Breastfeeding is the reference feeding practice for infants, as breast milk has been designed by nature to provide the necessary nutrients for infant’s growth and development. Breastfeeding has also been associated with benefits to both mother and infant.

The World Health Organization recommends exclusive breastfeeding (i.e. breast milk as the sole source of nutrition) for the first six months of life. In addition, the WHO also recommends that breastfeeding should be given on demand, meaning as often as the infant wants, day and night – and that breastfeeding should continue for two years or more. The WHO also emphasizes the importance of introducing safe and appropriate complementary foods, beginning at sixth months of age.

UNICEF reports that globally breastfeeding no longer declining at the global level. In Asia, breastfeeding rates vary from country to country; and in Southeast Asia, it is estimated that 49 per cent of all infants are exclusively breastfed in the first six months.

Achievement of the WHO goals regarding breastfeeding depends on many different parameters many of which have to do with socioeconomic and cultural factors. One of the cultural factors is the fact that in many instances women do not decide by themselves about whether they will breastfeed, or for how long. In Pakistan, for example, a Save the Children survey revealed that only 44 per cent of mothers considered themselves the prime decision maker relative to how their children were fed. Instead, it is often husbands or mothers-in-law who decide.

Some of the most important socio-economic factors influencing breastfeeding are the absence of institutionalized maternity leave and the financial pressure for women to return to work. Another factor closely linked to socioeconomics is a shortage in governmental health workers and educational programs. As a result one-third of infants are born without a skilled birth attendant present. As a result, the opportunity for new mothers to be supported to or informed about the benefits to breastfeed within the first hours following delivery is lost. An analysis of data from 44 countries found that women who had a skilled attendant present at birth were twice as likely to initiate breastfeeding within the first hour.

Today, many women return to work soon after giving birth, and there is an absence in most settings, specific legal conditions governing breastfeeding in the workplace. This makes it difficult, if not impossible for mothers to continue breastfeeding. Changing this situation requires governments to initiate changes in three areas of national policy to support a mother’s ability to breastfeed – maternity leave, financial protection to help maintain the family’s income while the mother is not working, and workplace provisions to allow breastfeeding to continue once a mother returns to work.

Infant Formula

When an infant is not or only partially breastfed, the World Health Organization (WHO) acknowledges the need of an infant formula, also referred to as a breast-milk substitute, as a safe and nutritious substitute to breast milk.

Infant formula is a specifically designed food to solely or partially substitute breast milk from birth onwards. Infant formula has been specifically developed to contain all the necessary nutrients to meet the infant’s nutritional requirements.

Infant formula is the most regulated food and its compositional requirements have been established at global level by Codex Alimentarius (CODEX STAN 72 – 1981) and by numerous national regulatory authorities. This Codex Alimentarius standard has been established to define compositional, quality and labelling requirements for infant formula in support of the safe, nutritionally and adequate use of infant formulas as a breast milk substitute.

Complementary Feeding

The transition from exclusive breastfeeding to semi-solid and solid foods is referred to as complementary feeding. This transition happens at about six months, when breast milk alone is no longer sufficient to meet the nutritional needs of infants. The complementary feeding period is critically important as it is a time when appropriate, safe and nutritious complementary food is introduced into the infant’s diet.

Inadequate complementary feeding is considered to be a key determinant of child malnutrition, especially in developing countries. Recently, a number of successful strategies have been identified that can improve complementary feeding practices in low- and middle-income countries. These include:

• Practicing good hygiene and proper food handling;
• Starting complementary feeding at six months of age with small amounts of food and increase the quantity as the child gets older;
• Gradually increasing food consistency and variety as the infant gets older, adapting to the infant’s requirements and abilities
• Increasing the number of times that the child is fed complementary food, as he gets older. For the average healthy infant, meals should be provided 4-5 times per day, with additional nutritious snacks offered 1-2 times per day, as desired;
• Feeding a variety of foods to ensure that nutrient needs are met; and
• Using fortified complementary foods or vitamin-mineral supplements for the infant, as needed.

Follow-up Formula

Follow-up formula for older infants and young children has been developed to meet the nutritional needs of older infants, from six to 12 months of age, and of young children, 1-3 years of age, as part of the complementary feeding diet. It is a specialised product complying with Codex Alimentarius food standards (CODEX STAN 156-1987).

Follow-up formula contains added vitamins and minerals – such as vitamin D and iron – which are important nutrients that older infants and young children need as they develop. Iron helps brain development, and both calcium and vitamin D support the growth of bones and teeth.

These products are complementary to breastfeeding or to a breast-milk substitute, when either becomes insufficient to satisfy the nutritional requirements of the infant.

Useful links and resources:

http://www.who.int/nutrition/topics/global_strategy/en/index.html – The Global Strategy for Infant and Young Child Feeding aims to revitalise efforts to promote, protect and support appropriate infant and young child feeding. It builds upon past initiatives, in particular the Innocenti Declaration and the Baby-friendly Hospital initiative and addresses the needs of all children including those living in difficult circumstances, such as infants of mothers living with HIV, low-birth-weight infants and infants in emergency situations.

http://www.who.int/nutrition/topics/complementary_feeding/en/index.html – WHO articles, recommendations and consultations related to complementary feeding.

http://www.who.int/bulletin/volumes/91/6/12-109363/en/ – This study analyses the number and nature of breastfeeding breaks that mothers are guaranteed so that women can breastfeed for the minimum 6 months recommended by WHO for breastfeeding. We then conduct the first analysis of how labour policies affect breastfeeding rates around the world. Understanding the relationships between national policy and breastfeeding rates is critically important because of the substantial health benefits of breastfeeding to infant and mother, in addition to the facts that the majority of pregnant women are now employed and that a sizable proportion of women prefer to breastfeed.

http://www.who.int/elena/titles/continued_breastfeeding/en/index.html – WHO articles on continued breastfeeding

Codex Alimentarius – Standard for Infant Formula and Formulas for Special Medical Purposes Intended for Infants – CODEX STAN 72 – 1981

Codex Alimentarius – Standard for Follow-up Formula – CODEX STAN 156-1987