Barriers to optimal breastfeeding

The fact that exclusive breastfeeding is practiced by a minority of women may be attributed to a number of factors. Among these are cultural, social, economic and political factors.

Cultural factors may be crucial when promoting exclusive breastfeeding everywhere, but are particularly crucial in traditional rural communities. Local perceptions of what constitutes optimal infant feeding practices may differ greatly from international recommendations. Globally, prelacteal feeding is a common practice which includes giving the infant various liquids as well as water, prior to initiation of breastfeeding (Morse et al., 1990) and continuing throughout the duration of the breastfeeding period.

Davies-Adelugbo (1997), in a recent study on socio-cultural factors and the promotion of exclusive breastfeeding in rural communities, concluded that exclusive breastfeeding totally lacked credibility among the locals, with even health workers not believing that it was possible or feasible. Therefore promotion of optimal breastfeeding practices, including exclusive breastfeeding, cannot be successful if the cultural barrier is not adequately addressed.

Exclusive breastfeeding for up to six months requires the mother and her infant to be in close proximity for this period and to use expressed breastmilk for separation of short duration. However, practicing exclusive breastfeeding may be perceived as being non-compatible with working outside of the home, thus creating an economical barrier. This includes mothers working both in the formal and informal sector.

This notion may be viewed from two angles. Firstly, from that of the employer, including governments, who may wrongly perceive that the provision of adequate maternity leave, breastfeeding breaks and cres at the work place would result in losses rather than profits. Secondly, from that of the mother, who may believe that practicing exclusive breastfeeding would limit the time she has for other activities - especially income generating activities.

A sick infant results in a worried mother, which in turn may result in a less productive mother. Absenteeism from work due to a sick infant may have more economical consequences than adequate maternity protection measures for optimal breastfeeding.

The lack of social support systems at the household and community levels is also a barrier to optimal breastfeeding. Mothers require an enabling environment if they are to practice optimal breastfeeding and this can only be possible with full support at both the household and the community levels. The issues to be addressed include the workload of the pregnant and lactating woman, among others.

National policies on breastfeeding are important for the promotion and support of breastfeeding at all levels. The lack of political commitment to breastfeeding promotion and support may probably be due to ignorance of its many benefits for the individual (mother and infant), household, community and the nation. Governments have still to understand the health, social and economic benefits of breastfeeding.

In light of all the barriers outlined above, how can we successfully get mothers to practice optimal breastfeeding including exclusive breastfeeding?