Breastfeeding and complementary infant feeding, and the postpartum effects of breastfeeding

Additionally, trends in breastfeeding and its postpartum effects are examined using data from 27 countries where two or more DHS or World Fertility Survey (WFS) studies were conducted between 1975 and 1996. Analyses from the 37 DHS countries indicate that breastfeeding is almost universally practiced in most developing countries, and that first-year and second-year breastfeeding continuation rates have increased markedly over the past 20 years in the majority of countries studied. The trends in increased breastfeeding among countries with multiple DHS (or WFS) surveys suggest that the vigorous international and national efforts of the past two decades -- particularly the 1980s -- to promote breastfeeding have been effective in increasing the numbers of children breastfed and in prolonging the duration of breastfeeding in the first 2 years. However, breastfeeding and complementary feeding practices critical to child health and survival are far from optimal. Although almost all children are breastfed from birth, few are put to the breast immediately after birth, and in some countries almost half of children are put to the breast later than the second day after birth. Newborns not only are deprived of the beneficial effects of colostrum, but are at greater risk of being given prelacteal liquids that lead to diarrhea. Fewer than half of all infants under 4 months are exclusively breastfed, and by 5 months of age the prevalence of exclusive breastfeeding is in the single-digit range in all but a handful of countries. By 6-9 months of age, only about half the children are fed complementary foods, and among these the frequency of giving milk, meat, and other protein-based foods is low. Although breastfeeding through the first year of life is practiced widely in all regions, just over half the children in sub-Saharan Africa and Asia, and about a fourth of the children in Latin America/Caribbean and the Near East/North Africa, are breastfed through the second year. In some of the poorest countries in Asia, breastfeeding is prolonged beyond the third year, suggesting a lack of complementary foods. Bottle feeding of infants is not commonly practiced except in Latin America/Caribbean, where rates as high as 60-85% are reported. Bottle feeding appears to increase as countries advance along the economic development scale. National policies to improve child health, nutrition, and survival should focus on the crucial areas of initial breastfeeding immediately after birth, exclusive breastfeeding for about the first 6 months of life, appropriate complementary feeding from around the age of 6 months onward, and continued breastfeeding until the age of 2 years. In terms of postpartum effects, breastfeeding clearly prolongs postpartum amenorrhea and thus insusceptibility to pregnancy. This insusceptibility is highest in sub-Saharan African and shortest in the Near East/North Africa region. Few breastfeeding women in any region meet lactation amenorrhea method (LAM) criteria, although at least 75% of breastfeeding women in most countries say they breastfeed to avoid pregnancy. Efforts to increase exclusive breastfeeding, prolong the durations of breastfeeding and postpartum sexual abstinence, and improve understanding of LAM criteria among women and health-care providers are urgently needed in countries where contraceptive use is low. (Author abstract, modified)