This document discusses exclusive breastfeeding and reasons why some women do not breastfeed. It defines breastfeeding and exclusive breastfeeding according to WHO. Exclusive breastfeeding for six months is recommended for optimal infant health but some women are unable or unwilling to do so for various reasons. These include lack of support, need to return to work, unsupportive healthcare providers, lack of resources, financial barriers, personal issues, health concerns, and dependency on illegal drugs.

2. BY
ADEJUMOBI ADEJUMOKE 15/0177
ALAO ADENIKE S. 15/0184
EZEKIEL ADA - EZE H. 15/0190
OMOGE ADEYEMI O. 15/0199
SPECIAL TOPIC ON HUMAN NUTRITION (PHS 491)
DEPARTMENT OF PUBLIC HEALTH
FACULTY OF BASIC MEDICAL SCIENCES
ADELEKE UNIVERSITY, EDE, OSUN STATE
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF B.SC. IN PUBLIC HEALTH
1ST OCTOBER, 2018 2

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TABLE OF CONTENT
 INTRODUCTION
 DEFINITIONS OF BREASTFEEDING
 WHY EXCLUSIVE BREASTFEEDING IS A PUBLIC HEALTH CONCERN
 REASONS WHY SOME WOMEN DO NOT BREASTFEED THEIR BABY
 FACTORS INFLUENCING BREATFEEDING
 PROS OF BREASTFEEDING
 CONS OF BREASTFEEDING
 CONCLUSION
 RECOMMENDATIONS
 REFERENCES

4. INTRODUCTION
 Public health organisations, including the World Health Organisation recommend 6months of exclusive
breastfeeding for optimal growth, cognitive development and health. Exclusive breastfeeding for 6 months is the
optimal method of infant feeding (WHO, 2001).
 The WHO recommends exclusive breastfeeding for 6 months and continued breastfeeding until 2 years of age
along with complementary foods (Kramer & Kakuma, 2001).
 Although the health benefits of exclusive breastfeeding are widely acknowledged, opinions and
recommendations are strongly divided on the optimal duration of exclusive breastfeeding and the practice of
exclusive breastfeeding in different cultures and regions. This has led to many lactating women not practicing
exclusive breastfeeding. (UNICEF, 2012).
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5.  As expected, breastfeeding initiation is positively associated with the pros of breastfeeding and negatively with the
cons (Kools et al., 2005). The attitude towards breastfeeding in this study was measured prenatally by two
different scales ‘Pros’ and ‘Cons’ which contained questions about the perceived advantages and disadvantages
of breastfeeding. (Kools et al., 2005).
 In Nigeria, child malnutrition, which occurs in more than 60% of children has been identified to be responsible for
more than 50% of infant’s death in the country.
 Between 1996 and 2006, the rate of exclusive breastfeeding for the first 6 months of life increased from 33% to
37%. Significant increases were made in sub-Saharan Africa, where rates increased from 22% to 30%, and
Europe, where rates increased from 10% to 19%. In Latin America and the Caribbean, excluding Brazil and
Mexico, the percentage of infants exclusively breastfed increased from 30% in 1996 to 45% in 2006. (UNICEF,
2007)
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 Socio-demographic influences play a major role in explaining the low rates of exclusive breastfeeding. The
importance of mothers’ social groups and networks in affecting the infant feeding beliefs and practices should
never be underestimated. (Alder EM et. al, 2004).
 Depression arising from sickness affects infant feeding choices since depressed women may doubt their ability to
feed the infants leading to early termination of breastfeeding efforts. (Hellin K and G Waller 1992).
 Moreover, early return to work is also a significant factor in the decision whether or not to breastfeed and thus a
more conducive work environment (providing breastfeeding mothers with nurseries, breast milk expressing
equipment and longer maternity leave incentives) with regard to breastfeeding might encourage the practice.
(Arora S, Mcjunkin C, Wehrer J and P Kuhn, 2000).

7. DEFINITIONS OF BREASTFEEDING
 WHO has defined breastfeeding as the normal method to provide infants with the nutrients they need for
healthy growth and development (WHO, 2013).
