Why are fewer women breastfeeding in SA despite its enormous benefits?

While global exclusive breastfeeding rates have seen a slight increase in recent years, South Africa is still lagging behind with a concerning decline in exclusive breastfeeding rates from 32% in 2016 to 22% in 2024. Civil society and the Department of Health say the current trend means the country is unlikely to achieve the World Health Assembly breastfeeding target of at least 50% by the end of 2025, and 70% in 2030 unless women receive support beyond education campaigns.

The Department of Health in collaboration with various stakeholders hosted an event to mark  the beginning of World Breastfeeding Week at Loftus Park Shopping centre in Pretoria on 1 August 2025. It aimed to intensify awareness about the long-term health benefits of exclusive breastfeeding for both the mother and child, as part of ongoing efforts to increase the rate of breastfeeding in the country. 

Multiple factors contribute to the decline in breastfeeding. Chantell Witten, the health systems director at iLifa Labantwana with expertise in breastfeeding and nutrition, told Daily Maverick that some of these factors were lack of support, income and formula marketing through health centres and professionals.  

“Given the lack of maternity protection and stable employment opportunities, South African mothers are not protected to enjoy a successful breastfeeding journey. Furthermore, the insidious marketing of formula through health professionals undermines government efforts to promote, support and protect breastfeeding,” said Witten.

World Breastfeeding Week is a global movement aimed at promoting breastfeeding and creating a conducive environment that supports mothers who breastfeed their babies, ultimately contributing to their wellbeing.

Speaking to Daily Maverick, Edzani Mphaphuli, the Executive Director of Grow Great Campaign, said the first 1,000 days, from conception to a child’s second birthday, were the most important for shaping lifelong health, learning and wellbeing. 

“During this period, the brain develops rapidly, and the foundations for emotional, cognitive and physical growth are laid. If children are undernourished or neglected during this time, they risk becoming stunted. Stunting has irreversible effects on brain function, school performance and future productivity. Breastfeeding plays a central role in preventing stunting. It provides complete nutrition, supports immunity, and fosters emotional bonding. Supporting mothers to breastfeed is not just about nutrition, it is about brain development, emotional security, and human potential. Every child deserves the chance to grow great from the very beginning, and that means ensuring their mothers are nourished, supported and cared for too,” Mphaphuli said.

Shared responsibility

So this makes the decline concerning for the department, health and nutrition practitioners and civil society organisations in the space. The department says exclusive breastfeeding is a shared responsibility, “extending beyond just the role of mothers, with families, communities, healthcare systems and employers having important roles to play. Breastfeeding is not just about reaching country and global targets, but also about supporting infant health and development, as well as maternal wellbeing.” 

Witten echoed this point, saying breastfeeding promotion and support programmes had multiple benefits, such as “saving children’s lives, better health outcomes, lower economic and environmental impact. It’s good for mothers, children and the economic development of the country… Programmes to support mothers and their children are not prioritised, and  (mothers should be) protected from profit-driven industries like the formula industry,” said Witten.

Significant impact

A mother’s nutrition does not drastically affect the quality of breast milk, but it has a significant impact on her ability to continue breastfeeding. 

Mphaphuli said the campaign aimed to reduce child stunting and malnutrition through multiple programmes and interventions. She added that mothers’ bodies prioritised the baby “drawing nutrients from the mother’s own reserves, often depleting her energy, muscle, and bone mass. Without proper food, mothers feel exhausted, anxious, and overwhelmed. Breastfeeding is physically demanding, and doing it while hungry can be debilitating,” says Mphaphuli.

In a written response to Daily Maverick, Mphaphuli said that many mothers supported by Grow Great’s Flourish programme and community health workers reported stopping breastfeeding due to hunger and stress. 

“Hunger increases cortisol in the mother’s body — this stress hormone transfers into breast milk, leaving babies fussy and colicky, which creates a cycle of emotional strain. This cycle makes breastfeeding even harder. What a mother eats while breastfeeding is determined not just by knowledge, but by what she can afford. Finances drive dietary choices. When money is tight, nutritious foods like fruit, vegetables, protein and dairy are often replaced with cheaper, calorie-dense but nutrient-poor alternatives. Financial support is therefore essential to help mothers eat well and breastfeed with confidence. Without it, the risk of burnout, poor mental health, and early breastfeeding cessation increases, contributing to poor growth and stunting in infants, especially in vulnerable households,” Mphaphuli said.

The Grow Great Flourish programme is an intervention supporting breastfeeding and early child development in South Africa. It provides antenatal and postnatal support groups, led by trained local women who are mothers themselves. Mphaphuli said the programme demystified breastfeeding, covering topics like how milk was produced, how to latch, and how to manage common challenges. 

“The safe, non-judgmental environment encourages mothers to ask questions and support each other. Beyond the sessions, WhatsApp groups keep the community connected, allowing mothers to share concerns and receive encouragement around the clock. Nearly all Flourish moms breastfeed, and 62% do so exclusively. This stands in stark contrast to the national average. Grow Great also trains community health workers to deliver in-home breastfeeding support. These workers reinforce critical messages and help mothers persevere. Together, these programmes are preventing stunting by ensuring that babies receive the best start in life, beginning with breast milk.”  DM