Sustained Breastfeeding, Complementation, and Care

Abstract

Breastfeeding can enhance care of infants. In most cultures there is an age after which breastfeeding is no longer considered socially acceptable. In Western countries, shorter periods have long been the norm. Researchers may underestimate how common sustained breastfeeding is in both industrialized and low-income settings. Little is known about the contributions breastfeeding may make to the emotional and physical health of mothers and infants when sustained for longer periods. It clearly offers economic and certain nutritional advantages, such as preventing severe vitamin A deficiency, and it reduces fertility. Sustained breastfeeding is often associated with slower child growth. This is probably not often a unidimensional causal relationship. Part of the explanation may be that sustained breastfeeding increases infant survival under extreme conditions of poverty and food insecurity. The duration of breastfeeding, especially exclusive breastfeeding, may have decreased in some areas in recent decades due to inappropriate messages from health workers, in part due to a lack of careful definitions. A schematic figure depicts four separate processes, each referred to at times as “weaning.” To reduce the incidence of early cessation of breastfeeding, it is important to separate the “complementation” and “replacement” components. Modernization processes such as urbanization can occur so rapidly that new ideas for achieving infant care goals may be needed. However, in relatively stable resource-poor settings, care strategies such as sustained breastfeeding are likely to be well adapted, and outsiders would be wise to focus on protecting them. Indeed, breastfeeding programmes should place priority on protection (marketing codes) and support (breastfeeding-friendly practices at delivery and support measures for women in the market labour force) before promotion (mass media).