10 facts on breastfeeding

WHO recommendsWHO recommends exclusivebreastfeeding for the first six months oflife. At six months, solid foods, such asmashed fruits and vegetables, should beintroduced to complement breastfeedingfor up to two years or more. In addition:

- breastfeeding should begin withinone hour of birth

- breastfeeding should be "ondemand", as often as the child wants day

and night; and- bottles or pacifiers should be avoided.

Health benefits for infantsBreast milk is the ideal food for newbornsand infants. It gives infants all thenutrients they need for healthydevelopment. It is safe and containsantibodies that help protect infants fromcommon childhood illnesses such asdiarrhoea and pneumonia, the twoprimary causes of child mortalityworldwide. Breast milk is readily availableand affordable, which helps to ensurethat infants get adequate nutrition.

Benefits for mothersBreastfeeding also benefits mothers.Exclusive breastfeeding is associatedwith a natural (though not fail-safe)method of birth control (98% protection inthe first six months after birth). It reducesrisks of breast and ovarian cancer later inlife, helps women return to their pre-pregnancy weight faster, and lowers ratesof obesity.

Long-term benefits for childrenBeyond the immediate benefits forchildren, breastfeeding contributes to alifetime of good health. Adolescents andadults who were breastfed as babies areless likely to be overweight or obese.They are less likely to have type-2diabetes and perform better inintelligence tests.

Why not infant formula?Infant formula does not contain theantibodies found in breast milk. Wheninfant formula is not properly prepared,there are risks arising from the use ofunsafe water and unsterilizedequipment or the potential presence ofbacteria in powdered formula.Malnutrition can result from over-dilutingformula to "stretch" supplies. Whilefrequent feeding maintains breast milksupply, if formula is used but becomesunavailable, a return to breastfeedingmay not be an option due to diminishedbreast milk production.

HIV and breastfeedingAn HIV-infected mother can pass theinfection to her infant during pregnancy,delivery and through breastfeeding.Antiretroviral (ARV) drugs given toeither the mother or HIV-exposed infantreduces the risk of transmission.Together, breastfeeding and ARVs havethe potential to significantly improveinfants' chances of surviving whileremaining HIV uninfected. WHOrecommends that when HIV-infectedmothers breastfeed, they should receiveARVs and follow WHO guidance forinfant feeding.

Regulating breast-milk substitutesAn international code to regulate themarketing of breast-milk substitutes wasadopted in 1981. It calls for:

all formula labels andinformation to state the benefits ofbreastfeeding and the health risks ofsubstitutes;

no promotion of breast-milksubstitutes;

no free samples of substitutes tobe given to pregnant women, mothersor their families; and

no distribution of free orsubsidized substitutes to healthworkers or facilities.

Support for mothers is essentialBreastfeeding has to be learned andmany women encounter difficulties atthe beginning. Nipple pain, and fear thatthere is not enough milk to sustain thebaby are common. Health facilities thatsupport breastfeedingby makingtrained breastfeeding counsellorsavailable to new mothersencouragehigher rates of the practice. To providethis support and improve care formothers and newborns, there are"baby-friendly" facilities in about 152countries thanks to the WHO-UNICEFBaby-friendly Hospital initiative.

Work and breastfeedingMany mothers who return to workabandon breastfeeding partially orcompletely because they do not havesufficient time, or a place to breastfeed,express and store their milk. Mothersneed a safe, clean and private place inor near their workplace to continuebreastfeeding. Enabling conditions atwork, such as paid maternity leave,part-time work arrangements, on-sitecrches, facilities for expressing andstoring breast milk, and breastfeedingbreaks, can help.

The next step: phasing in solid foodsTo meet the growing needs of babies atsix months of age, mashed solid foodsshould be introduced as a complementto continued breastfeeding. Foods forthe baby can be specially prepared ormodified from family meals. WHO notesthat:

breastfeeding should not bedecreased when starting on solids;

food should be given with aspoon or cup, not in a bottle;

food should be clean, safe andlocally available; and

ample time is needed for youngchildren to learn to eat solidfoods.

Benefits for mothersWhy not infant formula?HIV and breastfeedingRegulating breast-milk substitutesSupport for mothers is essentialThe next step: phasing in solid foods