Breastfeeding : style, structure and advantages
Breastfeeding as a process is culturally constructed: that is, in spite of its physiological base, the process itself, its meaning, and the way it is integrated into cultural systems varies globally. Until recently, we have had minimal information on the sociocultural context of breastfeeding from detailed, long-term ethnographic analysis. This evidence is now available, and it demonstrates that women’s lives and child-care practices are changing rapidly. One conceptual model emerging from these ethnographic data approaches cultural context as the interaction between style and structure. Style refers to the manner of expression characteristic of an individual, a period of time, and a place. The concept of infant-feeding style communicates fundamental cultural assumptions underlying infant-feeding decisions. It refers to the manner of feeding infants in particular communities and includes both the way to feed an infant and the values, attitudes, and beliefs associated with that behaviour. Infant-feeding style includes the style of interaction between mothers and infants, eating style (how does the infant-feeding pattern fit with the household meal pattern?), breastfeeding style (how is breastfeeding accomplished?), and feeding “in style,” reflecting the fact that infant-infant feeding choices are part of dynamic, changing trends and fashions. To understand differences in breastfeeding style, it may be useful to distinguish between breastfeeding as a process and breastmilk as a product. Process or product interpretations may be emphasized in different contexts. Both personal and shared styles of infant feeding interact with organizational and institutional structures, such as health-care institutions and marketing systems. These structures are important in influencing mothers’ infant feeding choices. The interaction between style and structure should allow us to predict how infant-feeding choices might be affected by different policy options. A meeting of WHO and UNICEF policy makers in 1990 resulted in the adoption by 30 governments of a global initiative, the Innocenti Declaration, on the Protection, Promotion, and Support of Breastfeeding. This Declaration stated that for optimal breastfeeding,all women should be enabled to practice exclusive breastfeeding, and all infants should be fed exclusively on breastmilk from birth to four to six months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond. In order to bring this about, efforts should be made to increase women’s confidence in their ability to breastfeed. Such empowerment involves the removal of constraints and influences that manipulate perceptions and behaviour towards breastfeeding, often by subtle and indirect means. This requires sensitivity, continued vigilance, and a responsive and comprehensive communications strategy involving all media and addressed to all levels of society. Furthermore, obstacles to breastfeeding within the health system, the workplace, and the community must be eliminated. This carefully worded statement is a challenge to change many priorities of the modern world to rebuild breastfeeding cultures. The language stresses the empowerment of women to breastfeed, rather than their duty to breastfeed, a change that should bring more advocates for women’s health to support breastfeeding policies. To rebuild breastfeeding cultures that will protect, support, and promote breastfeeding, we must work from models of breastfeeding and child care that are more sensitive to gender and the forces that constrain women’s lives. What is entailed in recreating breastfeeding cultures? In some parts of the world, changing assumptions about body image is a priority; ensuring women are adequately fed is of higher priority elsewhere. A great deal of political will to make changes benefiting women and children is crucial in all state and international institutions. At some point, policy makers need numbers to evaluate and finance policies and programmes. But that does not mean that ethnographic observations and other cultural information are merely illustrative anecdotes. The linkage between cultural data and policy can be directly relevant to establishing priorities. Because ethnographic description is both holistic and richly contextualized, it is easy for policy makers to picture the real-life conditions of the families that their policies will affect. Some products of ethnographic fieldwork, such as community sketches and mothers’ life histories, are available much faster than survey data, which require substantial processing. Solutions to infant-feeding problems must come from the cultural context underlying infant-feeding decisions. The same “culture” that some policy makers view as an
obstacle to development must ultimately provide solutions assembled from available options, ideas, and strategies already in the cultural repertoire. In this case, the task of the policy maker is to choose options and implementation strategies that are most compatible with the infant feeding style in different countries. Knowledge of style without consideration of structural constraints or supports would, however, be unproductive. Structural constraints, such as the powerful influence of the health-care system, the marketing practices of transnational manufacturers of infant foods, and structural supports, such as vendors selling porridges or traditional midwives, must also be included in policy decisions to suggest new directions to improve infant-feeding practices. Breastfeeding-promotion activities, mother support projects, and consumer-advocacy campaigns are often viewed in isolation from each other and from other programmes. Nevertheless, breastfeeding has been linked to related child survival campaigns, such as immunization, family planning, growth monitoring, and oral rehydration therapy. To encourage the changes envisioned by the Innocenti Declaration, breastfeeding advocates must seek new allies and closely examine the concerns such potential allies have with regard to past promotion of breastfeeding. A number of potential allies could be called on to offer support for breastfeeding initiatives. Specific advantages of breastfeeding include;
- helps bond mother and child
- confers passive immunity and protects against NNS
- provides optimal growth and neurological development
- prevents malocclusion/leads to better teeth/jaw development
- protects against hypothermia
- enhances visual development
- is less risky for premature babies and low birth weight babies
- Reduces PPH (uterine contractions after childbirth)
- Helps mothers to return to shape faster after delivery
- Convenient (the milk is pre-warmed, clean and always available)
- contributes to natural family planning
- fosters confidence and promotes self-esteem
- is protective against cancer (breast, ovarian, cervical)
- reduces the requirements of insulin for lactating diabetic mothers
