Sweden 38 chapter title goeS here
S av e t h e c h i l D r e N · S tat e o F t h e Wo r l D ’ S M ot h e r S 2 0 1 2 39 BreaStFeeDiNg iN <strong>the</strong> iNDUStrialiZeD WorlD In developed countries, breastfeed<strong>in</strong>g usually is not critical to an <strong>in</strong>fant’s survival, as it often is <strong>in</strong> impoverished develop<strong>in</strong>g countries. Uncontam<strong>in</strong>ated, nutritious alternatives to breast milk are readily available <strong>in</strong> wealthier countries, and while malnutrition does exist, it is relatively uncommon. Still, breastfeed<strong>in</strong>g has many benefits for mo<strong>the</strong>rs and babies, and more can be done to support mo<strong>the</strong>rs who want to breastfeed. Accord<strong>in</strong>g <strong>the</strong> World Health Organization, exclusive breastfeed<strong>in</strong>g for <strong>the</strong> first six months is best for babies everywhere.132 Babies who are fed formula and stop breastfeed<strong>in</strong>g early have higher risks of illness, obesity, allergies and sudden <strong>in</strong>fant death syndrome (SIDS).133 They tend to require more doctor visits, hospitalizations and prescriptions.134 Various studies also suggest breastfeed<strong>in</strong>g enhances a child’s cognitive development.135 While health professionals agree that human milk provides <strong>the</strong> most complete form of nutrition for <strong>in</strong>fants, <strong>the</strong>re are a few exceptions when breastfeed<strong>in</strong>g is not advised, such as when <strong>the</strong> mo<strong>the</strong>r is tak<strong>in</strong>g certa<strong>in</strong> drugs or is <strong>in</strong>fected with HIV or tuberculosis.136 Mo<strong>the</strong>rs who breastfeed have lower risks of breast137 and ovarian138 cancers. Breastfeed<strong>in</strong>g delays <strong>the</strong> return to fertility and helps a mo<strong>the</strong>r lose <strong>the</strong> weight she ga<strong>in</strong>ed while pregnant. In <strong>the</strong> long term, breastfeed<strong>in</strong>g reduces <strong>the</strong> risk of type 2 diabetes.139 It also <strong>in</strong>creases <strong>the</strong> physical and emotional bond between a mo<strong>the</strong>r and her child. In all countries of <strong>the</strong> world, it is cheaper to breastfeed than to feed a baby formula or o<strong>the</strong>r milk. Breastfeed<strong>in</strong>g is also <strong>the</strong> most environment-friendly way to feed a baby. Breast milk does not require packag<strong>in</strong>g, storage, transportation or refrigeration. It generates no waste, is a renewable resource, and requires no energy to produce (except of course, <strong>the</strong> calories burned by <strong>the</strong> mo<strong>the</strong>r’s body). Op<strong>in</strong>ions vary on <strong>the</strong> benefits of breastfeed<strong>in</strong>g mixed with o<strong>the</strong>r foods <strong>in</strong> <strong>the</strong> early months of a baby’s life. While some breast milk is seen as better than none, a number of recent studies have suggested that <strong>the</strong> immunity benefits for babies come only with exclusive breastfeed<strong>in</strong>g.140 Despite <strong>the</strong>se many known benefits of breastfeed<strong>in</strong>g for mo<strong>the</strong>rs and <strong>the</strong>ir children, significant percentages of women <strong>in</strong> developed countries do not breastfeed optimally. In Belgium and <strong>the</strong> United K<strong>in</strong>gdom, only about 1 percent of children are exclusively breastfed for <strong>the</strong> first 6 months. In Australia, Canada, F<strong>in</strong>land, Italy, Norway, Sweden, <strong>the</strong> United States and several o<strong>the</strong>r countries, 15 percent or fewer of children have 6 months of exclusive breastfeed<strong>in</strong>g. Even <strong>the</strong> “best” countries <strong>in</strong> <strong>the</strong> <strong>in</strong>dustrialized world have exclusive breastfeed<strong>in</strong>g