BY

ADEJUMOBI ADEJUMOKE 15/0177

ALAO ADENIKE S. 15/0184
EZEKIEL ADA - EZE H. 15/0190
OMOGE ADEYEMI O. 15/0199

SPECIAL TOPIC ON HUMAN NUTRITION (PHS 491)

DEPARTMENT OF PUBLIC HEALTH

FACULTY OF BASIC MEDICAL SCIENCES
ADELEKE UNIVERSITY, EDE, OSUN STATE

IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF B.SC. IN PUBLIC HEALTH

1ST OCTOBER, 2018 2

 TABLE OF CONTENT

 INTRODUCTION

 DEFINITIONS OF BREASTFEEDING

 WHY EXCLUSIVE BREASTFEEDING IS A PUBLIC HEALTH CONCERN

 REASONS WHY SOME WOMEN DO NOT BREASTFEED THEIR BABY

 FACTORS INFLUENCING BREATFEEDING

 PROS OF BREASTFEEDING

 CONS OF BREASTFEEDING

 CONCLUSION

 RECOMMENDATIONS

 REFERENCES

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 INTRODUCTION

 Public health organisations, including the World Health Organisation recommend 6months of exclusive

breastfeeding for optimal growth, cognitive development and health. Exclusive breastfeeding for 6 months is the

optimal method of infant feeding (WHO, 2001).

 The WHO recommends exclusive breastfeeding for 6 months and continued breastfeeding until 2 years of age

along with complementary foods (Kramer & Kakuma, 2001).

 Although the health benefits of exclusive breastfeeding are widely acknowledged, opinions and

recommendations are strongly divided on the optimal duration of exclusive breastfeeding and the practice of

exclusive breastfeeding in different cultures and regions. This has led to many lactating women not practicing

exclusive breastfeeding. (UNICEF, 2012).

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 As expected, breastfeeding initiation is positively associated with the pros of breastfeeding and negatively with the

cons (Kools et al., 2005). The attitude towards breastfeeding in this study was measured prenatally by two

different scales ‘Pros’ and ‘Cons’ which contained questions about the perceived advantages and disadvantages

of breastfeeding. (Kools et al., 2005).

 In Nigeria, child malnutrition, which occurs in more than 60% of children has been identified to be responsible for

more than 50% of infant’s death in the country.

 Between 1996 and 2006, the rate of exclusive breastfeeding for the first 6 months of life increased from 33% to

37%. Significant increases were made in sub-Saharan Africa, where rates increased from 22% to 30%, and

Europe, where rates increased from 10% to 19%. In Latin America and the Caribbean, excluding Brazil and

Mexico, the percentage of infants exclusively breastfed increased from 30% in 1996 to 45% in 2006. (UNICEF,

2007)
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 Socio-demographic influences play a major role in explaining the low rates of exclusive breastfeeding. The

importance of mothers’ social groups and networks in affecting the infant feeding beliefs and practices should

never be underestimated. (Alder EM et. al, 2004).

 Depression arising from sickness affects infant feeding choices since depressed women may doubt their ability to

feed the infants leading to early termination of breastfeeding efforts. (Hellin K and G Waller 1992).

 Moreover, early return to work is also a significant factor in the decision whether or not to breastfeed and thus a

more conducive work environment (providing breastfeeding mothers with nurseries, breast milk expressing

equipment and longer maternity leave incentives) with regard to breastfeeding might encourage the practice.

(Arora S, Mcjunkin C, Wehrer J and P Kuhn, 2000).

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 DEFINITIONS OF BREASTFEEDING

 WHO has defined breastfeeding as the normal method to provide infants with the nutrients they need for

healthy growth and development (WHO, 2013).

 Breastfeeding: the method of feeding a baby with milk directly from the mother's breast (Bristow, 2012).

 Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and

development (WHO, 2013).

 Exclusive breastfeeding: breast milk only, excluding water, other liquids, and solid foods (WHO, 2013).

 Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given –

not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or

medicines. (WHO, 2013).

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 WHY EXCLUSIVE BREASTFEEDING IS A PUBLIC HEALTH CONCERN

 For infants to survive, grow and develop properly they require the right proportion of nutrients. Breast milk is

rich in nutrients and anti-bodies and contains the right quantities of fat, sugar, water and protein. These nutrients

are major pre-requisites to the health and survival of the baby.

 When a child is exclusively breast fed, their immune system is strengthened, enabling it to life-threatening

illnesses like pneumonia and diarrhoea amongst other infections.

 Reports indicate that babies who are not breast fed for the first six months of life are 15 times more likely to die

from Pneumonia compared to newborns that are breast fed exclusively for six months after birth. (Healthy

Newborn Network).

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 Infants who continued to be exclusively breastfed tended to be those who remained healthy and on an accepted

growth trajectory. (Sauls H, 1979). The World Health Organization estimates that around 220,000 children could

be saved every year with exclusive breastfeeding.

 Breastfeeding is healthier than formula feeding; it contains all necessary nutrients for a baby and protects against

several infections and diseases.

 Breastfeeding helps you to recuperate more rapidly after pregnancy and has health advantages for the mother.

 The availability of information about formulafeeding, for example, was found to be negatively correlated with the

duration of breastfeeding (Howard et al., 2000). In this experimental study, comparing women who received

promotion materials related to formulafeeding and a control group, a larger proportion of women in the

experimental group stopped breastfeeding during the first two weeks.

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 REASONS WHY SOME WOMEN DO NOT BREASTFEED THEIR BABY

 Lack of Support: In the past, formula feeding was popular and very common. Many of our own mothers used

formula, and they do not understand breastfeeding. They have little or no experience with nursing a child, so they

cannot offer advice, guidance, or help. Sometimes, they are not even supportive. Partners and friends may not

have enough information about breastfeeding to understand this choice. Husbands may fear that breastfeeding

will interfere with the couple relationship. Since husbands or partners play a vital role in breastfeeding success,

without their support many women will choose not to breastfeed.

 Early Return To Work or School: It can be overwhelming to handle a new baby, family responsibilities, a

home, and the additional stress of work or school. If the stress of breastfeeding is too much for a woman, she

may decide not to breastfeed.

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 Attitudes of Doctors and Nurses: Some healthcare professionals are not educated in breastfeeding technique or

how to handle breastfeeding issues. If the mother's or the baby's health care provider does not support and

understand breastfeeding, then problems will not be resolved and the mother will not be encouraged to continue

to nurse.

 Lack of Help and Resources: Many first time mothers do not have breastfeeding support once they leave the

hospital. They do not know where to turn to for help, or who to go to with questions if they run into problems. If

women are not given follow-up instructions and information on the breastfeeding resources available, they can

easily give up on breastfeeding.

 Financial Barriers: Lactation specialists and pump rentals can be expensive. If women do not know where to go

for assistance, then they may not be able to afford to get the help they need to continue to breastfeed.

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 Personal Issues: Embarrassment, body image issues, fear, and lack of confidence can all contribute to negative

feelings about breastfeeding. Some women cannot see the breasts as anything but sexual objects. Concerns about

exposing the breasts to nurse can make women feel uncomfortable. When thoughts of breastfeeding are

embarrassing, uncomfortable, or shameful, it is more likely a woman will decide against breastfeeding.

 Health Concerns: Even though women with many types of health issues can breastfeed and are often encouraged

to do so, it can still be difficult. Certain health conditions can cause a low milk supply, or a mom might worry

about the medications that she has to take and how it will affect her baby. It can be overwhelming and exhausting.

Women who have had breast cancer may not be able to breastfeed after radiation therapy or a mastectomy. Plus,

there are some health-related issues, such as HIV infection, when breastfeeding is not recommended.

