Safe as milk

To mark Mother's Day, Life talks to a nutritional expert about the current breastfeeding situation in Thailand

Breast milk is the best food for babies. It has a myriad of health benefits: it's an immunity booster, the most complete form of infant nutrition, great for the brain, the list goes on.

Advisor to Mahidol University's Institute of Nutrition Assoc Prof Prapaisri Sirichakwal says that, although Thais have a much better understanding of the benefits of breastfeeding than they used to, there are still several hindrances that prevent mothers from breastfeeding their newborns.

"Thailand has much better public awareness when it comes to breastfeeding. The majority of people now know it's good not just for babies but also for new mums. But when it comes to the reality, breastfeeding isn't practised as much as it should be," said Prapaisri.

There is no data as to the number of breastfeeding mums in Thailand currently. The most recent figures from the Ministry of Public Health date from 2012, when approximately 23% of Thai women continued exclusive breastfeeding -- meaning infants were only fed breast milk -- for the first six months after they gave birth.

Unicef, however, has provided statistics for the global situation last year. According to Unicef IYCF Global Database, which covers infant and young child feeding, and the 2019 Global Breastfeeding Scorecard, around 41% of babies around the world were exclusively breastfed for the first six months in 2018. Breastfeeding rates were higher in less developed nations, with the highest rates in Rwanda (86.9%), Burundi (82.3%), Sri Lanka (82%), the Solomon Islands (76.2%) and Vanuatu (72.6%).

Prapaisri says that there are various reasons why so many women in Thailand don't exclusively breastfeed for six months as recommended. The first of these is the fact that there may be concerns over the health of the mother herself.

"Some new mothers are worried about their own health. Many are overly anxious that they might not be producing enough milk," said Prapaisri.

Other challenges facing breastfeeding mothers are associated with a lack of facilities in the workplace or in public areas. Although an increasing number of offices now provide designated breastfeeding areas and breast milk storage, many more still lag behind.

In addition, Thai law only allows for 90 days of maternity leave. So when new mothers return to work, many can no longer breastfeed exclusively.

Thailand implemented the Control of Marketing of Infant and Young Child Food Act in 2017, banning all advertising for infant formula and other food products for infants and young children. Prior to this, many mothers would have found such advertising attractive, especially those who are concerned about their physical health.

"After repeatedly seeing such advertisements, many started to believe that infant formula could provide better nutrition for their newborns than their own breast milk," Prapaisri explained. "Alongside doubts over whether they were practising healthy eating habits, many mothers misunderstood the chemical terms used in the commercials, thinking the formula was healthier than their own milk."

Breast milk is known to be able to provide adequate nutrition for newborns during the first six months of life. Yet Prapaisri still believes infant formula isn't all bad.

"Mothers who are worried about their health and milk supply should talk to a specialist first before using infant formula," she stressed. "Let the doctor assess whether it's necessary. Mental stress and worry can lead to a reduction in milk supply. Together with expectations from relatives and loved ones, in many cases, new mothers become too stressed out, affecting how much breast milk they produce."

The Control of the Marketing of Infant and Young Child Food Act, according to Prapaisri, has been successful in curbing campaigns by infant formula manufacturers, who would reach out to pregnant women and new mums by offering promotional freebies, discounts or other customer privilege. Even so, she is of the opinion that it is still vital for medical personnel in the country to have thorough understanding and knowledge with regard to infant formula in case they need to recommend it to certain mothers who suffer medical conditions or milk supply shortage.

Now, the Ministry of Public Health has set a new target for exclusive breastfeeding for the first six months: 50%. The 2017 Act has helped to lay the groundwork, but more measures still need to be implemented in order to promote breastfeeding and achieve such targets.

"Workplace facilities to support breastfeeding should be put in place," advised Prapaisri. "More active breastfeeding campaigns should be launched. Health volunteers in hospitals and in communities should help give new mums a better understanding of the benefits of breastfeeding and should help pregnant women get ready to breastfeed right after labour.

"We must spread the word as much as possible with regard to how good breast milk really is. Artists and celebrities can play their part by helping to advocate breastfeeding. When new mothers see that these celebrities are still in great shape even after breastfeeding, they would stop believing that breastfeeding mums are fat. Breastfeeding celebrities can be their role models."

Initiate breastfeeding within one hour of birth.

Introduce nutritionally adequate and safe solid foods at six months, together with continued breastfeeding up to two years of age or beyond.

Upper-middle-income countries have the lowest breastfeeding rates.

Availability of longer maternity leave could mean higher chances of breastfeeding.

Increasing breastfeeding could help prevent 823,000 annual deaths in children under five and 20,000 annual deaths from breast cancer, making it beneficial to both infants and mothers.

According to the 2019 Global Breastfeeding Scorecard, not enough babies breastfeed in the first hour. In 2018, less than half of babies worldwide were breastfed within the first hour of life.

Immediate skin-to-skin contact and early breastfeeding keeps a baby warm, builds immunity, promotes bonding and helps boost a mother's milk supply.

The first milk, or colostrum, is rich in antibodies which help protect babies from disease and mortality.

If optimal breastfeeding were achieved, there would be an estimated reduction in global healthcare costs of US$300 billion.

Information from the WHO and Unicef.