 Breastfeeding: the method of feeding a baby with milk directly from the mother's breast (Bristow, 2012).
 Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and
development (WHO, 2013).
 Exclusive breastfeeding: breast milk only, excluding water, other liquids, and solid foods (WHO, 2013).
 Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given –
not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or
medicines. (WHO, 2013).
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WHY EXCLUSIVE BREASTFEEDING IS A PUBLIC HEALTH CONCERN
 For infants to survive, grow and develop properly they require the right proportion of nutrients. Breast milk is
rich in nutrients and anti-bodies and contains the right quantities of fat, sugar, water and protein. These nutrients
are major pre-requisites to the health and survival of the baby.
 When a child is exclusively breast fed, their immune system is strengthened, enabling it to life-threatening
illnesses like pneumonia and diarrhoea amongst other infections.
 Reports indicate that babies who are not breast fed for the first six months of life are 15 times more likely to die
from Pneumonia compared to newborns that are breast fed exclusively for six months after birth. (Healthy
Newborn Network).

9.  Infants who continued to be exclusively breastfed tended to be those who remained healthy and on an accepted
growth trajectory. (Sauls H, 1979). The World Health Organization estimates that around 220,000 children could
be saved every year with exclusive breastfeeding.
 Breastfeeding is healthier than formula feeding; it contains all necessary nutrients for a baby and protects against
several infections and diseases.
 Breastfeeding helps you to recuperate more rapidly after pregnancy and has health advantages for the mother.
 The availability of information about formulafeeding, for example, was found to be negatively correlated with the
duration of breastfeeding (Howard et al., 2000). In this experimental study, comparing women who received
promotion materials related to formulafeeding and a control group, a larger proportion of women in the
experimental group stopped breastfeeding during the first two weeks.
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10. REASONS WHY SOME WOMEN DO NOT BREASTFEED THEIR BABY
 Lack of Support: In the past, formula feeding was popular and very common. Many of our own mothers used
formula, and they do not understand breastfeeding. They have little or no experience with nursing a child, so they
cannot offer advice, guidance, or help. Sometimes, they are not even supportive. Partners and friends may not
have enough information about breastfeeding to understand this choice. Husbands may fear that breastfeeding
will interfere with the couple relationship. Since husbands or partners play a vital role in breastfeeding success,
without their support many women will choose not to breastfeed.
 Early Return To Work or School: It can be overwhelming to handle a new baby, family responsibilities, a
home, and the additional stress of work or school. If the stress of breastfeeding is too much for a woman, she
may decide not to breastfeed.
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11.  Attitudes of Doctors and Nurses: Some healthcare professionals are not educated in breastfeeding technique or
how to handle breastfeeding issues. If the mother's or the baby's health care provider does not support and
understand breastfeeding, then problems will not be resolved and the mother will not be encouraged to continue
to nurse.
 Lack of Help and Resources: Many first time mothers do not have breastfeeding support once they leave the
hospital. They do not know where to turn to for help, or who to go to with questions if they run into problems. If
women are not given follow-up instructions and information on the breastfeeding resources available, they can
easily give up on breastfeeding.
 Financial Barriers: Lactation specialists and pump rentals can be expensive. If women do not know where to go
for assistance, then they may not be able to afford to get the help they need to continue to breastfeed.
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12.  Personal Issues: Embarrassment, body image issues, fear, and lack of confidence can all contribute to negative
feelings about breastfeeding. Some women cannot see the breasts as anything but sexual objects. Concerns about
exposing the breasts to nurse can make women feel uncomfortable. When thoughts of breastfeeding are
embarrassing, uncomfortable, or shameful, it is more likely a woman will decide against breastfeeding.
 Health Concerns: Even though women with many types of health issues can breastfeed and are often encouraged
to do so, it can still be difficult. Certain health conditions can cause a low milk supply, or a mom might worry
about the medications that she has to take and how it will affect her baby. It can be overwhelming and exhausting.
