With the world grappling with the challenges of the Covid-19 pandemic, the health of people across the globe has never been more important. This World Breastfeeding Week, let us celebrate the role breastfeeding plays in improving the health of our babies, but also the effect it has on our health later on in life.
The benefits of breastfeeding
Breastfeeding isn’t always possible of course. But to give an idea of the benefits, if mothers all round the world breastfed their babies in line with guidelines, it would prevent around 823,000 child deaths and 20,000 breast cancer deaths every year (Victoria et al. 2016).
Breastmilk has unique nutritional properties that help reduce the incidence and severity of gastro-intestinal and respiratory infections. It also helps babies recover from illness quicker (Victoria et al. 2016). And it helps prevent chronic illness later in life in both children and mums.
Breastfeeding practices are a cost-effective solution to the malnutrition crisis in many low- and middle-income countries (LMICs) (Swigart et al. 2016).
WHO recommends that mothers exclusively breastfeed their babies for six months, then continue to breastfeed in addition to giving other foods until their child is 2. But only 37% of infants globally below the age of six months are being exclusively breastfed (Global Nutrition Report 2017).
Breastfeeding in Latin America
Breastfeeding rates are even lower in Latin America. In Mexico for example, exclusive breastfeeding dropped from 22.3% in 2006 to 14.4% in 2012 (Gonzales de Cossio et al. 2013). The most dramatic decrease was seen in rural areas where poverty is highest (36.9% to 18.5%). In 2012, the median duration of breastfeeding in Mexico was around 10 months and this had been the case since 2006. Why is such a beneficial, convenient and cost-effective solution as breastfeeding so unpopular in Mexico especially among poorer communities?
Interestingly, studies have shown it’s not necessarily lack of a mother’s desire to breastfeed. Women need to ‘want’ to breastfeed their child but, just as importantly, they also need social support from their family, community and their health systems (Göksen 2002).
Mexican women typically live with their partner’s family and it is common for three or four generations to live under the same roof. Grandmothers play an influential role in decision-making and fathers generally work away and are excluded from antenatal and postnatal education and activities. In this setting, wider family attitudes and beliefs around breastfeeding can be counter-productive. For example, it is a common belief that hot tea is best for a poorly baby and that water can quench thirst better than breastmilk.
Furthermore, many women, especially in urban settings, are uncomfortable about breastfeeding in public. Many also have to return to work soon after having their baby which forces them to switch to formula milk. Many have also struggled with contradictory advice from their primary care facilities (Swigart et al. 2016). Consequently, the problem of low breastfeeding rates in places like Mexico is systemic in nature.
In 2017, Pérez-Escamilla et al. from Yale School of Public Health developed the Becoming Breastfeeding Friendly (BBF) toolbox to guide countries in scaling up breastfeeding protection, promotion and support. Some of the key recommendations are:
- Raise national awareness on breastfeeding based on an evidence-based national strategy
- Incorporate the Code of Marketing of BreastMilk Substitutes in national legislation
- Extend paid maternity leave to six months to help mums exclusively breastfeed their babies for this period.
Mexico was the first country along with Ghana to pilot the BBF toolbox. Pre-testing is still taking place in some countries.
Boosting breastfeeding in Mexico
Here at Thrive we are proud to have played a small role in helping to improve breastfeeding rates in Mexico. Because of our experience of working in maternal and child health and behaviour change programmes across the globe, we know that encouraging breastfeeding requires a nuanced approach that harnesses the motivations of the community and addresses the typical barriers that women face – both individual and systemic.
In 2016, Thrive partnered with the Mexican Government, UNICEF and other partners to develop a text messaging programme for pregnant women and new mothers. Text messages were sent to low-income Mexican families in the Mexican Government’s now-defunct Prospera programme.
The messages were timed and targeted to the stage of pregnancy and the age of the child and offered vital information about maternal, newborn and child health. They were designed to encourage positive behaviours around maternal and child health including breastfeeding.
Using behaviour change techniques and principles, the messages served to walk the journey of the mother sharing her joys and supporting her through common challenges that she might face during her pregnancy and parenting journey. Our focus groups with the community and various stakeholder interviews helped us gain a deep understanding of the needs and circumstances the audience, and this was reflected in the messages we developed. Early results show a significant improvement in the knowledge levels of the mothers.
Sadly, Mexico’s flagship social protection programme Prospera has ended, but we are optimistic that our efforts in conjunction with the government’s breastfeeding-friendly policies, will lead to improved breastfeeding practices in Mexico.
Gayatri is the Head of mHealth at Thrive. With a Master of Public Health (MPH) degree, she has extensive experience working in global health projects as well as national level programmes such as India’s National AIDS Control Programme.
González de Cosío T Escobar-Zaragoza L González-Castell LD Rivera-Dommarco JA. [Infant feeding practices and deterioration of breastfeeding in Mexico.] Salud Publica Mex 2013;55(Suppl 2):S170–9 (in Spanish).
Swigart TM, Bonvecchio A, Théodore FL, Zamudio-Haas S, Villanueva-Borbolla MA, Thrasher JF (2017) Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies. PLoS ONE 12(7): e0180185. https://doi.org/10.1371/journal.pone.0180185
Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al.; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475–90. http://dx.doi.org/10.1016/S0140-6736(15)01024-7 pmid: 26869575
Global nutrition report 2017: nourishing the SDGs. Bristol: Development Initiatives; 2017. Available from: https://globalnutritionreport.org/documents/2/Report_2017.pdf [cited 2019 Sep 26].
Pérez-Escamilla R. 2017. Becoming Breastfeeding Friendly: a guide to global scale up. Yale School of Public Health. [cited 2017 Jun 22]. Available from: http://medicine.yale.edu/ysph/bfci/bbf/intro.aspx
Göksen F. Normative vs. attitudinal considerations in breastfeeding behavior: multifaceted social influences in a developing country context. Soc Sci Med. 2002 Jun;54(12):1743–53. pmid:12113432″
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