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History and culture of breastfeeding

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History and culture of breastfeeding
Summary

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Breastfeeding in Cuba has been officially recognized and supported by the Cuban government since the 1940 constitution, which included provisions promoting maternal and child health. The support for breastfeeding was further strengthened in the 1975 constitution, particularly through Article 68, which outlines protections for women during pregnancy and nursing.

Article 68 guarantees that women receive paid leave both before and after childbirth. Specifically, it provides for six weeks of paid leave before and six weeks after giving birth, ensuring that women retain their employment and associated rights during this period. Additionally, the article includes specific provisions to support breastfeeding mothers once they return to work. It mandates two extraordinary daily rest periods of half an hour each, allowing mothers to breastfeed or express milk for their children while still at work. This protection aims to facilitate the continuation of breastfeeding even after maternity leave has ended, promoting the health and well-being of both mother and child.

In addition to legal protections, Cuba has implemented several public health initiatives to encourage breastfeeding as part of the country's broader focus on maternal and child health. The Cuban government, through its healthcare system, promotes breastfeeding as an essential part of infant nutrition. Cuba has adopted the World Health Organization's recommendations, advocating for exclusive breastfeeding for the first six months of a child's life and continued breastfeeding alongside complementary foods up to two years of age or beyond.

Cuba's efforts to promote breastfeeding are also supported by its robust healthcare infrastructure, which provides free prenatal and postnatal care to all women. Healthcare professionals in Cuba receive training in breastfeeding support and education, and the country's healthcare system includes programs designed to increase public awareness about the benefits of breastfeeding. These efforts are part of a broader maternal and child health strategy that has contributed to low infant mortality rates and improved child health outcomes.

In 2019, only 40.9% of infants in Cuba were exclusively breastfed for the first six months of life.

Japan

Traditionally, Japanese women gave birth at home and breastfed with the help of breast massage. Weaning was often late, with breastfeeding, in rare cases, continuing until early adolescence. After World War II, Western medicine was taken to Japan and the women began giving birth in hospitals, where the baby was usually taken to the nursery and given formula milk. In 1974, a new breastfeeding promotional campaign by the government helped to boost the awareness of its benefits and its prevalence has sharply increased. Japan became the first developed country to have a baby-friendly hospital, and as of 2006, has another 24 such facilities.

United Kingdom

Between 2005 and 2010 breastfeeding initiation in the UK increased from 76% to 81%, exclusive breastfeeding at three months increased from 13% to 17% and exclusive breastfeeding at six months increased from 7% to 12%. In Scotland, the 2018 Scottish Maternal and Infant Nutrition Survey found that breastfeeding at six months rose between 2010 and 2017 from 32% to 43%. The Baby Friendly Initiative, in line with the WHO and UK governments' recommendations, currently promotes exclusive breastfeeding to six months.

However, in a study published in the UK in 2015, a lack of role models such as mothers, other female relatives, and friends who breastfeed was cited as one of the potential barriers for breastfeeding. Breastfeeding during family gatherings or in the presence of others has also been reported as a challenge for some women from ethnic minority groups in the United Kingdom.

United States

In 2018, Transgender Health reported that a transgender woman in the United States breastfed her adopted baby; this was the first known case of a transgender woman breastfeeding.

Developing nations

In many countries, particularly those with a generally poor level of health, malnutrition is the major cause of death in children under 5, with 50% of all those cases being within the first year of life. International organisations such as Plan International and La Leche League have helped to promote breastfeeding around the world, educating new mothers and helping the governments to develop strategies to increase the number of women exclusively breastfeeding.

Traditional beliefs in many developing countries give different advice to women raising their newborn child. In Ghana babies are still frequently fed with tea alongside breastfeeding, reducing the benefits of breastfeeding and inhibiting the absorption of iron, important in the prevention of anaemia.

Publicity, promotion and law

In response to public pressure, the health departments of various governments have recognised the importance of encouraging mothers to breastfeed. The required provision of baby-changing facilities was a large step towards making public places more accessible for parents and in many countries there are now laws in place to protect the rights of a breastfeeding mother when feeding her child in public.

