Why mothers don’t breastfeed

Breastfeeding rates in the UK are much lower than in many European countries. Less than 1 per cent of mothers in the UK are exclusively breastfeeding at six months. 

breastfeedingpublic

A focus group study in the UK suggested a number of reasons why women may not breastfeed or why they stop breastfeeding early. These were as follows: 

  • The attitude of other people – women felt that breastfeeding in public was unacceptable and embarrassing, while bottle-feeding was accepted by everybody and in all places. A lack of places to breastfeed out of sight restricted women’s ability to get out of the house. This may be a bigger issue for low-income women, who may not have the option of breastfeeding in the car. Some women reported breastfeeding in public toilets as the only option. Women wished that cafés and shops could provide places to breastfeed with some privacy.
  • Attitudes of family and friends – some women said that even family and friends found it ‘repulsive’ to be in the same room when they were breastfeeding. Some grandparents thought it excluded them from having the chance to feed the new baby. It was clear that the opinion of family and friends was a stronger influence than that of health practitioners. 
  • Lack of knowledge – women vaguely knew that breastfeeding was supposed to be beneficial, but they could not name any benefits, and were not convinced about them. In the study only one woman had learnt at school about benefits of breastfeeding; most did not hear about it until they were pregnant. Feeding was not well covered in antenatal classes. 
  • Lack of professional support – women experienced difficulty in trying to establish breastfeeding but were unwilling ‘to bother the midwife’. Bottle feeding seemed easier. 
  • Experience – breastfeeding seemed difficult and painful, and many women experienced problems ranging from getting the baby latched on, sore nipples, and disturbed sleep. Women, especially adolescents, complained of a lack of freedom to travel/socialise/work. 
  • Worry about baby’s weight gain – women said that health visitors were ‘always worried about weight gain’.

Although some women in this study mentioned the benefits of breastfeeding – including feelings of wellbeing and relaxation during feeds, convenience (less washing up), and less expense, it is clear that there are significant barriers for women in the UK which impact on their choice to breastfeed. 

Source: McFadden A & Toole G (2006) Exploring women’s views of breastfeeding: a focus group study within an area with high levels of socio-economic deprivation. Maternal & Child Nutrition 2: 156-68.

For further information about healthy food for babies and children, please come to a Cooking for Health course led by nutrition expert, Dr Jane Philpott.

Infant feeding affects obesity in later life

Three decades ago, it was proposed that disease risk in human adults may be programmed by environmental influences acting on hormones, metabolites and neurotransmitters, during sensitive periods of early development.  Since then, much supporting evidence for this hypothesis has accumulated from epidemiologic and experimental studies and clinical trials.  For example, numerous studies have reported programming effects of infant feeding choices on later obesity.  Three meta-analyses of observational studies found that obesity risk at school age was reduced by 15 to 25 per cent with early breastfeeding compared with formula feeding. 

A new paper in the American Journal of Clinical Nutrition reports on investigations into whether breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy.  One reason for this may be the lower protein content of human milk compared with most infant formula (the early protein hypothesis).

Researchers are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial that includes >1000 infants in 5 countries (Belgium, Germany, Italy, Poland, and Spain).

Healthy infants who were born at term were randomly assigned to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 y indicate that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the new World Health Organization growth standard, which may furnish a significant long-term protection against later obesity.

Researchers conclude that infant feeding practice has a high potential for long-term health effects, and the results obtained should stimulate the review of recommendations and policies for infant formula composition.

breastfeeding2

It is interesting that the authors do not also suggest public health action to encourage higher rates of breastfeeding. 

All current guidelines, including those from the Department of Health (DH), recommend exclusive breastfeeding for newborns and for the first six months of infancy.

Breast milk provides all the nutrients required at this age in a form that is hygienic and easy to digest. The protein, carbohydrate and fat profiles are unique to breast milk and differ in many ways from other animal milks.  Breast milk also contains a range of bioactive components, including anti-microbial and anti-inflammatory factors, digestive enzymes, hormones and growth factors.  Growth factors are thought to be important for gut maturation. Lactoferrin is one of several specific binders in human milk that greatly increase the bioavailability of micronutrients.

