The World Health Organization (WHO) has stressed that 1.5 million infants die annually, unnecessarily, from deprival or from insuf®ciency of breast milk. Hence, the need for its maximal use, very particularly in impoverished populations, such as those in sub-Saharan Africa. In many developed populations, a generation ago the practice was very low, but now it has risen considerably. In contrast, in Africa and in most developing populations, despite the far greater need for breast-feeding, the practice is tending to decrease, especially among urban mothers. While the most common reasons given concern insuf®ciency of breast milk and employment of mothers, the latter, especially urban mothers, are under strong and increasing pressure to use proprietary replacement foods. These are often made up unsatisfactorily and are contaminated. Also in¯uential are the often less than enthusiastic, and confusing, attitudes of staff at clinics and hospitals, albeit, due in part to their very heavy workloads. Additionally, there is society's relatively indifferent attitude to breastfeeding. Currently, a hugely adverse factor is the danger of human immunode®ciency virus (HIV) transference from seropositive mothers to their infants ± in some African countries almost half of antenatal mothers are infected. Chances of early control of the infection are remote. However, apart from this danger, and from the pressure from replacement food companies, the outlook for breast-feeding practice in many African countries is unlikely to improve signi®cantly until greater encouragement is given from State, local and other health authorities.
Keywords
Breast-feeding bene®ts Developed populations African populations Breast milk substitutes HIVWhat is the magnitude of the problem at issue? How important to the health of the infant is the choice of breastfeeding or not breast-feeding? As noted in a recent editorial 1 , WHO has estimated that 1.5 million infant deaths per year could have been prevented had they been breast-fed 2 . In a low income country, evidence indicates that arti®cial feeding would produce an excess of postneonatal deaths at 6 months ranging from 13% at 10% prevalence of arti®cial feeding, to 59% at 100% of arti®cial feeding 3 .It is noteworthy that compared with the recent past, developed populations are experiencing an increase in breast-feeding initiation rates and in the duration of the practice; whereas, unfortunately, and in contrast, in developing populations the rate and the duration of breastfeeding appear to be decreasing, especially among urban mothers 4±6 . In seeking to throw light on the outlook for breastfeeding in sub-Saharan African populations, after brie¯y describing the bene®ts from the practice, the intention is to indicate trends in this regard, past and present. This will be done, ®rst, for perspective, in developed populations and then in sub-Saharan African populations. Next, primary in¯uencing factors will be discussed, and then, from the information gathered, an answer will be sought ± what ar...