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 A True Low Breast Milk Supply: Only a small percentage of women who want to breastfeed can’t due to

lactation failure or a true low breast milk supply. A true low milk supply is usually the result of an underlying

condition. With treatment, some issues can be corrected, so a mother can go on to build a milk supply. However,

some problems cannot be resolved. The causes of a true low milk supply include:

 Insufficient glandular tissue (hypoplastic breasts)

 Polycystic ovary syndrome (PCOS)

 Hypothyroidism

 A previous breast surgery such as mastectomy or a breast reduction surgery

 Prior radiation treatment for breast cancer

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 Dependency on Illegal Drugs: The use of illegal drugs is not compatible with pregnancy, breastfeeding, or

parenting. Besides being illegal, street drugs are dangerous for a mother and her child. Drugs do get into the

breast milk and pass to the baby. When babies receive illicit drugs through breast milk, it can cause irritability,

sleepiness, poor feeding, growth problems, neurological damage, and even death. The use of recreational drugs

puts a mother at risk of contracting infectious diseases such as Human immunodeficiency virus (HIV) and

Human T-cell lymphotropic virus (HTLV) and impairs her ability to care for her child. Mothers who use illegal

drugs during pregnancy and breastfeeding can find themselves in trouble with the law and lose custody of their

children.

 Medication: Many medications are compatible with breastfeeding, but some are not. Certain prescription drugs

can hurt the baby, and other medications can cause a decrease in the milk supply. Some of the medications that

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are not compatible with breastfeeding are chemotherapy drugs, antiretroviral medications, radioactive iodine, some

sedatives, seizure medication, and medicines that may cause drowsiness and suppress breathing. Medications that

can decrease the supply of breast milk include cold and sinus medications that contain pseudoephedrine and certain

types of hormonal birth control.

 Infectious Disease: However, there are a few infectious diseases that can pass to a baby through breast milk and

the risk of transmission outweighs the benefits of breastfeeding. These conditions include: HIV: The human

immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS), HTLV: The

human T-cell lymphotropic virus (HTLV-1 &2) is a virus that can lead to leukemia and lymphoma. Human T-cell

lymphotropic virus 2 (HTLV-2) can cause brain and lung issues, Active tuberculosis infection (TB), Herpes on the

breast, etc.

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 FACTORS INFLUENCING BREASTFEEDNING

 Psychosocial Factors

Knowledge and attitudes (psychosocial factors) are important factors that influence breastfeeding prevalence in

general (Chambers, McInnes, Hoddinott, & Alder, 2007). Mothers usually obtained their knowledge about

breastfeeding from different resources such as: physicians, books or articles about breastfeeding, internet, friends

and families, advertisement, traditional birth attendants (TBAs), religious leaders, place of work, worship centers

and from mother to mother etc. (M. Auger, personal communication, November 6, 2013). Health care providers

should be aware that their own beliefs and attitudes toward breastfeeding may affect a woman’s choice to breastfeed

(Auger, 2013). Mothers’ trust their health care providers; therefore, care providers opinions regarding a particular

issue such as breastfeeding could be considered.

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 Demographic Characteristics: Maternal Age, Maternal Level of Education, and Family Income

According to CDC (2010), there is a significant association between breastfeeding rates and socio-demographic

characteristics for mothers including maternal age, maternal education level, and family income. It has been found

that breastfeeding rates increased with increasing maternal age for all race-ethnicity groups. Older mothers are more

likely to choose breastfeeding than young mothers (McDowell, 1999; Wang, 2006; & Kennedy-Stephenson, 2010).

However, low level of maternal education has been liked with low breastfeeding rates (Bertini, Perugi, Dani, Pezzati,

Tronchin, Rubaltelli, 2003). Also, breastfeeding rates were higher among mothers who have high family incomes

than for mothers who have low family income (McDowell, Wang, & Kennedy-Stephenson, 2010). It is well

documented that, in the U.S., women who are of high-income status and are college - educated tend to have the

highest breastfeeding rate, while young mothers from low socio-economic backgrounds with low educational levels

have the lowest breastfeeding rate.

