Breastfeeding is a critical component of improving infant health, yet exclusive breastfeeding rates remain alarmingly low both globally and in South Africa. Despite recommendations to breastfeed exclusively for six months and continue alongside complementary feeding for up to two years, barriers such as inadequate support from health care workers, unsupportive work environments, and negative household attitudes hinder mothers’ ability to breastfeed effectively. Currently, only a fraction of South African mothers breastfeed exclusively for the recommended six months, far below global targets. This highlights the urgent need for improved awareness, education, and systemic support to create an environment conducive to breastfeeding.
UNICEF’s report highlights global trends in breastfeeding and shows how supportive environments can significantly improve early breastfeeding rates. Alongside the WHO, UNICEF advocates exclusive breastfeeding for the first six months and continued breastfeeding for two years or more with complementary foods. While progress has been made, more needs to be done to ensure mothers have the support they need at home, in healthcare settings, and in the workplace to sustain these critical practices.
What You Should Know About Breastfeeding
Breastfeeding is crucial for newborn survival and long-term health. Research shows that early initiation—putting a baby to the breast within the first hour—can save hundreds of thousands of lives each year, especially for infants under six months. Breastfeeding boosts brain development, protects against obesity, and lowers health risks for mothers, including breast and ovarian cancer. In South Africa, 89% of newborns are breastfed within the first hour, but sustaining exclusive breastfeeding for six months remains a challenge due to work pressures and lack of support systems. Despite legislation allowing breastfeeding breaks, few workplaces have proper policies in place, making it even harder for mothers to continue.
Importance of Breastfeeding
Breastfeeding is vital for child survival and overall health. It provides essential nutrients, strengthens the immune system, and reduces the risk of infections like diarrhea and pneumonia. Colostrum, the first milk, acts as the baby’s first immunization. Breastfed babies are also less likely to develop chronic conditions later in life, such as obesity and diabetes. For mothers, breastfeeding helps with postpartum recovery, reduces cancer risks, and offers natural contraceptive effects when done exclusively.
Successful Breastfeeding Practices
To establish breastfeeding, mothers should start feeding within the first hour after birth and practice on-demand feeding. Proper latching and frequent feeding are essential to maintain milk supply. Support from healthcare workers and family members is critical in ensuring breastfeeding success.
Challenges to Breastfeeding
Barriers include a lack of healthcare support, cultural practices, and early introduction of formula or solid foods. Smoking, alcohol, and stress can also hinder milk production. Additionally, societal norms often discourage breastfeeding in public, making it harder for mothers to feed comfortably.
Feeding During Separation
Expressed breastmilk can be safely stored for up to 8 hours at room temperature or up to 5 days in the fridge. Donated human milk from milk banks is another safe alternative for infants in need, particularly in neonatal care.
Breastfeeding and Medication
Most mothers can safely breastfeed while on medications, but consulting a healthcare provider is essential. Milk-stimulating supplements are generally unnecessary with proper feeding techniques.
Nutrition During Breastfeeding
Breastfeeding mothers should drink plenty of fluids (6–8 glasses of water daily) and maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. No special diet is required, but healthy eating supports milk production and energy levels.
Breastfeeding and HIV
HIV-positive mothers are encouraged to breastfeed exclusively for six months while adhering to antiretroviral therapy (ART). This significantly reduces the risk of transmission and ensures better health outcomes for both mother and child.
Breastfeeding Support
Support from families, communities, and workplaces plays a vital role. Establishing breastfeeding rooms, peer support groups, and workplace accommodations can help mothers continue breastfeeding. Fathers are encouraged to actively support and bond with their babies during the breastfeeding period.
Breastfeeding During Emergencies
Breastfeeding is critical during emergencies as it provides a safe and readily available food source for infants. It offers protection against illnesses when access to clean water and food is limited. Even in challenging circumstances, mothers are advised to breastfeed exclusively for the first six months.
Where to Find Help
In South Africa, several organizations provide support and information for breastfeeding mothers:
- La Leche League South Africa (LLLSA): A voluntary organization offering mother-to-mother support and information to women who wish to breastfeed. Accredited Leaders, who are experienced breastfeeding mothers, assist with questions and concerns. LLLSA
- South African Breastmilk Reserve (SABR): An award-winning non-profit organization founded in 2003, dedicated to promoting breastfeeding and providing safe, nutritious donated breastmilk to vulnerable infants. SABR coordinates human milk banking efforts in partnership with various provincial Departments of Health and supports breastfeeding mothers across the country. SABR
- Department of Health: The South African Department of Health offers resources and support for breastfeeding through local clinics and healthcare professionals.
