Some thoughts about infant feeding.

Abstract

This article summarizes the nutritional considerations, impact on infection and immunity, and psychosocial aspects of the breast versus bottle feeding debate and concludes with guidelines for reorganizing government health services to promote breastfeeding. Its aim is to encourage reappraisal on the part of physicians of the direct implications of infant feeding for the health and well-being of people in all societies, but especially in developing countries. As a result of widespread abandonment of breastfeeding in developing countries, marasmus and infant diarrhea have increased. Although the biologic advatages of breast over bottle feeding are indisputable, the social and economic advantages are more difficult to quantify. Many Third World women curtail breastfeeding to meet the conditions of employment; however, the economic advantages of artificial feeding diminish as one descends down the pay scale. The counterproductive trend toward bottle feeding has been compounded by adoption of this method on the part of the educated elite in Third World countries, including medical and nursing professionals, thus conferring on it as status associated with progress and affluence. The present trend can be reversed only if communities are convinced of the advantages of breastfeeding and make adjustments to facilitate this practice. Preparation for motherhood must be viewed as an integral function of the health care system, with emphasis placed on the nutrition of pregnant and lactating women, preparation for breastfeeding, and the initiation and continuation of breastfeeding. Obstetric units must actively discourage the removal of infants from their mothers or routine artificial feeding. In addition, facilities must be provided at workplaces for breastfeeding, the working day should be modified to allow brestfeeding, maternity leaves should be extended, and appropriate payments should be made to nursing mothers. The nutrition needs of infants must be viewed as a shared responsibility of the communiuty, the medical and nursing professions, and the baby food industry.