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 Hospital Practices

To improve breastfeeding rates it is important to involve healthcare providers in the process of encouraging mothers

to choose breastfeeding for their children. A published joint statement from WHO and UNICEF to improve

breastfeeding rates recommended that all healthcare facilities encourage breastfeeding choice (WHO & UNICEF,

2003). Studies have shown that health care professionals such as physicians have inadequate training in

breastfeeding management (ADA Reports, 1997). Although health care professionals have been shown to positively

influence breastfeeding women, research shows that they also provide women with inaccurate and/or inadequate

breastfeeding information and recommendations. Surveys evaluating health care professionals’ knowledge and

attitudes about breastfeeding revealed that these professionals do strongly advocate to their clients that breastfeeding

is the optimum method of infant feeding (Pascoe et al., 2002).

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 Biomedical Factors

WHO provides a list of medical conditions for both mothers and babies that affect breastfeeding (WHO, 2009). This

report suggests permanent avoidance of breastfeeding for mothers who have HIV, and temporary avoidance of

breastfeeding for mothers who have; herpes simplex virus type 1 (HSV-1); illnesses that prevent mothers from taking

care of their babies such as sepsis; and maternal medications that could affect the infants health. WHO provides, also,

a list of health conditions including: breast abscess, hepatitis B, hepatitis C, mastitis, and tuberculosis, that mothers

with these conditions could continue breastfeeding but they should consider bottle feeding instead. Also, infants with

specific medical conditions including classic galactosemia, maple syrup urine disease, and phenylketonuria, should

not receive breast milk or any other milk except specialized formula according to doctors’ orders.

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On the other hand, other conditions including infants born weighing less than 1500g (very low birth weight), infants

born at less than 32 weeks of gestational age (very pre-term), and newborn infants who are at risk of hypoglycemia,

may need other food in addition to breast milk for a limited period ( WHO, 2009).

 Sources of Support

Lack of support from a significant other and negative attitude of the significant other toward breastfeeding have been

observed as major predictors of bottle feeding. Fathers who support bottle feeding are more likely to believe that

“breastfeeding is bad for the breasts and interferes with sex” (p.509, Losch et al., 1995). Research shows that fathers

have less knowledge about and positive attitudes toward breastfeeding compared to mothers (Sharma and Petosa,

1997). A study that evaluated a corporate lactation program that provided breastfeeding education and services for

male employees and their partners showed that fathers who participated in breastfeeding education programs were

more supportive of their partners and their female colleagues who breastfed.
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21
 PROS OF BREASTFEEDING

FOR THE BABY

 Breast milk is the most complete form of nutrition for infants: A mother's milk has just the right amount of

fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to

digest breast milk than they do formula.

 Increased survival: Studies in developing and industrialized countries confirm the life saving benefits of

breastfeeding, particularly in preventing diarrhea, pneumonia and sudden infant death syndrome (SIDS) deaths.

 Decreased morbidity: Infectious and chronic illness is reduced by exclusive breastfeeding, beyond the impact of

breastfeeding alone.

 Premature babies do better when breastfed compared to premature babies who are fed formula.

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 Adequacy: Mean intakes of human milk provide sufficient energy and protein to meet mean requirements during

the first six months of infancy. Since infant growth potential drives milk production, the distribution of intakes

likely matches the distribution of energy and protein requirements.

 Improved growth parameters: Exclusive breastfeeding helps overcome low birth weight (LBW) and reduces

stunting.

 Reduced cardiac risk factors: Early breastfeeding, especially exclusive, is associated with reduced obesity and

other factors related to heart disease.

 Breastfed infants grow exactly the way they should: They tend to gain less unnecessary weight and to be

leaner. This may result in being less overweight later in life.

 Breastfed babies score slightly higher on IQ tests, especially babies who were born pre-maturely

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 Breast milk tastes good to your child: Breast milk is sweet and creamy, a flavor that is much different and,

arguably, better than formula. Also, the taste of the foods you eat is passed along to your baby, which can

diversify their diet right from the start.