Women who have had breast cancer may not be able to breastfeed after radiation therapy or a mastectomy. Plus,
there are some health-related issues, such as HIV infection, when breastfeeding is not recommended.
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13.  A True Low Breast Milk Supply: Only a small percentage of women who want to breastfeed can’t due to
lactation failure or a true low breast milk supply. A true low milk supply is usually the result of an underlying
condition. With treatment, some issues can be corrected, so a mother can go on to build a milk supply. However,
some problems cannot be resolved. The causes of a true low milk supply include:
 Insufficient glandular tissue (hypoplastic breasts)
 Polycystic ovary syndrome (PCOS)
 Hypothyroidism
 A previous breast surgery such as mastectomy or a breast reduction surgery
 Prior radiation treatment for breast cancer
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 Dependency on Illegal Drugs: The use of illegal drugs is not compatible with pregnancy, breastfeeding, or
parenting. Besides being illegal, street drugs are dangerous for a mother and her child. Drugs do get into the
breast milk and pass to the baby. When babies receive illicit drugs through breast milk, it can cause irritability,
sleepiness, poor feeding, growth problems, neurological damage, and even death. The use of recreational drugs
puts a mother at risk of contracting infectious diseases such as Human immunodeficiency virus (HIV) and
Human T-cell lymphotropic virus (HTLV) and impairs her ability to care for her child. Mothers who use illegal
drugs during pregnancy and breastfeeding can find themselves in trouble with the law and lose custody of their
children.
 Medication: Many medications are compatible with breastfeeding, but some are not. Certain prescription drugs
can hurt the baby, and other medications can cause a decrease in the milk supply. Some of the medications that

15. are not compatible with breastfeeding are chemotherapy drugs, antiretroviral medications, radioactive iodine, some
sedatives, seizure medication, and medicines that may cause drowsiness and suppress breathing. Medications that
can decrease the supply of breast milk include cold and sinus medications that contain pseudoephedrine and certain
types of hormonal birth control.
 Infectious Disease: However, there are a few infectious diseases that can pass to a baby through breast milk and
the risk of transmission outweighs the benefits of breastfeeding. These conditions include: HIV: The human
immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS), HTLV: The
human T-cell lymphotropic virus (HTLV-1 &2) is a virus that can lead to leukemia and lymphoma. Human T-cell
lymphotropic virus 2 (HTLV-2) can cause brain and lung issues, Active tuberculosis infection (TB), Herpes on the
breast, etc.
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16. FACTORS INFLUENCING BREASTFEEDNING
 Psychosocial Factors
Knowledge and attitudes (psychosocial factors) are important factors that influence breastfeeding prevalence in
general (Chambers, McInnes, Hoddinott, & Alder, 2007). Mothers usually obtained their knowledge about
breastfeeding from different resources such as: physicians, books or articles about breastfeeding, internet, friends
and families, advertisement, traditional birth attendants (TBAs), religious leaders, place of work, worship centers
and from mother to mother etc. (M. Auger, personal communication, November 6, 2013). Health care providers
should be aware that their own beliefs and attitudes toward breastfeeding may affect a woman’s choice to breastfeed
(Auger, 2013). Mothers’ trust their health care providers; therefore, care providers opinions regarding a particular
issue such as breastfeeding could be considered.
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17.  Demographic Characteristics: Maternal Age, Maternal Level of Education, and Family Income
According to CDC (2010), there is a significant association between breastfeeding rates and socio-demographic
characteristics for mothers including maternal age, maternal education level, and family income. It has been found
that breastfeeding rates increased with increasing maternal age for all race-ethnicity groups. Older mothers are more
likely to choose breastfeeding than young mothers (McDowell, 1999; Wang, 2006; & Kennedy-Stephenson, 2010).
However, low level of maternal education has been liked with low breastfeeding rates (Bertini, Perugi, Dani, Pezzati,
Tronchin, Rubaltelli, 2003). Also, breastfeeding rates were higher among mothers who have high family incomes
than for mothers who have low family income (McDowell, Wang, & Kennedy-Stephenson, 2010). It is well
documented that, in the U.S., women who are of high-income status and are college - educated tend to have the
highest breastfeeding rate, while young mothers from low socio-economic backgrounds with low educational levels
have the lowest breastfeeding rate.
