Breastfeeding: A Review of the Challenges & Benefits

Breast milk is recommended as the best source of nutrition for infants. It is safe and contains important nutrients necessary for infant growth and development. According to the World Health Organization, close to a million lives of children under 5 years could be saved every year if all children were adequately breastfed (World Health Organization[WHO], 2023). Despite these benefits, over 7 million children do not receive breastmilk each year globally and 1 out of every 5 babies are not breastfed in high-income countries (United Nations Children’s Fund, 2018). In the United States, most infants receive some breast milk after birth. However, only a few are exclusively breastfed for six months. About 24.9% of babies born in 2019 in the United States were exclusively breastfed and 55.8% received any breast milk at all by the sixth month (Centers for Disease Control and Prevention[CDC], 2022).

Breastfeeding recommendations/guidelines

The American Academy of Pediatrics and the WHO recommend exclusive breastfeeding of infants for the first 6 months after birth (Meek & Noble, 2022; WHO, 2023). Exclusive breastfeeding means giving infants only breast milk, without any foods, liquids, or water except for medication and nutrient supplements (WHO, 2009a). Exclusive breastfeeding promotes healthy growth and protects infants from infections. The WHO also recommends the initiation of breastfeeding within one hour after delivery (WHO, 2023). Early initiation of breastfeeding after birth reduces the risk of infant mortality (Edmond et al., 2016). Mothers are encouraged to introduce appropriate complementary foods from the age of 6 months while continuing breastfeeding up to the age of 2 years or beyond for the best health outcomes in children (WHO, 2023).

Benefits of breastfeeding

Breastfeeding has numerous benefits for the baby, the mother, and society:

• Nutritional benefits: Breast milk contains whey and casein proteins which provide important amino acids for growth and development. It contains lactose as the main carbohydrate and some oligosaccharides. Breast milk is also rich in lipids, vitamins, minerals, and water (WHO, 2009b). Water makes up almost 90% of breast milk and allows the suspension of nutrients and other milk components (Kim & Yi, 2020). Breastmilk is easily digested in the baby’s gut, and the nutrients are in the right balance tailored to the baby’s nutritional needs (WHO, 2009a).
• Immunologic benefits: Breast milk contains important immune components that protect infants from infections including secretory immunoglobins IgA, IgG, IgM, white blood cells, proteins, and enzymes. Colostrum, the thick, yellow milk produced during the first few days after delivery is particularly rich in these immune-boosting components that strengthen the baby’s immune system (Kim, 2021).
• Chronic disease prevention: Breastfed babies are less likely to become overweight, obese, or develop diabetes later in life compared to non-breastfed babies (WHO, 2023).
• Cognitive benefits: Exclusive breastfeeding is associated with good cognitive and behavioral outcomes in children (Couto et al., 2020). Breastfed children perform better in cognitive tests and reach developmental milestones faster than non-breastfed babies (Jeong et al., 2018).
• Maternal benefits: Breastfeeding decreases the risk of breast cancer, ovarian cancer and other chronic conditions in mothers (Westerfield et al., 2018). Oxytocin, a hormone released during lactation relieves maternal pain, reduces postpartum depression and promotes recovery from labor. Lactation also helps with pregnancy spacing as it can suppress the hormones responsible for ovulation (Del Ciampo & Del Ciampo, 2018).
• Socio-economic benefits: In addition to breast milk being free, the positive health outcomes due to breastfeeding can reduce medical costs for families and the healthcare system in general (Quesada et al., 2020). Low breastfeeding rates contribute over $3 billion a year to the United States healthcare expenditure for both mothers and babies (CDC, 2023).

