Appendix B: More Information on Breastfeeding
Breastfed children have at least six times greater chance of survival in the early months than non-breastfed children. The potential impact of optimal breastfeeding practices is especially important in developing countries that have a high burden of disease and low access to clean water and sanitation. But non-breastfed children in industrialized countries are also at greater risk of dying – a recent study in the United States found a 25% increase in deaths among non-breastfed infants. In a UK survey, six months of exclusive breastfeeding was associated with a 53% decrease in hospital admissions for diarrhea and a 27% decrease in respiratory tract infections.
UNICEF and WHO recommend that breastfeeding begin within one hour of birth, that babies receive only breast milk (not even water) for the first six months, that mothers actively breastfeed their babies (i.e., feed at least 10 times a day) for the first six months, and that breastfeeding continue with safe, nutritious foods and drinks from 6 months until the child is at least two years old. In order to breastfeed optimally, mothers need to keep up their strength: they should eat two extra meals a day of diverse, nutritious foods until the child is 2 years old and they stop breastfeeding.
Breastfeeding has an extraordinary range of benefits. It has major impact on a child’s survival, health, nutrition and development. Breast milk provides all of the nutrients, vitamins and minerals an infant needs for the first six months. In addition, breast milk carries antibodies from the mother to the child that act as natural vaccines and help combat disease (see also Stopping exclusive breastfeeding). The act of breastfeeding itself stimulates the child proper growth of the mouth and jaw. It also helps the baby digest well and feel full. Breastfeeding creates a special bond between mother and baby, and the interaction between the mother and child during breastfeeding has positive lifelong effects on behavior, speech, sense of wellbeing and security, and how the child relates to other people. Studies have even shown that breastfed infants do better on intelligence and behavior tests into adulthood than formula-fed babies.
Virtually every mother can breastfeed, if given the right support, advice, encouragement, and problem-solving help. Early skin-to-skin contact between the mother and baby, frequent and unlimited breast-feeding to ensure continued milk production, and help with positioning and attaching the baby increase the chances of successful breastfeeding.
Breastfeeding also contributes to the mother’s health immediately after delivery because it helps reduce the risk of bleeding after birth. In the short term, breastfeeding delays the return to fertility. In the long term, it reduces type 2 diabetes and some cancers.  Stopping breastfeeding early can also contribute to post natal depression in mothers.
While breastfeeding is beneficial to mothers, it is also an energy-intensive activity that burns a lot of calories. Because of this, breastfeeding can cause the mother to rapidly lose weight. To replace those necessary calories, breastfeeding mothers need to eat two extra meals a day. These meals should include a variety of healthy foods so mothers get the nutrition they need to meet their increasing energy demands.
There are many societal and commercial pressures to stop exclusive breastfeeding, including aggressive marketing and promotion by formula producers, and inaccurate medical advice from health workers who lack proper skills and training in breastfeeding support. Sometimes the mother or family members believe breast milk alone no longer satisfies the child. Women who have to return to work soon after delivery face particular challenges and pressures that can lead them to stop exclusive breastfeeding early. Working mothers need support, including from their family members and community as well as laws, to help them continue breastfeeding.
Giving other liquids or foods together with breast milk to infants under 6 months of age can increase their chance of getting diarrhea and other infectious diseases. It can also reduce milk production because the baby sucks less at the breast. Babies do not need any other liquids, not even water, in the first 6 months. Breast milk contains all the water a baby needs, even in very hot climates.
Not practicing exclusive breastfeeding during the first six months also increases the risk of HIV+ mother to child transmission of HIV. In several African studies, mixed-fed infants were three to four times more likely to get HIV than were infants who were exclusively breastfed for up to six months.
Artificial feeding is expensive and carries risks of additional illness and death, particularly where the levels of infectious disease are high and access to safe water is poor. Formula-feeding poses many practical challenges for mothers in developing countries, including ensuring the formula is mixed with clean water, that dilution is correct, that enough formula can continually be acquired and that the feeding utensils, especially if bottles are used, can be adequately cleaned.
Formula is not an acceptable substitute for breast milk because formula, at its best, only replaces most of the nutritional components of breast milk: it is just a food, whereas breast milk contains antibodies from the mother that protect the child and that simply cannot be included in formula.