The World Health Organization (WHO), along with grassroots non-governmental organisations like the International Baby Food Action Network (IBFAN) have played a large role in encouraging these governmental departments to promote breastfeeding. Under this advice they have developed national breastfeeding strategies, including the promotion of its benefits and attempts to encourage mothers, particularly those under the age of 25, to choose to feed their child with breast milk.

Government campaigns and strategies around the world include:

However, there has been a long, ongoing struggle between corporations promoting artificial substitutes and grassroots organisations and WHO promoting breastfeeding. The International Code of Marketing of Breast-milk Substitutes was developed in 1981 by WHO, but violations have been reported by organisations, including those networked in IBFAN. In particular, Nestlé took three years before it initially implemented the code, and in the late 1990s and early 2000s was again found in violation. Nestlé had previously faced a boycott, beginning in the U.S. but soon spreading through the rest of the world, for marketing practices in the third world (see Nestlé boycott).

Breastfeeding in public

A breastfeeding mother in public with her baby will often need to breastfeed her child. A baby's need to feed cannot be determined by a set schedule, so legal and social rules about indecent exposure and dress code are often adapted to meet this need. Many laws around the world make public breastfeeding legal and disallow companies from prohibiting it in the workplace, but the reaction of some people to the sight of breastfeeding can make things uncomfortable for those involved. Some breastfeeding mothers feel reluctant to breastfeed in public.

United States

WPA]] poster, 1938.

A United States House of Representatives appropriations bill (HR 2490) with a breastfeeding amendment was signed into law on September 29, 1999. It stipulated that no government funds may be used to enforce any prohibition on women breastfeeding their children in Federal buildings or on Federal property. Further, U.S. Public Law 106-58 Sec. 647 enacted in 1999, specifically provides that "a woman may breastfeed her child at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location." A majority of states have enacted state statutes specifically permitting the exposure of the female breast by women breastfeeding infants, or exempting such women from prosecution under applicable statutes, such as those regarding indecent exposure.

Most, but not all, state laws have affirmed the same right in their public places. By June 2006, 36 states had enacted legislation to protect breastfeeding mothers and their children. Laws protecting the right to nurse aim to change attitudes and promote increased incidence and duration of breastfeeding. Recent attempts to codify a child's right to nurse were unsuccessful in West Virginia and other states. Breastfeeding in public is legal in all 50 U.S. states and the District of Columbia. Despite the legal status, a lack of supportive workplace environments and an inability to express milk have been cited by women as barriers for publicly breastfeeding in the United States. Some states have laws protecting a woman's right to breast feed in the workplace. In California, employers must provide a private, non-bathroom space near the employee's work area for lactation that is safe, clean, and equipped with seating, a surface for personal items, and access to electricity. They must also provide access to a nearby sink and refrigeration for milk storage. Small employers with fewer than 50 employees may be exempt if they demonstrate undue hardship but must still make reasonable efforts to provide a private, nearby space.

United Kingdom

A 2004 UK Department of Health survey found that 84% of people find breastfeeding in public acceptable if it is done discreetly; however, 67% mothers are worried about general opinion being against public breastfeeding.

In legislation, under the UK Equality Act 2010 the legal right to breastfeed is explicitly included in law. It specifies that a business must not discriminate against a woman who is breastfeeding a child of any age in a public place. In Scotland, a bill safeguarding the freedom of women to breastfeed in public was passed in 2005 by the Scottish Parliament. The legislation allows for fines of up to £2500 for preventing breastfeeding in legally permitted places.

Ireland

The Republic of Ireland Equal Status Act 2000 protects the right to breastfeed in public.