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18.  Hospital Practices
To improve breastfeeding rates it is important to involve healthcare providers in the process of encouraging mothers
to choose breastfeeding for their children. A published joint statement from WHO and UNICEF to improve
breastfeeding rates recommended that all healthcare facilities encourage breastfeeding choice (WHO & UNICEF,
2003). Studies have shown that health care professionals such as physicians have inadequate training in
breastfeeding management (ADA Reports, 1997). Although health care professionals have been shown to positively
influence breastfeeding women, research shows that they also provide women with inaccurate and/or inadequate
breastfeeding information and recommendations. Surveys evaluating health care professionals’ knowledge and
attitudes about breastfeeding revealed that these professionals do strongly advocate to their clients that breastfeeding
is the optimum method of infant feeding (Pascoe et al., 2002).
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19.  Biomedical Factors
WHO provides a list of medical conditions for both mothers and babies that affect breastfeeding (WHO, 2009). This
report suggests permanent avoidance of breastfeeding for mothers who have HIV, and temporary avoidance of
breastfeeding for mothers who have; herpes simplex virus type 1 (HSV-1); illnesses that prevent mothers from taking
care of their babies such as sepsis; and maternal medications that could affect the infants health. WHO provides, also,
a list of health conditions including: breast abscess, hepatitis B, hepatitis C, mastitis, and tuberculosis, that mothers
with these conditions could continue breastfeeding but they should consider bottle feeding instead. Also, infants with
specific medical conditions including classic galactosemia, maple syrup urine disease, and phenylketonuria, should
not receive breast milk or any other milk except specialized formula according to doctors’ orders.
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20. On the other hand, other conditions including infants born weighing less than 1500g (very low birth weight), infants
born at less than 32 weeks of gestational age (very pre-term), and newborn infants who are at risk of hypoglycemia,
may need other food in addition to breast milk for a limited period ( WHO, 2009).
 Sources of Support
Lack of support from a significant other and negative attitude of the significant other toward breastfeeding have been
observed as major predictors of bottle feeding. Fathers who support bottle feeding are more likely to believe that
“breastfeeding is bad for the breasts and interferes with sex” (p.509, Losch et al., 1995). Research shows that fathers
have less knowledge about and positive attitudes toward breastfeeding compared to mothers (Sharma and Petosa,
1997). A study that evaluated a corporate lactation program that provided breastfeeding education and services for
male employees and their partners showed that fathers who participated in breastfeeding education programs were
more supportive of their partners and their female colleagues who breastfed.
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22. PROS OF BREASTFEEDING
FOR THE BABY
 Breast milk is the most complete form of nutrition for infants: A mother's milk has just the right amount of
fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to
digest breast milk than they do formula.
 Increased survival: Studies in developing and industrialized countries confirm the life saving benefits of
breastfeeding, particularly in preventing diarrhea, pneumonia and sudden infant death syndrome (SIDS) deaths.
 Decreased morbidity: Infectious and chronic illness is reduced by exclusive breastfeeding, beyond the impact of
breastfeeding alone.
 Premature babies do better when breastfed compared to premature babies who are fed formula.
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23.  Adequacy: Mean intakes of human milk provide sufficient energy and protein to meet mean requirements during
the first six months of infancy. Since infant growth potential drives milk production, the distribution of intakes
likely matches the distribution of energy and protein requirements.
 Improved growth parameters: Exclusive breastfeeding helps overcome low birth weight (LBW) and reduces
stunting.
 Reduced cardiac risk factors: Early breastfeeding, especially exclusive, is associated with reduced obesity and
other factors related to heart disease.
 Breastfed infants grow exactly the way they should: They tend to gain less unnecessary weight and to be
leaner. This may result in being less overweight later in life.