The role of leptin in breast milk may be of particular importance in the early development of both adipose (fatty) tissue and appetite regulatory systems in the infant, and ultimately on propensity to obesity in later life.

Despite the many benefits of breastfeeding, less than 1 per cent of women in the UK are still breastfeeding at 6 months.  Studies have shown that women in the UK experience substantial barriers to breastfeeding.

For further information about healthy food for your children, please come to a Cooking for Health course, led by nutrition expert Dr Jane Philpott.

Long term health is affected by maternal nutrition

This month, the British Medical Association (BMA) Board of Science has published a report on Early Life Nutrition and Lifelong Health.  The report reviews the evidence that the diets of women of reproductive age, and those of their foetuses and young children, are significant factors in influencing the risk of chronic diseases such as heart disease, diabetes, obesity, brittle bone disease and even some forms of cancer and mental illness, later in those children’s lives.

Lead author Professor Mark Hanson, director of the Centre for the Developmental Origins of Health and Disease at the University of Southampton, comments:

“Society and public health organisations need to pay much greater attention to these issues if the rising epidemic of these diseases is to be prevented. Tackling the diseases once children reach adulthood is often too late. By taking steps to improve maternal nutrition we could save many people from a lifetime of ill health.”

obese-kids1

Unbalanced nutrition can result from both inadequate and excessive dietary intakes, and both can exist at the same time in many populations. Moreover diets which lead to over-nutrition (e.g., excess calories) are often micronutrient poor.

There is strong evidence that undernutrition (stunting or wasting) during the first two years of life leads to impaired adult cognitive, physical and economic capacity, which cannot be repaired even if nutrition improves later in childhood.

Improved availability of energy-rich foods has however, enabled large numbers of people to escape from hunger. This has brought considerable benefits, but is already giving rise to obesity and obesity-related disease. Developing countries are reporting high rates of coronary heart disease (CHD) and type 2 diabetes that have appeared in one or two generations to become leading causes of morbidity and mortality. These epidemics are expected to intensify.  By the year 2030, the prevalence of diabetes is predicted to rise by over 100 per cent in India, China, sub-Saharan Africa, Latin America, the Caribbean and the Middle East; an increase far exceeding that in high-income countries (54%).

There is good evidence that an increased deposition of fat tissue in foetuses and babies is an outcome of both undernutrition and excessive nutrition.  Low birth weight babies born to underweight women in India have proportionately more fat than would be expected for their body weight.  Maternal obesity, another form of maternal malnutrition, also increases the fat tissue of the foetus and newborn baby. This phenomenon is exacerbated further if maternal obesity is complicated by gestational diabetes.

Extremes of maternal body composition, either excessive thinness or obesity, are associated with adverse patterns of foetal and infant development leading to poorer long-term health.

“It’s not only women who need to be careful about the quality of their food intake. Prospective fathers should also eat well and steps need to be taken to ensure that young people understand the importance of good nutrition as part of their lifestyle choices.”

The numbers of women who breastfeed their infants is still too low, with many women starting to breastfeed but then stopping too soon, and many infants being fed inappropriate foods at the weaning stage.  Breastfeeding rates in the UK are much lower than in many European countries. Less than1 per cent of mothers in the UK are exclusively breastfeeding at six months.

breastfeeding1

While there are gaps in the evidence about the long-term consequences of poor maternal and infant nutrition, and we do not as yet understand the mechanisms fully, it is clear that steps need to be taken to promote healthy diets in young women and their families, to encourage breastfeeding and the use of appropriate complementary foods.

More advice could be given to people with young children about the importance of a balanced diet for those children and more support could be given to women to help them start breastfeeding and to continue with it.

If you have enjoyed this post please leave your comments below.

If you would like to keep in touch, please click here to sign up for my free e-newsletter and browse my website.

You can also join me on FacebookTwitterPinterest and LinkedIn, where I post interesting information which is not included in this blog.