Breastfeeding is a collective responsibility (Op-Ed)

Even after so many years of having strong protective evidence of breastfeeding, our society in Bangladesh is not ready to provide women with a safe environment.

External link to Dhaka Tribune news article: Breastfeeding is a collective responsibility

Authors: Aniqa Tasnim Hossain and Sumaiya Nusrat

Published: July 2, 2024

Motherhood can be a beautiful experience. But it brings a plethora of mixed emotions and responsibilities to the mother. Life changes overnight with the arrival of a new family member. What is the first thing that a mother has to offer her child? Feeding, right? Ideally, from her own body, or otherwise, only when breastfeeding is not possible. As public health professionals, we always advocate for early initiation of breastfeeding, exclusive breastfeeding for the first six months, and continued breastfeeding until the baby turns two years old and beyond.

Global evidence published in The Lancet discussed how breastfeeding can provide protection against infections in children, increase intelligence, and decrease the proportion of obesity and diabetes. Additionally, breastfeeding provides protection against breast cancer, ovarian cancer, and diabetes to the nursing mothers. The Lancet 2016 series on breastfeeding reported that if all women could breastfeed their children, 823,000 annual deaths in children younger than five years old and 20,000 annual deaths of women from breast cancer could be averted.

These are big numbers, yet only 37% of children younger than six months of age are exclusively breastfed in low- and middle-income countries. While in Bangladesh, the proportion is slightly higher (55%), this rate is declining from previous years, as we know from the Bangladesh Demographic Health Survey 2022. The proportion of immediate (early initiation) breastfeeding has also gone down. To answer “why,” let’s have a closer look at potential causes.

The reasons for avoiding breastfeeding may range from cultural and medical to personal choices. There is a global marketing push to promote commercial milk formula (CMF). This can lead to a long debate on whether to choose the industrial formula for baby feeding. Many mothers would argue for the benefits of choosing CMF for their children over breastfeeding them. However, the economic burden of purchasing formula milk, alongside the physical and emotional strain, may substantially affect mothers.

It requires a high maintenance of hygiene while feeding a newborn something from outside. Sterilizing bottles carefully, every time you feed formula can be tiring and requires considerable attention. The possibility of getting the baby sick by feeding formula can take a toll on the mother’s mental health. According to an editorial published in The Lancet, we experience an economic loss of nearly$350 billion each year globally for inadequate breastfeeding, while the CMF industry makes profits of about $55bn every year.

Bangladesh was one of the first countries in South Asia to adopt legal measures for limiting breastmilk in 1984 through the Breastmilk Substitutes (Regulation of Marketing) Ordinance. Later, the government of Bangladesh came up with an act in 2013 entitled “Breast Milk Substitutes, Baby Foods, Commercially Manufactured Supplementary Baby Foods and Its Equipment (Regulation of Marketing) Act, 2013.” The act urged for a complete restriction on advertisement of breast milk substitutes. In 2017, the government again introduced Breast-Milk Substitutes (BMS) Rules to strengthen the provisions on communication materials to limit the promotion of breast-milk substitutes.

However, according to a recent multi-country study, there are major gaps in the implementation of these rules. The government should take prompt measures to address concerns within the CMF industry that may impede efforts to promote and support breastfeeding. Implementing regulations to limit the CMF marketing, educating the healthcare professionals, and raising public awareness to dispel myths about insufficient milk should be prioritized.

Even after so many years of having strong protective evidence of breastfeeding, our society in Bangladesh is not ready to provide women with a safe environment, and our families do not have an appropriate mindset to support mothers in feeding their babies. Families need to be better educated to provide the mother with adequate privacy and comfort for feeding. While the baby is precious to all family members, every mother needs enough space to be able to nurse regardless of their education, age, or socio-economic conditions. How many of us allow that physical and mental space and provide social support to the mother?

A facility-based study supported by Global Affairs Canada (GAC) and the non-communicable diseases control (NCDC) program of the Directorate General of Health Services (DGHS) in Bangladesh, that was implemented by icddr,b, revealed that a 24-year-old married woman reported experiencing mental health issues due to challenges with breastfeeding. She said, “I had difficulty sleeping at night after my child was born. He used to wake up screaming in the middle of night. I had to breastfeed all the time. As a result, I did not sleep well at night. I had a headache all day! I used to misbehave with everybody in the family and I became psychologically unwell as I didn’t have enough support for other works.”

In this situation, it is reasonable for a mother to consider discontinuing breastfeeding. With adequate family support, she could delegate other responsibilities and prioritize getting enough sleep. Additionally, mothers often face pressure if they feel that the baby is not getting enough milk. This can lead to them contemplating stopping breastfeeding and switching to formula milk as a simpler alternative.

Next, let’s talk about the workplace. After completing their maternity leave, women go back to work, leaving their beloved baby at home or at daycare. Separation anxiety hits; women who choose to exclusively breastfeed suddenly must stop during the day. But how do their bodies respond to this? They experience engorgement unless they extract breast milk at regular intervals throughout the day. However, not all workplaces have breastfeeding facilities, such as a corner where women can peacefully pump or express. 

Finally, let’s talk about public places. The government was directed by the High Court to take the required actions to establish nursing corners at all workplaces, shopping malls, airports, bus stops, and railway stations across the country in 2019. But we rarely see initiatives to implement this directive.

World Breastfeeding Week (WBW) is observed during the first week of August every year, supported by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and many Ministries of Health and civil society partners. This year, WBW will focus on survival, health, and well-being with the theme “Closing the Gap: Breastfeeding Support for All.” We can all work together to reduce inequalities by improving breastfeeding support.

We must ensure that breastfeeding is not a mother’s sole responsibility but rather a shared and collective responsibility across all actors in the family, workplace, and society by extending support to the lactating women in their best capacities. The world celebrated International Mother’s Day in May, and in the spirit of that celebration, let’s work together to empower women to protect, promote, and support their breastfeeding rights.

Aniqa Tasnim Hossain works as an Assistant Scientist at icddr,b. She is a public health researcher and a statistician by training. Sumaiya Nusrat is a medical doctor with a passion for data, holding both an MBBS and a Master’s in Applied Statistics and currently serving as a Project Research Physician at icddr,b. This article was produced with the support of the United States Agency for International Development (USAID) under the terms of USAID’s Research for Decision Makers (RDM) Activity. Views expressed herein do not necessarily reflect the views of the US Government or USAID. The study cited in this op-ed was funded by the Department of Foreign Affairs, Trade and Development (DFATD), through Advancing Sexual and Reproductive Health and Rights (AdSEARCH) by icddr,b, project.