Canada

In Canada, the Canadian Charter of Rights and Freedoms gives some protection under sex equality. Although Canadian human rights protection does not explicitly include breastfeeding, a 1989 Supreme Court of Canada decision (Brooks v. Safeway Canada) set the precedent for pregnancy as a condition unique to women and that thus discrimination on the basis of pregnancy is a form of sex discrimination. Canadian legal precedent also allows women the right to bare their breasts, just as men may. In British Columbia, the British Columbia Human Rights Commission Policy and Procedures Manual protects the rights of female workers who wish to breastfeed.

Two early 20th century Korean women breastfeeding their babies while working

Recent global uptake

The World Health Organization aims to have at least half of all the mothers worldwide exclusively breastfeeding their infants in the first 6 months of life by the year 2025. The following table shows the uptake of exclusive breastfeeding.

CountryPercentageYearType of feeding
Armenia0.7%1993Exclusive
20.8%1997Exclusive
Benin13%1996Exclusive
16%1997Exclusive
Bolivia59%1989Exclusive
53%1994Exclusive
Central African Republic4%1995Exclusive
Chile97%1993Predominant
Colombia19%1993Exclusive
95% (16%)1995Predominant (exclusive)
Dominican Republic14%1986Exclusive
10%1991Exclusive
Ecuador96%1994Predominant
Egypt68%1995Exclusive
Ethiopia78%2000Exclusive
Mali8%1987Exclusive
12%1996Exclusive
Mexico37.5%1987Exclusive
Niger4%1992Exclusive
Nigeria2%1992Exclusive
Pakistan12%1988Exclusive
25%1992Exclusive
Poland1.5%1988Exclusive
17%1995Exclusive
Saudi Arabia55%1991Exclusive
Senegal7%1993Exclusive
South Africa10.4%1998Exclusive
Sweden55%1992Exclusive
98%1990Predominant
61%1993Exclusive
Thailand90%1987Predominant
99% (0.2%)1993Predominant (exclusive)
4%1996Exclusive
United Kingdom62%1990
66%1995
Zambia13%1992Exclusive
23%1996Exclusive
Zimbabwe12%1988Exclusive
17%1994Exclusive
38.9%1999Exclusive

Alternatives

Direct udder nursing 1895

If a mother cannot feed her baby herself, and no wet nurse is available, then other alternatives have to be found, usually animal milk. In addition, once the mother begins to wean her child, the first food is very important.

Feeding vessels dating from about 2000 BC have been found in Egypt. A mother holding a very modern-looking nursing bottle in one hand and a stick, presumably to mix the food, in the other is depicted in a relief found in the ruins of the palace of King Ashurbanipal of Nineveh, who died in 888 BC. Clay feeding vessels were found in graves with infants from the first to fifth centuries AD in Rome.

Valerie Fildes writes in her book Breasts, bottles and babies. A history of Infant Feeding about examples from the 9th to 15th centuries of children getting animal's milk. In the 17th and 18th century Icelandic babies got cow's milk with cream and butter. Human–animal breastfeeding shows that many babies were fed more or less directly from animals, particularly goats.

In 1582, the Italian physician Geronimo Mercuriali wrote in De morbis mulieribus (On the diseases of women) that women generally finished breastfeeding an infant exclusively after the third month and entirely around 13 months of age.

The Wabanaki and other Native American tribal nations of North America made an infant formula from nuts and cornmeal. The feeding of flour or cereal mixed with broth or water became the next alternative in the 19th century, but once again quickly faded. Around this time there became an obvious disparity in the feeding habits of those living in rural areas and those in urban areas. Most likely due to the availability of alternative foods, babies in urban areas were breastfed for a shorter length of time, supplementing the feeds earlier than those in rural areas.

Though first developed by Henri Nestlé in the 1860s, infant formula received a huge boost during the post–World War II baby boom. When business and births decreased, and government strategies in industrialised countries attempted to highlight the benefits of breastfeeding, Nestlé and other such companies focused their aggressive marketing campaigns on developing countries. In 1979 the International Baby Food Action Network (IBFAN) was formed to help raise awareness of such practices as supplementary feeding of new babies with formula and the inappropriate promotion of baby formula, and to help change attitudes that discourage or inhibit mothers from breastfeeding their babies.

References

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