 Breast milk is easy for your newborn to digest: Your body makes breast milk specifically for your baby. It is

easier to digest than formula and may help prevent gas and colic. A breastfed baby's bowel movements are not as

smelly, and they're not as irritating to a baby's skin and can reduce diaper rash. Breastfed babies tend to

experience less diarrhea and constipation as well.

 Breast milk is the healthiest food for the baby: Breastfeeding provides your baby with a variety of health and

developmental benefits. The natural ingredients found in breast milk help protect your baby from illness and

disease during infancy. They also continue to provide your child with better health as he or she grows.

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 FOR THE MOTHER

 Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get

back to its original size and lessens any bleeding a woman may have after giving birth.

 Breastfeeding, especially exclusive breastfeeding (no supplementing with formula), delays the return of normal

ovulation and menstrual cycles.

 Breastfeeding lowers the risk of breast and ovarian cancers, and possibly the risk of hip fractures and

osteoporosis after menopause.

 Breastfeeding makes your life easier: It saves time and money. You do not have to purchase, measure, and mix

formula. There are no bottles to warm in the middle of the night.

 A mother can give her baby immediate satisfaction by providing herbreast milk when her baby is hungry.

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 Breastfeeding requires a mother to take some quiet relaxed time for herself and her baby.

 Breastfeeding can help a mother to bond with her baby: Physical contact is important to newborns and can help

them feel more secure, warm and comforted.

 Breastfeeding mothers may have increased self-confidence and feelings of closeness and bonding with their

infants.

 Breastfeeding is natural: Breastfeeding is the most natural way to feed your baby. Your body was created as the

ideal way to supply your child with the perfect source of nutrition.

 Breast milk is the healthiest food for your child: Breastfeeding provides your baby with a variety of health

and developmental benefits. The natural ingredients found in breast milk help protect your baby from illness and

disease during infancy. They also continue to provide your child with better health as he or she grows.

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 Exclusive breastfeeding can prevent another pregnancy for up to 6 months: If you breastfeed exclusively

without adding any supplements, your child is under six months old, and your period has not yet returned, then

you can use the lactational amenorrhea method (LAM) for birth control. When you meet the criteria and follow it

correctly, this natural birth control method is up to 98 percent effective.

 You can always pump: Pumping your breast milk can give you a bit more freedom. It can make it easier for you

to spend time away from your baby, so you can return to work or do other activities that you enjoy. It can also

allow your partner to participate in feedings.

 Nighttime feedings are faster and easier: When you breastfeed, you don't have to make and warm bottles in the

middle of the night.

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 Breastfeeding is relaxing: While you're breastfeeding, your body releases a hormone called oxytocin, a feel-

good hormone that promotes relaxation. It also provides you with time each day to take a break, sit down with

your feet up, and spend quality time with your baby.

 Breastfeeding delays the return of your period: Breastfeeding can prevent your period from returning for six

months or even longer. Typically, menstruation returns approximately one month after you stop breastfeeding

exclusively.

 Breastfeeding is convenient: Your breasts are the perfect way to supply your baby with the optimal nutrition at

the perfect temperature. There's no need to worry about preparing and heating formula, and there won't be any

bottles to clean up after feedings.

 Breastfeeding is comforting: A scared, injured, or sick child can be more easily comforted by breastfeeding.

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 FOR THE SOCIETY

 Breastfeeding saves on health care costs. Total medical care costs for the nation are lower for fully breastfed

infants than never-breastfed infants since breastfed infants typically need fewer sick care visits, prescriptions,

and hospitalizations.

 Breastfeeding contributes to a more productive workforce. Breastfeeding mothers miss less work, as their

infants are sick less often. Employer medical costs also are lower and employee productivity is higher.

 Breastfeeding is better for our environment because there is less trash and plastic waste compared to that

produced by formula cans and bottle supplies.

