“When I am hungry, I even breastfeed her my hunger.” These were the words of one of my research participants back in December 2018. Long before Covid-19’s arrival.

It’s World Breastfeeding Week 2020, the annual global campaign to raise awareness about the importance of breastfeeding. The campaign has, since 1992, called on governments and all sectors of society to promote, protect and support breastfeeding.  

Much of the world has suboptimal breastfeeding rates, despite global and local breastfeeding promotion efforts. This year’s global theme is, “Support breastfeeding for a healthier planet”. Locally, the national Department of Health’s theme is, “Support breastfeeding for a healthier South Africa”. 

But the question remains. How can we call on women to breastfeed when, in so many cases, their circumstances are far from favourable to allow them to breastfeed successfully, much less optimally?

Breastfeeding provides lifelong benefits and therefore any investments in its support and promotion will have multiple returns – but if we want to meet our sustainable development goals, women and children must be prioritised.

It is the women in South Africa who bear the brunt of poverty, unemployment, abandonment and hunger. While this was revealed in the “shocking” findings of the recent NIDS-CRAM study, it’s a situation that has existed for decades.  

In fact, one of the first post-apartheid health surveys reported in 1998 that breastfeeding rates were suboptimal, with only 7.2% of infants under six months being breastfed exclusively: the breastfeeding duration was about 15 months.  

We acknowledge that HIV had a massively negative impact on breastfeeding in South Africa, but since 2011, South Africa has introduced lifelong antiretroviral treatment for all pregnant HIV-positive women to render breastfeeding safe. Since then, all women are encouraged to breastfeed exclusively for the first six months, and to continue breastfeeding until two years of age.  

Despite this, a demographic health survey in 2016 listed the highest proportion of children never breastfed at 25%, and although that’s a significant five-fold increase since 1998, only a third of infants under six months were breastfed exclusively.

My PhD research involved exploring the psycho-social barriers and enablers of exclusive breastfeeding rates in a cohort of mothers with infants aged two to 24 weeks.  The highlights of my research were that mothers were well aware of the benefits of breastfeeding, and mothers viewed breastfeeding as good mothering which brought them joy and contentment – but amidst all these positive feelings were the hostile home and social environments mothers experienced.  

Not having sufficient food in the home to help mothers make “enough” breast milk was a strong barrier to their breastfeeding intentions.  Mothers had also completely internalised the nutrition education they received from clinics that good health required a good diet. In the absence of a good diet, mothers questioned the nutritional value of their breast milk. In the absence of a supportive home environment, ranging from absent partners, demanding family and cultural practices, mothers reported feeling unsupported and unloved. 

These were disheartening findings.

If we are to really encourage women to breastfeed, then we need interventions that address the hostile environments women are confronted with.  

We need interventions that don’t come around only once a year for a week of hype and preaching to the converted. Mothers know that breast is best… mothers know about the healing and protective powers of breast milk: what mothers don’t know is how to navigate the difficulties of their lives. 

How to access food when they are hungry, while needing to produce enough breast milk for their baby. How to access nutritional food when they are reliant on already stretched households to provide them with much needed food like meat, milk and vegetables.

How to respond when their partner leaves them, or when their family considers them and their baby a burden.  

We need food support for pregnant and breastfeeding mothers and young children. Food support that will help alleviate the increasing levels of stunting and obesity in children. 

These are not new issues; they have been with us for decades. It’s up to government and all sectors of society to start putting women and their children first.  

Breastfeeding provides lifelong benefits and therefore any investments in its support and promotion will have multiple returns – but if we want to meet our sustainable development goals, women and children must be prioritised.  

If we hope to encourage breastfeeding, we need to improve the poor socio-economic conditions experienced by so many women. Healthier environments for women will mean a healthier planet for all. DM

Chantell Witten is a lecturer at the University of Free State and serves as the Chairperson for the Child Health Priorities Association and the Nutrition Lead for the South African Civil Society for Women’s, Adolescent’s and Children’s Health (SACSoWACH).