Italy
  18. Switzerland
  19. New Zealand
  20. Cyprus
  21. Denmark
  22. Greece
  23. Slovak Republic
  24. Spain
  25. United Kingdom
  26. Finland
  27. Israel
  28. Japan
  29. Hungary
  30. Liechtenstein
  31. Canada
  32. Iceland
  33. Monaco
  34. Australia
  35. Malta
  36. United States
Fleur Bickford is a mother of two, an RN, IBCLC and retired LLLL. She worked in obstetrics as an RN for several years before taking time off to raise her family. During that time she gained experience in labour and delivery, post partum care and pediatrics. As a Leader for La Leche League Canada, she served as a member of both the Professional Liaison Department and the Social Media Advisory Committee. Currently, Fleur works in private practice in Ottawa, Ontario as owner and operator of Nurtured Child, and she is President of Ottawa Valley Lactation Consultants. Fleur maintains a blog, and is very active on both Twitter (@NurturedChild) and Facebook (NurturedChild).

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