Citizens can aid in strengthening infant nutrition and malnutrition

South Africa is in the grip of a malnutrition crisis that seriously impacts the health of the population’s children. 

Low and declining breastfeeding rates are fuelling childhood obesity, but there is good news: there are practical ways for society to start curbing the decline by addressing the problem at grassroots level, says Dr Chantell Witten from the DSI/NRF Centre of Excellence in Food Security at the University of the Western Cape (UWC). She is currently leading an infant and young child feeding advocacy project that aims to mitigate the effect of the unethical and inappropriate marketing of formula, to improve the levels of breastfeeding around the country.

She noted, “It is the systematic breakdown of breastfeeding in a country like South Africa that’s a concern. We should have more breastfeeding mothers given the rates of poverty in our country. We have the highest level of stunting, so we haven’t even talked about the malnutrition that comes from poor feeding. South Africa has been unable to address these long standing rates of stunting for the last 25 years; we’ve not been able to change our stunting rates because we have not been able to improve infant and young child feeding practices.

“We compare poorly to the high breastfeeding rates of other countries such as Brazil, Rwanda and our next-door neighbours like Eswatini and Botswana. 

We do not have good breastfeeding rates and we carry one of the highest burdens of childhood obesity in the world.

“On the positive side, we do know that our public health sector that is pro-breastfeeding is doing much better in supporting moms to breastfeed their infants. We do know that some mothers are missed, but society itself needs to transform and work towards supporting breastfeeding mothers and developing a public pro-breastfeeding culture. We cannot want to support breastfeeding but shame mothers who choose to breastfeed in public spaces.”

Dr Witten said the benefits are endless.  “There is evidence that breastfeeding alleviates the mental strain, stress and distress in experiences of motherhood. The hormone oxytocin calms both the mother and baby. 

“From the health perspective of the physical body, moms who have breastfed have a lower risk of ovarian cancer and breast cancer.”

But there is a lot to do to educate and turn society’s perception about breastfeeding to into a positive one. 

“I think this is where the media can play a very important role, because the more we hear about breastfeeding and the more we see issues relating to breastfeeding in the media, it will eventually change public perception and acceptance towards South Africa being a pro-breastfeeding country.

“We as citizens can stop the decline in the numbers of breastfeeding mothers. Even in the home, instead of aunts and mothers adding pressure by discouraging breastfeeding, they should become advocates in favour of breastfeeding,” she said.

With regard to legislation, she said South Africa has no laws that prohibit women from breastfeeding anywhere, at any time, but we do have laws that allow private property to reserve their right as they see fit.

“If you are in a private facility, this may be stated as ‘rights are reserved’. But it is for us as a collective to respond to hostile experiences in retail stores, in airlines, and at hospitals – even when women are asked not to breastfeed in the medical waiting rooms. 

“Even a small room behind a curtain is unacceptable, because freedom of eating for anyone is not constrained, so we don’t want to constrain it, even for children.   South Africa actually needs a child-focused support system. Children should be at the centre of our public conversation, and our public systems should support child-feeding and breastfeeding.”

While completing her master’s at the University of the Western Cape (UWC), Witten had the opportunity to work with the late Prof David Sanders — a strong advocate for child nutrition. The experience set Witten on her path towards public health nutrition, and, after spending time in Bangladesh and Egypt, she joined the United Nations Children’s Fund (UNICEF) in 2011 as the Nutrition Specialist in South Africa.

She noted, “The World Health Organization has set a country target of 50% exclusive breastfeeding rate for children under the age of 6 months, but in reality, we should be working towards 80% to 90% of all infants under the age of six months optimally breastfed.

“We want all our children to be exclusively breastfed until at least six months of age because the first six months lay the foundation for  children’s health into adulthood.

“Currently, our exclusive breastfeeding rate is 32% for all children under six months, which means only one in three are exclusively breastfed, and 25%, which is one in four, are not breastfed at all.

“It is worrying that South Africa’s exclusive breastfeeding rate in the first six months are way below the World Health organization target of 50% by 2025.

“One in four infants are exclusively formula-fed. This is a great concern for us because we come out of an era between 2001 to 2011 when we used to have free formula provided by the programme for the prevention of mother-to-child transmission of HIV (PMTCT), with a lower rate of exclusive formula feeding.  Now we have life-long antiretroviral therapy for pregnant and breastfeeding mothers, and still our rate of exclusive breastfeeding has increased in a time when the government no longer gives free formula. And formula prices are exorbitantly high.”

The Barriers to Breastfeeding

“There are many barriers: moms have to return to work and there are instances where moms die at birth and the babies are left behind. So, I believe there is a place for formula. We call it the continuum of care, but formula feeding cannot be the norm in our country. 

“The WHO provided a report that the formula industry is insidious It is manipulative, and the marketing is basically undermining mother’s confidence in breastfeeding. And so mothers start doubting themselves, and the minute they struggle, they switch to formula.”

According to Dr. Witten, the formula industry has even infiltrated the training of health professionals. “So if you think about doctors meetings and nurses conferences, dieticians, webinars, you will find that they are often funded by the formula industry.  This is how the industry extends its marketing through health professionals who unknowingly or inadvertently also become pro-formula. 

“We also used to have breastfeeding clinics before, but it seems as if the formula industry has taken advantage of the situation and capitalised on the lack of breastfeeding clinics. It is not hard to see why it’s become so easy to give up on breastfeeding when the baby is not even two weeks old.”

She believes there is a very hostile environment towards breastfeeding mothers; the mother is constantly swimming upstream and she’s constantly confronted by negative messages from the family, workplace, community and media advocating pro-formula sentiments. 

But there is hope for what our world is supposed to look like, says Dr Witten.

“There are a few examples of workplaces creating favourable breastfeeding environments in the work setting. This is possible through supportive management buy-in where a space – not a room – is provided and  solely dedicated for moms to express breastmilk, with all the facilities she might need – a clean space with access to plugs (think electric breast pumps) and a wash basin so that mothers can clean equipment.”

The challenge here and the challenge to all employers is to put breastfeeding mothers first, even before they come back to work after maternity leave.

The National Department of Health has a campaign called Side by Side providing a link to available resources.