Barriers and challenges to effective breastfeeding

Some conditions might make breastfeeding difficult for mothers. These include:

• Breast pathology including inverted nipples, sore nipples engorged breasts and mastitis
• Maternal depression
• Lack of maternal support system
• Improper latching
• Tongue tie
• Cleft palate

Ways of addressing breastfeeding barriers

While the above challenges can make breastfeeding difficult for mothers, the following steps should be taken to encourage breastfeeding:

• Treatment of underlying medical conditions affecting breastfeeding
• Counselling for breastfeeding mothers
• Encourage family and social support
• Expression of breast milk to feed baby
• Education on proper latching

(Modak et al., 2023)

In addition to providing individual education and support, it is important to consider cultural and societal perspectives (Modak et al., 2023). Providing inclusive education that honors cultural values is crucial to supporting breastfeeding. Normalizing and creating awareness of the importance of breastfeeding can reduce the concerns of breastfeeding parents while creating a supportive environment. Policy, including accommodations for breastfeeding in the workplace, supporting parental leave, and providing access to lactation consultants is also crucial to creating an environment supportive of breastfeeding (Modak et al., 2023).

Breastfeeding promotes healthy growth and development in babies and provides important health benefits to mothers. Breastfeeding helps to achieve the broader health goals and mothers should be given all the support they need to breastfeed their children.

References

Centers for Disease Control and Prevention. (2022). Breastfeeding Report Card. https://www.cdc.gov/breastfeeding/data/reportcard.htm

Centers for Disease Control and Prevention. (2023). About Breastfeeding. https://www.cdc.gov/breastfeeding/php/about/index.html#:~:text=Only 1 in 4 infants are exclusively breastfed as recommended,the national average of 83%25.

Couto, G., Pessoa, U. F., & Oliveira, I. (2020). Benefits of exclusive breastfeeding: An integrative review. Nursing Practice Today, 7(4). https://doi.org/10.18502/npt.v7i4.4034

Del Ciampo, L. A., & Del Ciampo, I. R. L. (2018). Breastfeeding and the Benefits of Lactation for Women’s Health. Revista Brasileira de Ginecologia e Obstetricia : Revista Da Federacao Brasileira  Das Sociedades de Ginecologia e Obstetricia, 40(6), 354–359. https://doi.org/10.1055/s-0038-1657766

Edmond, K., Newton, S., Hurt, L., & Shannon, C. (2016). Timing of initiation , patterns of breastfeeding , and infant survival : prospective analysis of pooled data from three. The Lancet Global Health, 4(4), e266–e275. https://doi.org/10.1016/S2214-109X(16)00040-1

Jeong, H., Kyoung, S., & Ra, M. (2018). Early Human Development The relationship between exclusive breastfeeding and infant development : A. Early Human Development, 127(May), 42–47. https://doi.org/10.1016/j.earlhumdev.2018.08.011

Kim, S. Y., & Yi, D. Y. (2020). Components of human breast milk: from macronutrient to microbiome and microRNA. Clinical and Experimental Pediatrics, 63(8), 301–309. https://doi.org/10.3345/cep.2020.00059

Kim, Y. J. (2021). Immunomodulatory Effects of Human Colostrum and Milk. Pediatric Gastroenterology, Hepatology & Nutrition, 24(4), 337–345. https://doi.org/10.5223/pghn.2021.24.4.337

Meek, J. Y., & Noble, L. (2022). Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 150(1), 1–15. https://doi.org/10.1542/peds.2022-057988

Modak, A., Ronghe, V., & Gomase, K. P. (2023). The Psychological Benefits of Breastfeeding: Fostering Maternal Well-Being and  Child Development. Cureus, 15(10), e46730. https://doi.org/10.7759/cureus.46730

Quesada, J. A., Méndez, I., & Martín-Gil, R. (2020). The economic benefits of increasing breastfeeding rates in Spain. International Breastfeeding Journal, 15(1), 1–7. https://doi.org/10.1186/s13006-020-00277-w

United Nations Children’s Fund. (2018). UNICEF calls for the narrowing of “breastfeeding gaps” between rich and poor worldwide. https://www.unicef.org/eca/press-releases/unicef-calls-narrowing-breastfeeding-gaps-between-rich-and-poor-worldwide#:~:text=Worldwide%2C approximately 7.6 million babies,income countries are never breastfed.

Westerfield, K. L., Koenig, K., & Oh, R. (2018). Breastfeeding: Common questions and answers. American Family Physician, 98(6), 368–373.

World Health Organisation. (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

World Health Organization. (2009a). Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals.

World Health Organization. (2009b). The physiological basis of breastfeeding. In Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals.

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