Breastfeeding introduction (work in progress to answer my questions from weeks back!)

Goal 4 of the U.N. Millennium Development Goals and Beyond 2015 is a two-thirds reduction in the under-5 mortality rate. Suboptimum breastfeeding has been identified as a major factor in under-5 mortality rates 1.4 million deaths (12% of under-5 deaths) and 43.5 million DALYs (10% of the global under-5 DALYs (Black et al. 2008). Respectively, the percentage attributed to non-exclusive breastfeeding is 77% for mortality and 88% for DALYs. Exclusive breastfeeding is recommended for the first 6 months of the infant’s life, with complementary feeding recommended after 6 months and up to 2 years. Despite these recommendations, a sizable proportion of women worldwide do not exclusively breastfeed for the child’s first 6 months. For instance, the 2011 (most recent data) U.S. rate of exclusively breastfeeding for the full 6 months is about 19% (CDC, 2011). While this number has risen steadily in recent years, the vast majority of the U.S. population does not follow the recommendation on exclusive breastfeeding. Barriers vary by region and population, but some themes have emerged. Knowledge of best practices, concerns about milk production and suitability, support (spousal, family), and structural constraints are the primary culprits. The primacy of a barrier should change by population under consideration— structural barriers such as returning to work or need to work may be more or less critical depending on the role of women in a population. In Northern Vietnam, women may be expected to return to rice paddies as soon as possible after giving birth. If time and energy are at a premium, women may be less likely to exclusively breastfeed. 

Breastfeeding exclusively for 6 months is time consuming and requires constant forethought. Frequent stimulation is needed for milk production, and milk supply takes time to become established. In the beginning, the newborn should be fed “on demand”-- maybe 8-12 times per day. By 1-2 months, this number goes down to seven to nine times per day. While pumping (using a pump to extract milk for later use or to keep up your production at times when feeding is not recommended) is a viable option for mothers, this may not be available or feasible for certain populations. Pumping requires 1) equipment, and 2) refrigeration or freezing capability. If women must return to work, pumping may be the only option for providing the infant with mother’s milk. While you may lose some of the bonding associated with feeding on the nipple, the nutrient function is still in tact. Some countries have established laws to protect new mother’s ability to express milk. In the U.S., section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) was amended in 2010 to offer some protections to nursing women:

Employers to provide break time and a place for hourly paid workers to express breast milk at work. The law states that employers must provide a "reasonable" amount of time and that they must provide a private space other than a bathroom. They are required to provide this until the employee's baby turns one year old.