 Breastfeeding does have some physical costs for women.

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 CONS OF BREASTFEEDING

 Breast milk has agents (called antibodies) in it to help protect infantsfrom bacteria and viruses. Recent studies

show that babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of

infectious diseases including ear infections, diarrhea, respiratory illnesses and have more hospitalizations. Also,

infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.

 Some studies suggest that infants who are not breastfed have higher rates of sudden infant death syndrome

(SIDS) in the first year of life, and higher rates of type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's

disease, overweight and obesity, high cholesterol and asthma. More research in these areas is needed (American

Academy of Pediatrics, 2005).

 Babies who are not breastfed are sick more often and have more doctor's visits

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 Also, when you breastfeed, there are no bottles and nipples to sterilize. Unlike human milk straight from the

breast, infant formula has a chance of being contaminated

 You will have less freedom: When you breastfeed, you are always on call. You and your breasts need to be

available for every feeding, day and night. It can be exhausting, especially during the first few months when you

will be breastfeeding your baby every two to three hours around the clock.

 Breastfeeding can be painful: You may have to deal with some of the uncomfortable or even painful problems

common with breastfeeding. These include things like mastitis, breast engorgement, plugged milk ducts, and sore

nipples.

 Your partner can't breastfeed: Your partner might want to feed the baby and may feel left out of the

breastfeeding relationship.

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 It can be stressful if you are very modest: Some women may feel uncomfortable and embarrassed about

breastfeeding around others or in public. If you find it difficult to go out with your baby, you might end up staying

home more often. This may lead you to experience loneliness or feel isolated.

 Breastfeeding can be difficult in the beginning: Not every baby latches on immediately or breastfeeds well.

Breastfeeding might be harder than you think, and you may end up feeling disappointed or discouraged. For

some, breastfeeding is a learning process.

 You will have to make the lifestyle choices: You have to think about your diet and lifestyle choices when you

breastfeed. Your baby may have a reaction to different foods in your diet. So you may have to stop eating dairy

products or other items that you enjoy. There are also some things that you should avoid like caffeine, alcohol,

and nicotine which can be harmful to your baby. Stress and other factors can also affect breastfeeding and even

decrease your breast milk supply.

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 CONCLUSION

Breast milk remains the best and most secure form of nutrition for infants. The health benefits of exclusive

breastfeeding to infants especially in developing countries should not be underrated. Breastfeeding is well

recognized as the best food source for infants. It has been advocated as a cost effective means of improving the

child’s health, mother’s health and mother - infant bonding.

Breast feeding is the safest, least allergic and best infant feeding method. It has nutritional, immunological,

behavioral and economic benefits and also provide desirable mother infant bonding. Despite the demonstrated

benefits of breastfeeding, breastfeeding prevalence and duration in many countries, states and local governments are

still lower than the international recommendation of exclusive breastfeeding for the first six months of life.

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 RECOMMENDATIONS

 To avert the problems of child malnutrition, morbidity and mortality, high rate of child infections that may arise

from the lowering of the 6 months universal exclusive breastfeeding recommendation policy duration in

developing countries, the 6 months of exclusive breastfeeding should instead be promoted in all developing

countries and 4-6 months in all developed countries.

 The breastfeeding promotion programmes should be delivered by qualified and competent health professionals.

 The programmes should further highlight the importance of breastfeeding in relation to iron deficiency anaemia,

child malnutrition, protection against infant infections, breastfeeding and food safety and hygiene and the health

benefits that breastfeeding confers to the breastfeeding mothers.

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 Moreover, women’s rights and status have been found to be of much importance for the prevention of childhood

malnutrition. Now is the time to conduct research accordingly, on promoting the effects of breastfeeding that do

not take into account the real duration of breastfeeding before setting up generalized new recommendations. This

will reduce possible bias in the exclusive breastfeeding recommendation policy, confusion among breastfeeding

mothers and reduce the incidences of malnutrition in developing countries.

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