What does exclusive breastfeeding mean?
Why is it important and what happens if you don't do it?
“From the age of 6 months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to 2 years and beyond” World Health Organization recommendation
Exclusive breastfeeding is a global guideline for all infants in the first six months of life. It means that babies are given no foods other than human milk in their first half-year. No infant formula, no juices, no teas, no cereals, no “solids”.
Breastmilk contains all the nutrition a baby needs and supplements are not required.
Sounds great! So what's the problem?
Ideally, every baby should be given the opportunity to meet these health guidelines. However, there are many obstacles placed in their way and unfortunately, very few babies in the world are exclusively breastfed for the first six months.
So why are we not meeting these public health guidelines?
The first hurdle appears right at the start. Recent research in Western Australia suggests as many as 41% of newborn babies are being supplemented with infant formula at hospital discharge: just days after birth. By three weeks, this jumps to 66%. Already, just one third of babies are still classed as exclusively breastfed.
Many more babies begin to receive supplementary formula before six months, often due to perceived insufficient milk supply. Australian others who return to work after 18 weeks paid parental leave are also likely to introduce formula if they are not supported to pump their milk in the workplace. (In the US, some mothers return to paid work within days of giving birth as no paid maternity leave is provided.)
The recommended age to begin solids is six months, remaining unchanged since 2002. Despite this, many parents are told that 4 months is recommended and introduce foods like rice cereal, pureed vegetables and fruits at that time.
Data collected by the Australian Bureau of Statistics in 2017/18 showed that 29% of children aged 6 months to 3 years were exclusively breast fed to 6 months. Almost half (48%) of children aged 6 months to 3 years were introduced to solids at 6 months or later. Around 7 in 10 (70%) of infants living in the highest socioeconomic areas were exclusively breastfed to at least 4 months of age, compared with around 5 in 10 (53%) infants in the lowest areas.
Its not just you. Its not just Australia. This is a world-wide problem.
Globally, nearly 2 out of 3 infants are not exclusively breastfed for the recommended 6 months—a rate that has not improved in 2 decades.
The barriers to meeting guidelines for breastfeeding are not about the actions of individual mothers. Indeed, nearly all babies are breastfed initially. Parents have got the “Breast IS Best” message loud and clear. (In fact, that has never actually been a public health message. But that is a different discussion.)
Women do not give up on breastfeeding because they can’t be bothered. While nearly all breastfeeding problems can be resolved, mothers need skilled support and resources to do so. And this is where the failure is.
Mothers do not fail to breastfeed, society fails to support them to do so.
For mothers who intended to exclusively breastfeed their babies for the first six months but were advised to introduce formula and/or solids before then, seeing promotion of this guideline is confronting. The constant reminder of the importance of something you were unable to achieve is going to hurt or cause resentment. These messages are not intended to cause distress but to guide the decisions of other parents. More importantly though, they serve as a reminder to the wider community that breastfeeding support is a community responsibility. Nobody is suggesting you didn’t make the right decision for your child, in your circumstances, based on the information and advice given to you at that time.
[My first child was given infant formula before her first breastfeed and several more times before leaving hospital. She started solids just before turning four months and was weaned from the breast entirely at nine months. Her two younger siblings were exclusively breastfed for six months and weaned after their second birthday.]
The Big Picture
Today it is hard to believe that just a few decades ago breastfeeding rates were so low that natural feeding of infants was at risk of extinction. Grass-roots activism by groups like the Nursing Mothers Association of Australia (est. 1964) and Le Leche League International (est. 1956) have been recognised for their role in reversing the trend.
There has been a general increase in the proportion of women initiating breastfeeding after discharge from hospital. In the 1970s it was estimated that from 40-45% of women breastfed their infants after being discharged from hospital (Nursing Mothers Association of Australia 1995). National Health Survey results indicated that in 1995, 82% of all Australian 0-3 year olds were breastfed when first taken home from hospital, and the result in 2001 was similar (83% of all 0-3 year olds). Only a small proportion of children 0-3 years of age, who were initiated to breastfeeding, were not breastfed when first discharged from hospital (4% of all 0-3 year olds in 1995 and 2001).
Internationally, the impact of formula marketing was drawn to public attention in 1974 by the publication of The Baby Killer. Highlighting the practices of industry leaders like Nestle, the promotional tactics used to build new markets in the developing world made world headlines. You might have learned about this at school: The Nestle Boycott which followed is still active today. Baby Milk Action
“Protecting, promoting and supporting breastfeeding will save more lives of babies and children than any other single preventive intervention. Globally, exclusive and continued breastfeeding could help prevent 13% of deaths among children under five years old. Breastfed children have fewer childhood infections, fewer chronic diseases, 3–5 extra points of IQ, higher earning potential, more opportunities to prioritize education, and healthier mothers. Breastfeeding reduces burdens on society in terms of health spending, hospitalizations and absenteeism. It also saves families money because it obviates the need for commercial substitutes.”
The WHO International Code of Marketing Breastmilk Substitutes was adopted in 1981 by the World Health Assembly (WHA) to promote safe and adequate nutrition for infants, by the protection and promotion of breastfeeding and by ensuring the proper use of breast-milk substitutes, when these are necessary.
Prior to the implementation of what is commonly called “The WHO Code”, advertising and promotion of infant formula was unregulated. Over 40 years later, countries who have signed in agreement of the voluntary Code prohibit the marketing of breastmilk substitutes to parents of infants aged 0-12 months. In Australia, this means you won’t see ads for infant formula on TV or in magazines, on billboards or in shopping centres. However, in countries like the USA, who are not signatories to The Code, marketing and promotion is everywhere. The Milky Way is an extraordinary documentary revealing just what happens when advertising directly to parents is unregulated.
The WHO Code applies to all countries, not just those in the developing world.
Hang on a minute, haven’t you see all those formula ads???
Read the fine print: In 1981, formula was sold for babies without specified age, however many babies moved onto cows milk around 9-12 months. Originally, the Code focused on the 0-6 month age group, the period when exclusive breastfeeding is practiced. Industry reacted to this with the introduction of Follow-On formula, for babies aged 6-12 months! A clever marketing loophole was discovered and exploited. Later, the Code was amended to cover the first twelve months. This was quickly followed by a new product on the shelves: formula for toddlers! Brand awareness is achieved through saturation marketing of this product and parents of younger children are influenced.
Marketing 101: create a problem, sell the solution