Mothers are encouraged to contact local clinics, health professionals, and community groups for guidance and support in their breastfeeding journey.
Breastfeeding in South Africa
The World Health Organization (WHO) has set a global target to increase the rate of exclusive breastfeeding in the first six months to at least 50% by 2025. The 2023 Global Breastfeeding Scorecard reports significant progress in many countries, with over 10% increases in exclusive breastfeeding rates in 22 countries since 2017.
In South Africa, exclusive breastfeeding rates remain low at 32% as of 2016. The COVID-19 pandemic further impacted breastfeeding rates, as healthcare staff were redeployed, routine breastfeeding support was interrupted, and mothers were often separated from their infants despite WHO recommendations for continued skin-to-skin contact. Misconceptions about COVID-19 transmission through breastfeeding also played a role in declining rates.
South Africa has implemented several strategies to promote and support breastfeeding:
- Mother-Baby-Friendly Initiative (MBFI): This program focuses on integrating breastfeeding as a standard of care. It emphasizes the role of maternity staff in promoting breastfeeding and includes a comprehensive implementation framework.
- Human Milk Banks: With 43 operational milk banks (34 in the public sector and 9 run by private or nonprofit organizations), these facilities reduce neonatal morbidity and mortality for babies unable to breastfeed.
Legislation and Policy Framework
South Africa has developed sseveral instramnental policies to support breastfeeding:
- Workplace Support:
The Code of Good Practice ensures breastfeeding employees can take two 30-minute breaks daily during the first six months to breastfeed or express milk. - Regulations on Foodstuffs:
These aim to eliminate commercial pressures on infant feeding, ensuring parents receive unbiased information and that mothers who choose to breastfeed are supported.
National Plans and Guidelines
The National Food and Nutrition Security Plan (2018-2023) addresses food insecurity and malnutrition through a multisectoral approach. It emphasizes collective action across government departments to tackle nutrition-specific and nutrition-sensitive challenges. Updated guidelines also focus on improving the management of acute malnutrition in children and supporting early childhood development.
Challenges in Promoting Breastfeeding
Several challenges hinder breastfeeding in South Africa, including:
- Emergency contexts and disasters disrupting support.
- Aggressive marketing of breastmilk substitutes, particularly online.
- Health worker attitudes and gaps in professional training.
- Insufficient behavior change communication and capacity-building efforts.
Opportunities and Priorities
Despite challenges, there are opportunities to improve breastfeeding rates:
- Revising the National Breastfeeding Action Plan and mobilizing resources.
- Strengthening workforce training through pre-service and in-service programs.
- Updating Infant and Young Child Feeding (IYCF) policies and guidelines, including emergency protocols.
Awareness Campaigns
Awareness initiatives like World Breastfeeding Week (1-7 August) play a critical role in promoting breastfeeding. Tools such as the updated Road to Health Book provide educational resources on early childhood development, focusing on nutrition and breastfeeding.
Breastfeeding is the single most effective intervention to reduce child mortality, improve health, and optimize development, yet exclusive breastfeeding rates in South Africa remain critically low at 32%. With high formula costs and a third of infants living below the food poverty line, protecting and promoting breastfeeding is essential. Efforts such as enforcing Regulation 991 to eliminate commercial pressures and conflicts of interest, advocating for breastfeeding-friendly workplaces, and establishing private spaces like the Red Cross breastfeeding room are vital steps toward supporting mothers. By extending maternity leave, raising awareness of workplace breastfeeding rights, and fostering family-friendly policies, South Africa can ensure that every child has the opportunity to benefit from the unparalleled advantages of breastfeeding.
To address these challenges, efforts must focus on educating families, workplaces, and communities about the benefits of breastfeeding and their role in supporting mothers. By fostering a more enabling environment, stakeholders can help mothers achieve exclusive breastfeeding and continued feeding milestones. Public campaigns should also connect breastfeeding with global development goals, emphasizing its role in infant growth and health. Achieving higher breastfeeding rates requires collective action from health care providers, employers, and society to normalize and support breastfeeding as an essential practice for child development and health.