The choice to breastfeed is not an equal choice for all.

World Breastfeeding Week takes place annually between the 1st and 7th of August. It is a week that aims to raise awareness of the benefits that breastfeeding has for improving nutrition in children, and the need to provide more support for mothers to enable them have a choice to breastfeed. Today we reflect on breastfeeding, and the need to empower women to be able to make the choice to breastfeed.

In a world where food insecurity is an urgent problem in most countries, breastfeeding is a good start to improving food security and nutrition. Owing to its immediate availability and unobserved costs, many policies fall into the trap of assuming that breastfeeding is readily accessible to all.

Why breastfeeding is important

For many countries, particularly those that are developing, food insecurity is often observed through a malnourished population, which usually includes children and (pregnant) women. UNICEF malnutrition data show that the world is still far from reaching its goal of achieving zero hunger and a healthy world population by 2030. According to a study conducted by UNICEF and the World Health Organisation, worldwide, 149,2 million children under the age of five were stunted, 45,4 million suffered from wasting, and 38,9 million were overweight in 2018. While it is true that malnutrition affects all age groups, its roots lie in early childhood development (ECD).

The first 1000 days of a child’s life are crucial for good growth and development. These days are paramount in building cognitive ability and critical in strengthening children’s performance in school which affects their potential for a successful career later on. Therefore, if ECD is neglected in any way in those early days, children will be vulnerable to malnutrition. Depending on the severity of a baby’s malnourishment, stunting and wasting can occur which will have lifelong consequences.

One of the solutions to food insecurity that are suggested by leaders and researchers is breastfeeding during the first few months after birth. Breastfeeding is the cornerstone of a child’s food security and survival. Breastmilk provides the best nutrition, directly minimising vulnerability to malnutrition.

A mother’s ability to produce breastmilk potentially covers all dimensions of food security. Breastmilk is easily available to mothers, requiring no monetary exchange for its accessibility. Although there has been concern that the stability of feeding children breastmilk can be threatened by illnesses such as COVID-19, research has shown that a virus present in mothers cannot be transmitted through breastmilk. Therefore, stability in breastfeeding can hardly be threatened if breastmilk is used with caution and mothers are well-informed on the impact their nutritional behaviour has on the nutritional quality of breastmilk.

‘Imagine a menu that changes to adapt to its surroundings’—WABA. Breastmilk is exactly that, a food type that is adaptive to its surroundings to meet a child’s needs. Breastfeeding seems to be a sustainable intervention for both food security and nutrition, which makes it crucial for policy and the institutional environment to encourage and support it. Breastfeeding is however not always an option.

Why it is not readily accessible?

Global policies and frameworks have stirred countries in advocating and creating enabling environments for mothers to provide for their children’s nutritional needs. ECD has been mentioned in multiple Sustainable Development Goals such as Target 4.2 which states that governments and policies must ‘ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education’. It is also mentioned in several guidelines established by the WHO and UNICEF for improving food security and nutrition. National policies usually manage to support breastfeeding mothers through interventions that support increased maternity leave and supportive workplaces. These interventions, however, are relatively unfavourable to mothers categorised as being in low- to middle-income groups.

The scientific reasoning behind policy advocating for breastfeeding as an important aspect of ECD is based on the notion that this natural method of feeding offers essential nutrients at very little cost. This reasoning, however, ignores several socio-cultural and economic factors that can hinder a mother’s ability to breastfeed effectively. There is a paradox that links low-income households with low breastfeeding practices: it is assumed that the cost of formula milk and limited household resources will force mothers in low-income households to breastfeed; however, literature shows that such mothers would rather endure the cost of formula milk to get back to their routines that contribute to their ability to secure a livelihood.

Women in lower-income groups who live hand-to-mouth are associated with lower breastfeeding rates because there is a lack of flexibility in their lives that can support it. These women are often breadwinners of households without diverse income sources. In addition, these women lack the financial and social support to help them continue to breastfeed effectively while fulfilling other responsibilities.

A friend of mine, who is a mother of one, confirmed this when she mentioned in conversation that she only breastfed her child for eight days. Her short breastfeeding duration was the result of her having to go back to school and move away from her child. She said that she did not want to confuse her child and thus made sure that the child was introduced to formula milk as early as possible.

In conclusion, adequate maternal care includes a mother’s ability to supply food to a child. Breastfeeding should not be a privilege based on social status but a mother’s choice and possibly a nutritional right of all children. A policy can play a role in nudging mothers to provide that right by ensuring the means to make it readily accessible. Inclusivity in existing policies requires a shift in becoming community-specific for them to be relevant. While progress is being made in terms of improving policies that deal with child nutrition, breastfeeding practises continues to be hindered by external factors. Policymakers need to do better to change the way breastfeeding practises takes place, in South Africa and across the world.