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The Trend Away from Breast Feeding in a Developing Country
A Women's Perspective
*Huda Zurayk is Associate Professor of Public Health Statistics in the Department of Epidemiology and Biostatistics of the Faculty of Health Sciences of the American University of Beirut.
Hiam Shedid is Research Assistant in the same Department.
In this paper we have analyzed information on the breast-feeding patterns of women living in the South of Lebanon. We have demonstrated less practice of breast-feeding of infants among women who have moved away from the influence of traditional culture, either by education or by residence in an urban area.
In investigating why these women were giving up the traditionally supported and beneficial way of infant feeding, we have concentrated on the issues related to breast-feeding which affect the woman herself. The most important factors we have found that could have contributed to the decline of breastfeeding are:
- 1. Women seem to perceive breast-feeding to have a negative effect on their health. This attitude is probably a result of many factors among them the illnesses associated with pregnancy, the excessive number of pregnancies combined with prolonged breast-feeding and the energy expenditure because of a heavy work load for women. It certainly merits further investigation through more detailed questions. Nevertheless, this attitude may be causing women who move away from the influence of traditional culture to want to reduce their breastfeeding. It points, thus, to the importance of childspacing, and of maternal health, nutrition and well-being to the successful process of breast-feeding.
- 2. An inadequate milk supply was an important reason given by the women for early weaning. Lack of milk could have resulted from the interference of the social and psychological pressures of a changing environment with the let-down reflex and with prolactin secretion. Moreover, it could have resulted from the trend among educated and urban women to breast-feed on schedule as well as to use oral contraceptives while breast-feeding.
- 3. A majority of educated and urban women reported having been delivered by a trained midwife or by a physician. However, trained health personnel do not seem to be taking advantage of the contact they have with the mothers at delivery to advise and support them in the establishment of lactation. Such support is particularly important for women who are living in a changing environment. The basic question to investigate, of course, is whether the health and medical education processes are providing medical and health personnel with the proper information and with the motivation to spend the time and the effort required to guide the mothers through a successful experience of breast-feeding.
- 4. Some women, mostly rural women, reported weaning their infant prematurely because they got pregnant while breast-feeding. Such pregnancies result from an improper use of contraception postpartum.
Based on these findings the following recommendations seem to be in order:
- 1. There is a need for education campaigns to be organized both in "traditional" and "modernizing" culture in developing countries that are supportive of the traditional practice of breast-feeding. Such campaigns should be concerned with the woman's perspective on breast-feeding as much as with the infant's.
- 2. There is a need for an improved maternal health care system, for a higher level of nutrition and for a reduced physical stress load, for women in developing countries. Moreover, family planning programs active in developing countries should make proper breast-feeding of infants a major concern in their work. They should advise the women, and make it possible for them, to space their children both for the benefit of the women, particularly in terms of their health, and for the benefit of their infants, in terms of proper feeding and care. As such an acceptable method of contraception post-partum, which does not inhibit lactation, should be made available to women by these programs.
- 3. There is certainly a need for more attention given to the process of breast-feeding in the curriculum of education programs for health personnel, and more effort in convincing health practitioners of their essential role in sustaining this important traditional practice of infant feeding.
- 4. Finally, further research is certainly needed which focuses on the woman, her perceptions and her changing needs as her role in society develops, in order that action may be taken to make it possible for her to continue the historical and natural function of breast-feeding.