Every year, the first week of August is dedicated to promoting the exclusive feeding of newborn infants with natural breast milk, which evidence shows can ensure numerous health benefits for mother and child. There are few if any specialists in the field of infant health who would now dispute that. United Nations agencies, the World Health Organization, the World Bank and the most influential nongovernment experts concur.
Earlier this year, the published results of an innovative 30-year study in Brazil indicated that infants who were breastfed for 12 months or more had, by age 30, higher IQ scores, educational attainment and income levels, as reported in the British medical journal The Lancet. The widely adopted prescription for breastfeeding is that a newborn infant should be fed for the first time within an hour of birth, then exclusively on breast milk for six months and up to 24 months or longer with complementary nutritional feeding.
The obvious question is why, after decades of promoting this schedule, only 36 percent of babies are exclusively breastfed around the world, contributing to 800,000 infant deaths annually, according to recent data from the World Health Organization. Individuals, societies and governments have numerous explanations. Like other issues involving reproductive health and rights, these often differ in the global North and South.
Women in richer countries — and the most affluent mothers in poor nations — may be mostly concerned about problems of finding time and privacy (and acceptance) in the workplace or in public spaces, and have ready access to other options in commercial baby formulas or breast milk banks. In developing nations, where many poor women and their babies take to breastfeeding naturally and health providers try to fend off the commercial intrusion of formula makers, other factors are often present. There may be a lack of clean water and sanitation, no access to professional health care (especially trained midwives) and scant reliable information about safe pregnancy. Most important is the poor nutritional state of women.
The world’s poorest women, some with multiple births behind them and large families to feed with scarce resources, suffer from anemia in large numbers: 40 to 60 percent of all women of childbearing age in South Asia and parts of western Africa, compared with less than 20 percent in all but a few pockets in the Western hemisphere, from pole to pole, WHO data show. These weakened women may suffer or die in pregnancy or give birth to children who are born undernourished or are irreversibly stunted physically and mentally. Both high maternal and infant death rates are common in these situations.
Stunting, defined physically as a significant deviation from the median height of children in a given area and age group, was studied by WHO in 148 developed and developing nations between 1990 and 2010 (with predictions to 2020). In 2010, the study reported that 171 million children were stunted — 167 million of them in developing countries, including about half the children in India, soon to be the world’s most populous nation.
Breastfeeding alone is not always the solution to saving or strengthening low-birth weight babies; making mothers healthier is. Increasingly, experts argue, the conditions for safe motherhood should start well before pregnancy. Bangladesh is among the countries committed to universal breastfeeding standards while also actively involved in improving the nutrition of mothers.
“Breastfeeding within the first hour of birth, along with proper nutrition for mothers, is key to ensuring healthy brain and growth development in children,” said Susan Davis, president of BRAC USA. “For mothers in low-income countries, breastfeeding is the single most effective way to prevent child deaths as it wards off infection, diarrhea and respiratory infections that can be lethal for newborns. Breastfeeding for the first six months, along with complementary food in the 6-24 month period leads to proper cognitive and physical development and prevents malnutrition and permanent stunting.”
BRAC (formerly the Bangladesh Rural Advancement Committee) was founded in Bangladesh in 1972 by Fazle Hasan Abed, who has recently been named the winner of the 2015 World Food Prize. BRAC is now the world’s largest nongovernment development organization, focusing on increasing food security and ending poverty at local levels mostly in Asia and Africa. The organization’s projects are led by community health workers, who offer prenatal care and nutritional information to pregnant women and would-be mothers. It estimates that its programs have prevented 20,000 neonatal deaths.
BRAC has played an important role in helping Bangladesh meet numerous targets in the Millennium Development Goals through its holistic approach to development. The country has reduced poverty, reached parity between girls and boys in primary and secondary education as well as cut communicable disease rates, under-five deaths and maternal mortality.
“We are determined to do more,” Davis, a former president of the Women’s Environment and Development Organization (WEDO), said in an email interview with PassBlue. “Bangladesh still has an unacceptably high stunting rate. Working with the government of Bangladesh, BRAC and other groups are committed to improving nutrition. Breastfeeding is an important part of this strategy.”
Barbara Crossette is the senior consulting editor and writer for PassBlue and the United Nations correspondent for The Nation. She is also a member of the Council on Foreign Relations. She has also contributed to the Oxford Handbook on the United Nations.
Previously, Crossette was the UN bureau chief for The New York Times from 1994 to 2001 and previously its chief correspondent in Southeast Asia and South Asia. She is the author of “So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas,” “The Great Hill Stations of Asia” and a Foreign Policy Association study, “India Changes Course,” in the Foreign Policy Association’s “Great Decisions 2015.”
Crossette won the George Polk award for her coverage in India of the assassination of Rajiv Gandhi in 1991 and the 2010 Shorenstein Prize for her writing on Asia.