Breast-Milk Substitutes: A New Old-Threat for Breastfeeding Policy in Developing Countries. A Case Study in a Traditionally High Breastfeeding Country

Abstract

BackgroundDeveloping countries with traditionally breastfeeding are now experiencing the increasing pressure of formula milk marketing. This may endanger lives and undermine the efforts of national policies in achieving the objectives of the Millennium Development Goals. We examined the use of, and factors for use, of all available breast-milk substitutes (BMS) in a country with a traditionally high rate of breastfeeding.MethodsRandomised multi-stage sampling surveys in 90 villages in 12/17 provinces in Laos.Participants: 1057 mothers with infants under 24 months of age.Tools: 50-query questionnaire and a poster of 22 BMS (8 canned or powdered milk; 6 non-dairy; 6 formulas; 2 non-formulas).Outcome measures included: prevalence of use and age of starting BMS in relation to socio-demographic characteristics and information sources, by univariate and multivariate analyses.ResultsOf 1057 mothers: 72.5% currently breastfed; 25.4% gave BMS (10.6% infant formula); 19.6% gave BMS before 6 months of age (of them: 83% non-dairy or cereals; mean age: 2.9 months; 95% Confidence interval: 2.6–3.2). One formula and one non-formula product accounted for 85% of BMS. BMS were considered as milk by the majority of mothers. Thai TV was the main source of information on BMS for mothers. Lao Loum mothers (the main ethnic group) living in concrete houses with good sanitary conditions, were more likely than others to use BMS before 6 months (OR: 1.79, (1.15–2.78), p<0.009). Mothers who fed their infants colostrum at birth were less likely to use BMS before 6 months of age (OR: 0.63, (0.41–0.99), p = 0.04). Unemployed mothers living in rural areas were less likely to consider BMS better than breast milk.ConclusionIn Laos, mothers with the highest socio-economic status are showing a tendency to give up breastfeeding. Successful educational strategies and advocacy measures should be urgently developed to promote and sustain breastfeeding in developing countries.

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

“…Chief executives and senior management claim to be fully dedicated to nutrition promotion 42 and to be unaware of Code violations, 43 while their lower management maintains strong pressure on their staff to increase sales. 7,10 Code violations by formula companies are not "innocent mistakes" and should not be excused, as was done in India recently. 36 The formula industry repeatedly plays hide-and-seek with Code advocates.…”

“…7 In 2010, UNICEF, together with the Lao health authorities, launched a breastfeeding and Code information campaign. As a result, many serious violations disappeared from health centers and hospitals countrywide, and the EBF rate among infants < 6 months of age increased to 40%.…”

“…14 Another major barrier for EBF is the lack of regulations and protected breastfeeding areas in offices and factories with working mothers. 7,10 These barriers to breastfeeding are not insurmountable as evidenced by successful workplace interventions. 15 Exclusive breastfeeding reduces health care costs worldwide.…”

<b>Interfaces of the discontinuation of breastfeeding

“…Nursing strike may be associated with the mother's inexperience or lack of knowledge about the correct positioning for properly handling breastfeeding (Barennes et al, 2012). Educational strategies are capable of promoting and sustaining EBF.…”

Breastfeeding in the Course of History

“…The low socioeconomic status along with the dubious hygiene had a devastating result in infant mortality in these countries, as the rate of necrotizing enterocolitis had an impressive increase [51][52][53]. The most impressive aspect, though, of this issue is that mothers from these countries tended to believe that breast milk and especially colostrum was harmful for their babies [54].…”