elopment but also gives babies the antibodies they need to protect them against some of these common but deadly illnesses.
WHO recommends that all mothers, regardless of their HIV status, practise exclusive breastfeeding – which means no other liquids or food are given – in the first six months. After six months, the baby should start on complementary foods. Mothers who are not infected with HIV should breastfeed until the infant is two years or older.
Penny Reimers, of the Department of Nursing at Durban University of Technology, says the greatest declines in breastfeeding have taken place in countries where formula milk has been distributed at no cost, South Africa being a prime example. Infant formula was distributed by national and local authorities and by local nongovernmental organizations to prevent the transmission of HIV from mother-to-child, an initiative which inevitably undermined breastfeeding. An unforeseen consequence of the campaign was that even mothers who were not HIV positive turned to formula, says Reimers.
One reason for the switch was a belief that formula was in some way superior to breast milk, a perception that Coutsoudis believes derives, at least in part, from “strong and dishonest” marketing campaigns that make unfounded claims that the formula milk contains special ingredients that improve baby’s health. “Mothers are not told the truth, that breast milk is infinitely better [for the infant] and that formula milk can be dangerous; that it is not always a sterile product and is easily contaminated,” Coutsoudis says.
But even without formula producers’ marketing campaigns, other pressures are at work. One is the changing role of women in South African society. More women are in paid work than 20 years ago and many struggle to fit breastfeeding into their routines. When Pato Banzi, an administration officer at the Magistrates’ Court in Wynberg, Cape Town, had her second son she was granted four months’ maternity leave in accordance with South African labour law, but then struggled when the time came to return to work. “I was lucky that I lived close to where I worked so I could drive home to feed him and rush back to work,” she says. Later she switched to expressing milk, which she conserved in bottles, but had to go into the company boardroom to do this in private. Deidre Zimri, operations manager for a transport company, did her expressing in the waiting room when no one was using it. Both Banzi and Zimri felt that four months’ maternity leave was not enough.
Louise Goosen, a breastfeeding consultant at Mowbray Maternity Hospital in Cape Town, says that “going back to work” is one of the most common reasons for stopping breastfeeding. But even for mothers who don’t have to juggle paid work while caring for their babies, switching to formula is a huge temptation simply because it is thought to be convenient. But even for mothers who don’t have to juggle paid work while caring for their babies, switching to formula is a huge temptation simply because it is thought to be convenient. “However we need to encourage and educate mums on the ease and importance of expressing their breast milk to give to baby while mum is at work so that baby can still get the best nutrition,” Goosen explains.
So what can be done to make it easier for women to choose the breastfeeding option? The government needs to convince industry to make it easy for mothers to carry on breastfeeding after returning to work, says Lulama Sigasana, a nutritionist working at Ikamva Labantu, a South African non-profit organization based in Cape Town. She also believes that mothers should be provided with space and time to express milk in private at work. She says the government could do more to communicate the message that breastfeeding is good. “There are already some [campaigns]” she says, noting the Baby Friendly Hospital Initiative and World Breastfeeding Awareness week, held every August, but we need more programmes to boost breastfeeding uptake and continuation.
Sigasana thinks breastfeeding advocacy should also be directed to the 