rates well below 50 percent.141 Poor compliance with breastfeed<strong>in</strong>g recommendations costs <strong>the</strong> world economy billions of dollars each year. In <strong>the</strong> United States alone, it is estimated that low rates of breastfeed<strong>in</strong>g add $13 billion to medical costs and lead to 911 excess deaths every year.142 In <strong>the</strong> United K<strong>in</strong>gdom, it was estimated <strong>in</strong> 1995 that <strong>the</strong> National Health Service spent £35 million per year <strong>in</strong> England and Wales treat<strong>in</strong>g gastroenteritis <strong>in</strong> formula-fed <strong>in</strong>fants and that, for every 1 percent <strong>in</strong>crease <strong>in</strong> breastfeed<strong>in</strong>g at 13 weeks, £500,<strong>000</strong> would be saved.143 The reasons why women don’t breastfeed are varied and complex. In most developed countries, <strong>the</strong> majority of women report <strong>the</strong>y try to breastfeed, but <strong>the</strong>n at 3 months a significant percentage are not breastfeed<strong>in</strong>g exclusively, and at 6 months many have stopped nurs<strong>in</strong>g (see table on p.43). Mo<strong>the</strong>rs who want to breastfeed may become frustrated by physical challenges or <strong>the</strong> amount of <strong>the</strong> double Burden: hunger and obesity Childhood overweight and obesity are on <strong>the</strong> rise <strong>the</strong> world over. This is a grow<strong>in</strong>g problem <strong>in</strong> both rich and poor countries alike, with <strong>the</strong> poorest people <strong>in</strong> both affected most. People with lower <strong>in</strong>comes tend to consume more fat, meat and sugar, while those with higher <strong>in</strong>comes consume more fruit and vegetables. <strong>Children</strong> who are not breastfed are at higher risk of obesity. In addition, breastfeed<strong>in</strong>g for at least <strong>the</strong> first six months of life appears to be a factor protect<strong>in</strong>g aga<strong>in</strong>st obesity. obesity.144 144 In <strong>the</strong> United States, 10 percent of children under age 5 are overweight and an additional 10 percent of 2- to 5-year-olds are at risk of overweight. overweight.145 145 Among o<strong>the</strong>r developed countries with available data, <strong>the</strong> highest levels of child overweight (around 20 percent or more) are found <strong>in</strong> Albania, Bosnia and Herzegov<strong>in</strong>a, Georgia and Serbia. Serbia.146 146 Some of <strong>the</strong>se countries also have large numbers or high percentages of stunted children. In <strong>the</strong> United States, for example, 4 percent of young children are estimated to be stunted, which translates <strong>in</strong>to 840,<strong>000</strong> stunted children. children.147 147 Stunt<strong>in</strong>g rates are over 10 percent <strong>in</strong> Bosnia and Herzegov<strong>in</strong>a and Georgia. In Albania, <strong>the</strong> rate is over 20 percent. percent.148 148 Although be<strong>in</strong>g overweight is a problem most often associated with <strong>in</strong>dustrialized countries, obesity has been on <strong>the</strong> rise <strong>in</strong> develop<strong>in</strong>g countries <strong>in</strong> recent years as well. This has lead to a “double burden” of malnutrition, where countries have high rates of both stunt<strong>in</strong>g and overweight. In Comoros, for example, 22 percent of young children are overweight, while around half are stunted. In Egypt, 21 percent of children under 5 are overweight while 31 percent are stunted. Libya has stunt<strong>in</strong>g and overweight rates above 20 percent. O<strong>the</strong>r countries with serious levels of both extremes of malnutrition <strong>in</strong>clude: Azerbaijan, Belize, Ben<strong>in</strong>, Botswana, Central African Republic, Djibouti, Indonesia, Iraq, Malawi, Mongolia, Morocco, Nigeria, Peru, Sierra Leone and Syria. Syria.149 149