Breastfeeding: Our Position

Defining breastfeeding

There are many definitions of breastfeeding. Exclusive breastfeeding refers to infants who receive only breast milk and no other food or drink, including water. Predominant or full breastfeeding refers to infants who receive fluids such as juice and water in addition to breast milk. Complementary or partial breastfeeding refers to infants who receive foods or liquids in addition to breast milk.

Breastfeeding is extremely important for the healthy growth and development of infants and young children. In addition to contributing to the physiological, nutritional and cognitive development of children, it provides many health benefits for mothers.

The World Health Organisation recommends that babies are exclusively breastfed for the first six months of life. At six months, other foods should complement breastfeeding for up to two years or more. The Australian Dietary Guidelines for Children and Adolescents also recommend exclusive breastfeeding until six months of age, with the introduction of food at six months and continued breastfeeding until 12 months and beyond, if feasible.

Context – International and Australian

Breast milk contains all the nutrition a baby needs for the first six months of life and lays the foundation for healthy growth and development. Longer periods of breastfeeding are associated with lower rates of illness among infants and improved cognitive development. Breastfeeding not only strengthens the bond between mother and baby but also has positive outcomes in terms of a child’s behaviour, speech, wellbeing, intelligence and social skills. It also benefits mothers by reducing the risk of breast and ovarian cancers later in life and lowers rates of obesity.

Babies who are breastfed have reduced risk of chronic conditions later in life, such as obesity, high cholesterol, high blood pressure, diabetes, childhood asthma and childhood leukaemia. Breastfeeding stimulates babies’ immune systems and protects them from diarrhoea and acute respiratory infections – two of the major causes of infant mortality in the developing world.

UNICEF estimates that breastfed children have at least six times greater chance of survival in the early months than non-breastfed children. It also estimates that breastfed babies have 15% less medical consultations during their first six months of life than babies fed on formula. Breastfeeding of infants under two years of age has the potential to prevent 1.4 million deaths per year in children under five in the developing world, according to the World Health Organisation.

The most recent Australian National Health Survey, conducted in 2001, showed about 83% of babies in Australia were being breastfed upon discharge from hospital. This number dropped to 48% of infants being exclusively breastfed at three months and 18% at six months.

Even though many countries have had significant increases in breastfeeding rates over the past decade, only 38% of children aged less than six months in the developing world are exclusively breastfed. Increasing optimal breastfeeding practices is important in developing countries where the spread of disease is rife and access to clean water and sanitation is limited.

The barriers to successful breastfeeding include community attitudes and negative perceptions about breastfeeding (particularly in public), workplace policies, lack of partner or family support, inconsistent health care provider information and legislative gaps.

Breastfeeding during emergencies

Formula-feeding during and after emergencies – such as floods, tsunamis and wars – poses many practical challenges for mothers in developing countries. During emergencies, it is not always possible to ensure that the formula is mixed with clean water, that supplies of formula remain available and that bottles are adequately cleaned.

Australian Government policy and legislation

As part of the new Australian National Breastfeeding Strategy 2010 – 2015, endorsed by Federal and State Health Ministers in November 2009, mothers are now encouraged to exclusively breastfeed their babies for at least six months. The aim is to substantially boost breastfeeding rates.

The national strategy calls for more community acceptance of breastfeeding in public, more support and training for mothers before and after delivery, and increased access to parental leave. Support for workplaces to adapt to the needs of breastfeeding mothers is a crucial step to increasing breastfeeding rates.

The World Health Organisation recommends that mothers have at least 16 weeks’ leave after giving birth to establish breastfeeding and rest. Many mothers who return to work early and are able to breastfeed abandon exclusive breastfeeding before six months.

Australian infant formula manufacturers have adopted the World Health Organisation Code on International Marketing for Breast Milk Substitutes on a voluntary and self-regulatory basis.

The Code requires that infant formula advertisements and labels state the benefits of breastfeeding. The Code prohibits:

The promotion of infant formula through health care facilities;
Lobbying health care workers with free samples and gifts;
Providing new mothers with free formula; and
Using advertising imagery that idealises bottle feeding.

Save the Children Australia’s position on breastfeeding

Women should be encouraged to exclusively breastfeed for six months, and continue complementary feeding until at least 12 months, if possible.
Widespread acceptance of breastfeeding among members of the community is required.
Mothers in countries experiencing emergencies should be encouraged to breastfeed their babies within an hour of giving birth and to continue for six months.
We promote immediate and exclusive breastfeeding in our Survive to Five Campaign, a five-year campaign launched in 2009 that aims to cut child mortality by two-thirds by 2015.
We support the Australian National Breastfeeding Strategy 2010 – 2015 (endorsed by Australia’s Health Ministers in November 2009).
We support World Breastfeeding Week, an annual advocacy event celebrated around the world.

Recommendations

National:

Paid parental leave, due to come into effect in Australia in 2011, should be extended from 18 weeks to a minimum of 26 weeks to give women the opportunity to breastfeed exclusively for six months. Working mothers need support, including legislative measures, to enable them to continue breastfeeding.
The Federal and State Governments should launch an awareness campaign about the importance of breastfeeding and should provide sufficient resources for health care workers to inform and assist mothers about the benefits of breast milk. Teenage mothers and Indigenous mothers, who have particularly low breastfeeding rates, should be provided with more information and assistance.
Australian infant formula manufacturers should be required to adopt the World Health Organisation’s International Marketing for Breast Milk Substitutes Code, of which Australia is a signatory.
Ongoing, independent research that monitors national breastfeeding rates and evaluates strategies to increase the level of exclusive breastfeeding to six months is required.

Community:

Community facilities which enable and promote breastfeeding should be widely available.

Workplace:

Workplaces should:

Be flexible and allow working mothers to breastfeed, if they choose;
Promote a positive attitude to breastfeeding;
Develop their own breastfeeding and working policies;
Have flexible working hours and other family-friendly working conditions;
Allow for lactation breaks for expressing milk or breastfeeding; and
Distribute information to employees who are expectant mothers and parents about the benefits of breastfeeding.

International Health Sector:

Health workers should be given the resources to provide effective feeding counselling and their services should be extended in the community through the work of trained counsellors. This includes telephone and home visits to mothers.
All mothers should have access to skilled support to initiate and sustain exclusive breastfeeding for six months and to ensure the timely introduction of adequate and safe complementary foods, with breastfeeding continuing for up to two years or beyond.
Women who are unable to breastfeed should be given support and advice. The right of parents to make informed choices regarding their method of infant feeding must be respected.

Emergencies:

Mothers should be encouraged to breastfeed, where possible.
Before supplying mothers with infant formula during emergencies, emergency program teams should assess whether supplying infant formula is culturally acceptable, feasible, affordable, sustainable for six months and safe.
To help HIV-positive mothers make the best decision, they should contact their local health providers to discuss the risks and benefits associated with breastfeeding their child.

What is Save the Children doing?

The Primary Health Care Project in Laos is improving the health of people – particularly women and children – in the Sayaboury Province. In the 15 years since the project has been operating, the maternal and infant mortality rates have reduced by 80% compared to the Lao national average.
Within Australia, after staff members have completed 12 months service, we provide 14 weeks paid parental leave for the primary carer – which can be taken at half pay for 28 weeks. Such staff are eligible for up to 104 weeks leave in total (for any one pregnancy).
Parental leave for staff working in-country is governed by the relevant labour law(s).