Breastfeeding saves mothers' lives: lactation consultant Alison Blenkinsop discusses how breastfeeding affects maternal mortality in the developing world.

Janet Fyle's recent article in Midwives on the challenges of meeting the fifth of eight United Nations'(UN) millennium development goals or MDGs (Fyle, 2008) was a disturbing reminder that many countries lack the resources that the industrialised world enjoys. MDG5 aims to improve maternal health; reducing maternal mortality would protect many other lives.

The factsheet on MDG5 states: 'Meeting unmet needs for contraception alone would reduce up to a third of maternal deaths globally. Having fewer pregnancies and spacing births increases the survival rate of both women and their children' (UN, 2008).

However, there is a surprising absence of any mention of the contraceptive effect of lactation. Miriam Labbok showed that breastfeeding may have a greater effect on birth spacing than all other family planning methods combined worldwide (Labbok et al, 1994).

Full lactation has an enormous impact on the health of both mother and child for three main reasons:

Delayed fertility

In the first six postpartum months, if menstruation is absent, frequent and exclusive breastfeeding keeps the pregnancy risk below 2%. This effect, first described by Labbok as the lactational amenorrhoea method, has been confirmed by recent studies. If frequent nursing continues during weaning, periods may not return for many more months (Labbok et al, 1994; King, 2007).

Protection of iron status

As menstruation and pregnancy increase the risk of iron deficiency anaemia, infertility from amenorrhoea gives double protection, especially in menorrhagic women. The small amount of iron in breastmilk is not correlated with maternal haemoglobin, and babies absorb it efficiently during exclusive breastfeeding (Raj et al, 2008).

Maximum infant health

Breastfeeding for at least two years is important for babies' health. Earlier cessation increases infant mortality (World Health Organization, 2000), raising the risk of maternal mortality from higher birth rates (Cigno, 1998).

The survival of orphaned children depends largely on their diet. Guidance on feeding in emergencies highlights the preservation of breastfeeding wherever possible and minimal use of breastmilk substitutes (Emergency Nutrition Network, 2007).

Promotion of artificial feeding undermines breastfeeding, with an inevitable impact on maternal mortality. The World Health Organization Global Strategy for Infant and Young Child Feeding calls for compliance with the International Code of Marketing of Breastmilk Substitutes (World Health Organization, 2003). However, mothers and babies remain at risk from persistent code violations by some members of the babyfood industry (International Baby Food Action Network, 2007).

The impact of breastfeeding is not limited to those targeted by MDG5. The United Nations' Standing Committee on Nutrition Working Group on Breastfeeding states: 'Early and exclusive breastfeeding, complementary feeding and related maternal nutrition, as defined by the Global Strategy, directly addresses seven of the eight goals' (UNICEF, 2005).

It is clear that breastfeeding promotion and effective controls on the use of breastmilk substitutes play a vital part in child spacing in the developing world, thus saving the lives of mothers and their families.

References

Cigno A. (1998) Fertility decisions when infant survival is endogenous. Journal of Population Economics 11(1): 21-8.

Emergency Nutrition Network. (2007) Operational guidance on infant and young child feeding in emergencies. See: www.ennonline.net/ ife/view.aspx?resid=6 (accessed 13 March 2009).

Fyle J. (2008) MDG5--The emperor's new clothes? Midwives Oct/Nov: 44-5.

International Baby Food Action Network. (2007) Breaking the rules, stretching the rules. IBFAN: Penang.

King J. (2007) Contraception and lactation. J of Midwifery and Women's Health 52(6): 614-20.

Labbok M, Perez A, Valdes V, et al. (1994) The Lactational Amenorrhea Method (LAM): a postpartum introductory family planning method with policy and program implications. Adv Contracept 10(2): 93-109.

Raj S, Faridi M, Rusia U, Singh 0. (2008) A prospective study of iron status in exclusively breastfed term infants up to 6 months of age. Int Breastfeed J 3: 3.

UNICEF. (2005) Celebrating the Innocenti Declaration on the protection, promotion and support of breastfeeding. See: www.uniceforg/ nutrition/files/ Innocenti_plus15_BreastfeedingReport. pdf (accessed 1 March 2008).

United Nations. (2008) Millennium goals. See: www.un.org/ millenniumgoals/ (accessed 4 March 2009).

World Health Organization. (2003) Global strategy for infant and young child feeding. World Health Organization: Geneva.

WHO Collaborative Study Team. (2000) On the role of breastfeeding on the prevention of infant mortality, effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 355: 451-5.