 Breastfed babies score slightly higher on IQ tests, especially babies who were born pre-maturely
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24.  Breast milk tastes good to your child: Breast milk is sweet and creamy, a flavor that is much different and,
arguably, better than formula. Also, the taste of the foods you eat is passed along to your baby, which can
diversify their diet right from the start.
 Breast milk is easy for your newborn to digest: Your body makes breast milk specifically for your baby. It is
easier to digest than formula and may help prevent gas and colic. A breastfed baby's bowel movements are not as
smelly, and they're not as irritating to a baby's skin and can reduce diaper rash. Breastfed babies tend to
experience less diarrhea and constipation as well.
 Breast milk is the healthiest food for the baby: Breastfeeding provides your baby with a variety of health and
developmental benefits. The natural ingredients found in breast milk help protect your baby from illness and
disease during infancy. They also continue to provide your child with better health as he or she grows.
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25. FOR THE MOTHER
 Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get
back to its original size and lessens any bleeding a woman may have after giving birth.
 Breastfeeding, especially exclusive breastfeeding (no supplementing with formula), delays the return of normal
ovulation and menstrual cycles.
 Breastfeeding lowers the risk of breast and ovarian cancers, and possibly the risk of hip fractures and
osteoporosis after menopause.
 Breastfeeding makes your life easier: It saves time and money. You do not have to purchase, measure, and mix
formula. There are no bottles to warm in the middle of the night.
 A mother can give her baby immediate satisfaction by providing herbreast milk when her baby is hungry.
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26.  Breastfeeding requires a mother to take some quiet relaxed time for herself and her baby.
 Breastfeeding can help a mother to bond with her baby: Physical contact is important to newborns and can help
them feel more secure, warm and comforted.
 Breastfeeding mothers may have increased self-confidence and feelings of closeness and bonding with their
infants.
 Breastfeeding is natural: Breastfeeding is the most natural way to feed your baby. Your body was created as the
ideal way to supply your child with the perfect source of nutrition.
 Breast milk is the healthiest food for your child: Breastfeeding provides your baby with a variety of health
and developmental benefits. The natural ingredients found in breast milk help protect your baby from illness and
disease during infancy. They also continue to provide your child with better health as he or she grows.
26

27.  Exclusive breastfeeding can prevent another pregnancy for up to 6 months: If you breastfeed exclusively
without adding any supplements, your child is under six months old, and your period has not yet returned, then
you can use the lactational amenorrhea method (LAM) for birth control. When you meet the criteria and follow it
correctly, this natural birth control method is up to 98 percent effective.
 You can always pump: Pumping your breast milk can give you a bit more freedom. It can make it easier for you
to spend time away from your baby, so you can return to work or do other activities that you enjoy. It can also
allow your partner to participate in feedings.
 Nighttime feedings are faster and easier: When you breastfeed, you don't have to make and warm bottles in the
middle of the night.
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28.  Breastfeeding is relaxing: While you're breastfeeding, your body releases a hormone called oxytocin, a feel-
good hormone that promotes relaxation. It also provides you with time each day to take a break, sit down with
your feet up, and spend quality time with your baby.
 Breastfeeding delays the return of your period: Breastfeeding can prevent your period from returning for six
months or even longer. Typically, menstruation returns approximately one month after you stop breastfeeding
exclusively.
 Breastfeeding is convenient: Your breasts are the perfect way to supply your baby with the optimal nutrition at
the perfect temperature. There's no need to worry about preparing and heating formula, and there won't be any
bottles to clean up after feedings.
 Breastfeeding is comforting: A scared, injured, or sick child can be more easily comforted by breastfeeding.
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29. FOR THE SOCIETY
 Breastfeeding saves on health care costs. Total medical care costs for the nation are lower for fully breastfed
infants than never-breastfed infants since breastfed infants typically need fewer sick care visits, prescriptions,
and hospitalizations.
 Breastfeeding contributes to a more productive workforce. Breastfeeding mothers miss less work, as their
infants are sick less often. Employer medical costs also are lower and employee productivity is higher.
