“Economically, it just makes sense to breastfeed because you save a whole lot of money on breastfeeding, not only because you won’t have to buy formula, you are also not going to have a sickly baby,” said Phunyuka Bvuma-Ngwenya, a dietitian and certified lactation consultant.  

Bvuma-Ngwenya was speaking at a Daily Maverick webinar discussion on how breastfeeding can stem malnutrition and childhood stunting. The discussion was facilitated by Maverick Citizen journalist Zukiswa Pikoli and also included Dr Chantell Witten, a senior lecturer at the University of the Witwatersrand and chairperson of Heala. 

Breastfeeding is one of the most effective ways to ensure a child’s health and survival. Breastfed children perform better on intelligence tests, are less likely to be overweight or obese, and are less prone to diabetes later in life. Other benefits extend beyond the breastfeeding period, such as contributing to the baby’s IQ. 

“The benefits of breastfeeding are immense, and are not just nutritional benefits only,” said Bvuma-Ngwenya. 

Breastfeeding vs formula

However, contrary to World Health Organization (WHO) recommendations, less than half of infants under six months old are exclusively breastfed. Inappropriate marketing of breast milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide. 

The only benefit when looking at formula milk, Bvuma-Ngwenya said, is:  “The baby will be fed. That it is and it ends there, so you are not going to compare the two as they cannot be compared at all.”  

The evidence is clear that formula feeding carries a higher risk of disease and of negative economic impacts, but there are instances where individual mothers may need it. 

“So, if a mom has any problem where she is not able to breastfeed because she is sick or she is separated from her baby, of course, there is a place for formula,” she said. 

Pikoli asked what happens to mothers who are unable to breastfeed their children and feel that they have no other option but to use formula milk. Looking at all the possible avenues to get help when struggling with breastfeeding is important, said Bvuma-Ngwenya. 

“Breastfeeding needs a lot of support, you need a lot of support from all spheres — from your family, from your colleagues, your community, everybody has to be there,” she said. 

There are instances where despite all the help and support, babies are not able to be breastfed and that is when formula can be used. “If the mother has passed on, who is going to feed that baby? We also have mothers who deliver and are in ICU, for a short period we can use donor milk, but it will not be sustainable over a long period of time,” she said. 

Support structures necessary for breastfeeding 

Witten said that support for breastfeeding mothers needed to be looked at on three levels: the mother in her own family; the health system; and the sociocultural context or society. 

The home environment has to be conducive, both to the pregnant woman and when she is a breastfeeding mother. Research indicates that this is not often the case, Witten said. “They are still the main breadwinners, the ones who have to do the chores, the work at home and take care of themselves,” she said. 

This causes a significant amount of stress for mothers, and when stressed the body increases the production of corticosteroids, which are hormones that do not support breastfeeding milk production. 

In the sociocultural context, formula was a significant part of the health system. 

“In the PMTCT [Prevention of Mother-to-Child Transmission] programme, we can’t ignore that we were giving free formula for 10 years. We gave the message that it is better to formula-feed if you don’t know your HIV status, so formula is very much part of our norm,” she said. 

‘Selling happiness in a tin’

Witten described the marketing of formula products as “insidious” and “conniving”. Formula products, which do not offer help or health, are marketed with phrases like “Your baby will sleep longer, your baby will be happier, and you will be happier”. 

“We are selling happiness in a tin, and until we can tackle all of these issues, I think our mothers are comprised and they are unprotected because the support systems, starting from the household levels all the way to the societal levels, are not there,” Witten said.   

Read more in Daily Maverick: WHO releases SA-specific report on manipulative formula milk marketing tactics 

The formula industry and current regulations 

Although it has been more than a decade since the discontinuation of free formula distribution as part of the PMTCT programme, and a decade of the Regulations Relating to Foodstuffs for Infants and Young Children — the R991 — to regulate the inappropriate marketing of foods that displace breastmilk, formula feeding is still ubiquitous in South Africa. Witten says infant formula companies use creative ways to infiltrate health professionals. 

“I am in an academic institution, so the formula companies offer scholarships, continuous professional development opportunities, exposure for students to come and see how the milk is being made, and they offer lecturers to come to learning opportunities,” she said. While this all seems helpful and educational, that is not the case. 

“What we know from the WHO report, often this research that the infant company or the formula companies are using is biased, it is their own research. So, they are selling a product based on their own research,” Witten.  

Nutrition before giving birth 

Mothers are told at healthcare facilities to eat well, eat fruits and vegetables, and drink milk and water. Witten said with 60% of South Africa’s population living below the poverty line, many cannot eat well. Many mothers have voiced concerns about how their eating habits will influence their breast milk. 

“They don’t value their own milk because they have been brainwashed to say that ‘your body is not good enough to make a good product, try this in a tin’, and that to me is what we need to protect women against,” she said. 

Bvuma-Ngwenya said that when she sees this playing out, she finds out what women understand about their bodies and nutrition. Some mothers have expressed hesitancy about breastfeeding because they are worried about passing a chronic illness to their babies, and Bvuma-Ngwenya has had to explain that they will be protecting their babies if they breastfeed. 

If you as a mother are deficient in certain nutrients, your body is going to take what is stored in your body to make the nutrient for the baby, said Bvuma-Ngwenya.  

“If you need to make calcium for your baby, and you don’t have enough calcium in your diet, you are going to start extracting calcium from your bones. That is why it’s very important that our mothers eat correctly because otherwise they will end up with long-term nutritional deficiencies,” she said. 

Stigma around feeding

The commercialisation and modification of breastfeeding, which now includes having a lactation consultant, a doula, and a sleep therapist, has created a new stigma associated with breastfeeding. 

“Now the stigma is if you don’t breastfeed, you are not a good mommy,” said Witten. “We see that breastfeeding is increasing in the high-income groups. More high-income women can breastfeed because they get maternity leave, they get the health, they have a lactation consultant, they have a doula and a pro-breastfeeding paediatrician,” she said.  

Celebrating breastfeeding

It’s World Breastfeeding Week from 1–7 August and the theme this year is “Let’s make breastfeeding at work, work”. 

Bvuma-Ngwenya called on employers to support breastfeeding mothers in the workplace. 

“Most South Africans are not aware of our policy that allows mothers to breastfeed while they’re at a workplace or to express milk while they’re in the workplace for at least six months,” she said.  

Supporting breastfeeding mothers instead of making them feel bad is also important. 

“Some mothers want to express [their milk] but then they are told, ‘You’re not going to put your breast milk in the fridge that we share with everybody else.’ The milk is in the container, they’re not asking you to drink their milk, please let them put it in,” she said. 

Being critical of the information you receive is encouraged, and so is questioning your health professionals, Witten said. “Question your health professionals. You can ask the doctor or your dietician if they have seen a rep in the last 30 days because it will influence what they tell you,” she said.  

Witten appealed for everyone to be a breastfeeding advocate. “You can give support; when you see a mom who is breastfeeding, give her a nod, give her a smile, give her a thumbs-up because we need to build this breastfeeding culture,” she said. DM