Science of Life
Prof. William Reville
Human beings are members of a large group of animals known as mammals and all female mammals have mammary glands (breasts) that produce milk for feeding the young. This natural method of breastfeeding is scientifically well established as the optimal form of nutrition for babies and is enthusiastically promoted by national and international medical organisations.
Nevertheless, the traditional low rates of breastfeeding in Ireland remain among the lowest in the world. There is much scope for improvement here, but we must also remember that not all women can breastfeed for a variety of reasons and, in any event, we must respect the right of every mother to freely choose whether to breastfeed her baby or to bottle-feed her baby with formula milk.
Ireland has the lowest rate of breastfeeding in Europe. The National Longitudinal Study of Children (Growing Up in Ireland) published a report in October 2014 that is a veritable mine of information – Maternal Health Behaviours and Child Growth in Infancy, authored by Richard Layte and Cathal McGrory. The report covered both Irish citizens and women of other nationalities living in Ireland.
About 60% of mothers overall initiate breastfeeding in Ireland compared to a figure of about 93% for the EU as a whole. The most commonly stated reasons for never starting breastfeeding were inconvenience/fatigue (17.1%), difficulty with breastfeeding technique (8.3%) and embarrassment and social stigma (5.6%). The mean duration of breastfeeding for Irish citizen mothers is 47.8 days, but the mean is 112.2 days for mothers who are not Irish citizens.
Level of maternal education is strongly associated with initiation of breastfeeding – about 80% of mothers with postgraduate level education take up breastfeeding compared with about 30% of mothers with lower secondary level education or less. Level of household income is also positively associated with breastfeeding, but the association is weaker than that with education.
The report also notes that women who have caesarean sections (CS) are 50% less likely to breastfeed. Given that 25% of births are now delivered by CS and that this proportion is increasing, this issue merits policy attention at both national and hospital level.
Breastmilk is the natural, normal food for babies from birth. It cannot be replicated. It contains all the nutrients the infant needs for proper growth and development including water, proteins, amino acids, nucleic acids, fats, carbohydrates, minerals, vitamins, and trace elements. Breast milk also contains antibodies, antimicrobial factors, digestive enzymes, hormones
and growth factors that are important for passive protection against infections and for development of the immune system.
Breastfeeding encourages the development of a stronger immune system in the baby and reduces the risk of developing allergies, obesity, Type II diabetes, gastrointestinal disorders and middle ear infections. Breastfeeding also strengthens the emotional bond between mother and baby. In short, there is compelling scientific evidence that breastfeeding contributes to better child health, both in the short and long term and possibly into adulthood.
The annual cost of treating acute infections in infants in Ireland is €12 million–€15 million. If only a fraction of this money were spent promoting breastfeeding, significant overall savings would be made because breastfeeding prevents such infections in the first place. The Government spends only about €100,000 per year promoting breastfeeding.
In Ireland the proportion of mothers exclusively breastfeeding six months after birth is just 6% whereas the medical advice is to feed the baby exclusively by breastfeeding for at least the first six months. About half of Irish babies are put on solid food at four months, whereas medical advice is to hold off on solids until six months. Weaning too early mitigates against the optimum development of the baby.
But of course there are some cases where breastfeeding is not in the best interest of mother or baby, e.g. where the mother has suffered a stroke during delivery, where the mother is suffering from post-partum depression or psychosis, where the mother is on chemotherapy for breast cancer, or for several other reasons.
Mothers who do not breastfeed must bottle-feed their babies with formula milk instead. Cows’ milk formula, where the milk has been altered to resemble breast milk, is the most common. Although formula milk will provide adequate nutrition for the baby, it cannot replicate breast milk which undoubtedly is the superior food.
Formula milk lacks many components found in breast milk, e.g. many fatty acids. Breast milk is also more easily digested by the baby than formula, and breastfed babies tend to be less ‘gassy’ and to suffer less from constipation than formula-fed babies.
Several studies have investigated whether breastfeeding enhances babies’ IQ and early work suggested a link between breastfeeding and higher IQ. However, the latest and most rigorous study carried out by researchers from Goldsmith University of London found no significant difference in the intelligence of breastfed as compared to bottle-fed babies.
Dr Sophie Von Stumm, the chief researcher of the study comments: “Mothers should be aware they are not harming their child if they choose not to or cannot breastfeed. Being bottle-fed won’t cost your child a chance at a university degree later in life. Information such as this removes the level of guilt felt by many new mothers who are unable, or decide against, breastfeeding their baby.”
Nobody disputes that breastfeeding is the nutritional gold standard and we should continue to promote it as the best way to feed the new-born baby. However, while breastfeeding undoubtedly increases the likelihood of good health outcomes this does not mean that breastfeeding guarantees that obesity and other diseases will not occur in the future, and it does not mean that to exclusively bottle-feed a baby either condemns the baby to ill-health or otherwise seriously compromises his/her future.
Bottle-feeding infant milk formula can still give the baby a good start and, where it is voluntarily chosen by a mother as an alternative to breastfeeding, should never be condemned as a ‘bad’ choice. We must remember that as recently as the 1970s only about 20% of new mothers in Ireland breastfed their babies and the world didn’t cave in.
William Reville is an Emeritus Professor of Biochemistry at UCC.