Global Health

Exclusive Breastfeeding - What I've Learned

Published April 06, 2009 @ 05:49AM PT

(Looks like she's got a comfortable chair. Photo credit: Marc van der Chijs)

For the first six months of an infant's life, the World Health Organization recommends exclusive breastfeeding. Exclusive breastfeeding means that the baby gets nothing but breastmilk. No water, no formula, no cow's milk, no tea. The WHO also recommends that babies be fed on demand, rather than on a schedule.

This makes perfect sense. Breastmilk is nutritionally perfect for infants. It provides all the hydration and nutrition that they need. Giving anything else is both redundant and dangerous. Water is unnecessary, and may be contaminated. It has no caloric value, and can take up space in an infant's stomach that is needed for calories and nutrients. If you give a young baby cow's milk, in a best case scenario it will make her intestines bleed because her system isn't able to cope with it. In a worst case scenario, then milk is insufficiently pasteurized and could transmit bacteria.

Feeding on demand also makes sense. An infant with a cold will need to nurse more often, and take less each time. An infant in the throes of a growth spurt may need to eat all the time. These things can happened before a parent even notices; sticking to an overly strict feeding schedule can leave a sick or growing child malnourished.

Exclusive breastfeeding for six months is the best possible option for the infant. It should be promoted. But, when I used to go around recommending exclusive breastfeeding, I had no idea how hard it is. We are asking a lot of women when we recommend it. Understanding that makes us better at talking about breastfeeding, nor worse. When we recommend exclusive breastfeeding and ignore the challenges involved, we just look clueless.

Here's the challenge: infants nurse a lot. In the first few weeks on my son's life, I nursed him so much that I started tracking my time spent on a spreadsheet. On one particularly memorable day, he nursed for 16 out of 24 hours. He was a scrawny little guy, and we had some trouble with attachment, but I was not an unusual case. I learned to eat my meals while nursing, read a book, type on my laptop. It was hard, but it was worth it. When people acted like it wasn't hard, I wanted to kick them.

Exclusive breastfeeding takes a lot of the mother's time. I had my husband and my mom to help. They cleaned the house, made the food, and did the grocery shopping. A woman whose family depends on her to earn money, manage the livestock, or tend a garden may not be able to breastfeed exclusively. Not because she doesn't want the hassle of exclusive breastfeeding, but because she is literally unable to do so without putting her other children at risk.

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Comments (4)

  1. I currently (and in the past) am exclusively feeding my baby however, I do not feed on demand.  That seems ridiculous for me.  I have to have a schedule otherwise I will never know when I can go to the grocery store, get a haircut, work in the garden, mow the lawn, cook dinner.  Every 3 hours during the day for 10 minutes on each side works just fine.  At night he wakes when he needs to but is currently sleeping through the night. 

    Posted by C M on 04/10/2009 @ 01:56PM PT

  2. Alanna Shaikh

    Your choice of scheduled feeding is not based on evidence, even if that's not intuitive for you. But as long as your babies are happy and healthy, then whether your choice is optimal or nearly optimal doesn't really matter.

    Posted by Alanna Shaikh on 04/10/2009 @ 07:05PM PT

  3. Reply to thread
  4. Adrienne Michetti

    So, particularly in developing countries, then, where women are often the sole breadwinners *and* looking after the family, what are the options, other than education? I've never seen a Vietnamese woman breastfeeding in public, and friends tell me that most Vietnamese women don't breastfeed at all, if possible because it's a status thing: only very poor people can't afford baby formula.  I have many foreign friends here in Vietnam who do exactly what you recommend here: breastfeed exclusively, and on demand. And all the Vietnamese around them think we're crazy. But it's more socially acceptable for "us" to do that, because we're unusuaul to them anyway, being foreigners.

    It seems to me that this post could easily be cross-posted on the Women's Rights blog (as could several of yours) because it comes down to an issue of what is best for women and their children -- doesn't it?


    Posted by Adrienne Michetti on 04/10/2009 @ 11:42PM PT

  5. Alanna Shaikh

    It's a really tough issue. I'm working on a post about this now. Short answer: you can crack down on formula marketing, change laws and regulations to make breastfeeding easier, and do a lot of different forms of education, including a focus on making breastfeeding seem like normal behavior.

    Posted by Alanna Shaikh on 04/11/2009 @ 04:41AM PT

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Alanna Shaikh

Alanna Shaikh has spent the last ten years immersed in global health; she has worked for NGOs, companies, universities, and the US government on projects that ranged from preventing antibacterial resistance to improving maternal and child health.

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