Part 1: Breast‐feeding determinants in low‐income countries

Abstract

This review relates to 2 articles in Medical Anthropology (Greiner et al. 1981; Gussler and Briesmeister 1980) which infer a large decline in the extent of breastfeeding and focus on a limited set of myriad factors which are believed to affect lactation extent and duration. They concentrate on the insufficient milk syndrome and use attitudinal information to a large extent. The assumption of the lage universal breastfeeding decline is questioned as is the focus on the single issue of insufficient milk when ample evidence exists for the importance of many other factors. A broader focus on behavioral research is more relevant to the question at issue. An initial review of information on patterns precedes a review of possible effects of a wide range of individual household and community factors on breastfeeding followed by an examination of issues which have dominated public debate on breastfeeding recently particularly those related to the roles of infant formula manufacturers and the health sector. Estimates based on the best and most recent data available suggest there has not been a universal decline in the prevalence of breastfeeding -- the percentage of children ever breastfed although a decline in the duration of breastfeeding is implied (but not verified) by the existing low percentages of children continuing to be breastfed after their 1st year in most developing countries. Documented declines over time appear to have been observed in the more modernized areas of low income countries. Breastfeeding elsewhere i.e. in most of Asia and Africa and in rural Latin America which collectively comprise most of the population in the developing world appears to continue to be nearly universal for the children for at least the 1st 6-12 months of life. These generalizations derived from World Fertility Survey data available for only 17 countries are highly tentative. Difference observed in the data (e.g. between urban and rural areas and across socioeconomic groups) suggest that some of the differentials may have developed over a rather extended period of time as a result of the secualr forces of modernization. More contemporary developments such as promotinal efforts of some infant formula manufacturers and increased use of oral contraceptives (OCs) and modern health facilities have probably contributed to the differentials (and inferred declines) in breastfeeding but they have not been the only agents of change. The focus of much of the literature on breastfeeding extent rather than on duration may have deflected attention from a broader problem that of preschool nutrition in general and in particular the process and health consequences of both supplementing the infant and ceasing to breastfeed. More attention needs to be directed toward developing more effective policies for promoting breastfeeding or maintaining existing levels when they remain high. Potential interventions include facilitating breastfeeding for working mothers in developing countries and educating modern and traditional health workers about the advantages and management of breastfeeding.