 Breastfeeding is better for our environment because there is less trash and plastic waste compared to that
produced by formula cans and bottle supplies.
 Breastfeeding does have some physical costs for women.
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30. CONS OF BREASTFEEDING
 Breast milk has agents (called antibodies) in it to help protect infantsfrom bacteria and viruses. Recent studies
show that babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of
infectious diseases including ear infections, diarrhea, respiratory illnesses and have more hospitalizations. Also,
infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.
 Some studies suggest that infants who are not breastfed have higher rates of sudden infant death syndrome
(SIDS) in the first year of life, and higher rates of type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's
disease, overweight and obesity, high cholesterol and asthma. More research in these areas is needed (American
Academy of Pediatrics, 2005).
 Babies who are not breastfed are sick more often and have more doctor's visits
30

31.  Also, when you breastfeed, there are no bottles and nipples to sterilize. Unlike human milk straight from the
breast, infant formula has a chance of being contaminated
 You will have less freedom: When you breastfeed, you are always on call. You and your breasts need to be
available for every feeding, day and night. It can be exhausting, especially during the first few months when you
will be breastfeeding your baby every two to three hours around the clock.
 Breastfeeding can be painful: You may have to deal with some of the uncomfortable or even painful problems
common with breastfeeding. These include things like mastitis, breast engorgement, plugged milk ducts, and sore
nipples.
 Your partner can't breastfeed: Your partner might want to feed the baby and may feel left out of the
breastfeeding relationship.
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32.  It can be stressful if you are very modest: Some women may feel uncomfortable and embarrassed about
breastfeeding around others or in public. If you find it difficult to go out with your baby, you might end up staying
home more often. This may lead you to experience loneliness or feel isolated.
 Breastfeeding can be difficult in the beginning: Not every baby latches on immediately or breastfeeds well.
Breastfeeding might be harder than you think, and you may end up feeling disappointed or discouraged. For
some, breastfeeding is a learning process.
 You will have to make the lifestyle choices: You have to think about your diet and lifestyle choices when you
breastfeed. Your baby may have a reaction to different foods in your diet. So you may have to stop eating dairy
products or other items that you enjoy. There are also some things that you should avoid like caffeine, alcohol,
and nicotine which can be harmful to your baby. Stress and other factors can also affect breastfeeding and even
decrease your breast milk supply.
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33. CONCLUSION
Breast milk remains the best and most secure form of nutrition for infants. The health benefits of exclusive
breastfeeding to infants especially in developing countries should not be underrated. Breastfeeding is well
recognized as the best food source for infants. It has been advocated as a cost effective means of improving the
child’s health, mother’s health and mother - infant bonding.
Breast feeding is the safest, least allergic and best infant feeding method. It has nutritional, immunological,
behavioral and economic benefits and also provide desirable mother infant bonding. Despite the demonstrated
benefits of breastfeeding, breastfeeding prevalence and duration in many countries, states and local governments are
still lower than the international recommendation of exclusive breastfeeding for the first six months of life.
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34. RECOMMENDATIONS
 To avert the problems of child malnutrition, morbidity and mortality, high rate of child infections that may arise
from the lowering of the 6 months universal exclusive breastfeeding recommendation policy duration in
developing countries, the 6 months of exclusive breastfeeding should instead be promoted in all developing
countries and 4-6 months in all developed countries.
 The breastfeeding promotion programmes should be delivered by qualified and competent health professionals.
 The programmes should further highlight the importance of breastfeeding in relation to iron deficiency anaemia,
child malnutrition, protection against infant infections, breastfeeding and food safety and hygiene and the health
benefits that breastfeeding confers to the breastfeeding mothers.
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35.  Moreover, women’s rights and status have been found to be of much importance for the prevention of childhood
malnutrition. Now is the time to conduct research accordingly, on promoting the effects of breastfeeding that do
not take into account the real duration of breastfeeding before setting up generalized new recommendations. This
will reduce possible bias in the exclusive breastfeeding recommendation policy, confusion among breastfeeding
mothers and reduce the incidences of malnutrition in developing countries.
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