Asia-Pacific Population Journal - Volume 5, Issue 1, 1990

Breast-feeding has always been synonymous with human reproduction and the nourishment of infants. Yet it is only in the last 20-25 years that its effects on fertility and child survival have been systematically investigated. In light of the accumulated scientific evidence, the promotion of breast-feeding through family planning and maternal and child health programmes is increasingly considered to be a public health policy priority, especially in developing societies. In some countries, explicit policies to promote breast- feeding have been enacted. Research is being undertaken to assess the infant feeding situation, monitor changes, if any, in infant feeding patterns, and evaluate the impact of specific policies and programmes.

An important distinguishing characteristic of mammals is that the female has mammae (breasts in human beings), the function of which is to secrete milk for the nourishment of newborn offspring. The availability of artificial means (bottles and formula milk) of feeding human infants has considerably reduced the dependency of infants on breast milk; however, the newborns of all other mammalian species remain exclusively dependent on mother’s milk for survival in early life. The milk produced by each species is particularly suited to the needs of newborns of that species. It is not surprising then that breast milk is the most suitable food for the human newborn.

Breast-feeding is known to prevent women from becoming pregnant under certain circumstances. In recent years, reproductive physiologists have been studying the hypothalamic-pituitary-ovarian axis to learn more precisely how lactation postpones the return of “fertility,” or fecundity. Family planning researchers are interested in knowing not only how breast-feeding inhibits ovulation, but how the return of fertility can be predicted during breast-feeding so that its natural contraceptive benefit can be relied upon with confidence.

Breast-feeding is almost universal and lengthy in China, especially in less developed areas (SSB, 1986; Tu, 1989a). Breast-feeding serves as an effective means of birth spacing in traditional Chinese society where the reproductive potential is enormous owing to early and universal marriage. It also provides protection against malnutrition and infectious diseases that is very important for child survival, especially in rural areas where access to modern medical facilities is quite limited and infant formulas are not available (Tu, 1989a).

Recently, considerable importance is being given to the study of breastfeeding practices in different settings in developing and developed countries. Breast-feeding is important, particularly in developing countries, because of its relationship with child health and birth spacing. It is well documented that mother’s milk is the best food for the newborn child and it has a significant impact on reducing mortality in infants. Apart from these benefits, breast-feeding also plays an equally important role in controlling fertility in developing countries.

Breast-feeding plays an important and influential role in child survival and fertility, offering immunological protection to an infant against early morbidity and mortality, and contraceptive protection to a mother against closely spaced pregnancies. In developing countries, breast-fed infants experience substantially lower morbidity and mortality risks than infants who are not breast-fed, particularly in the first year of life (Retherford et al., 1989; Pebley and Stupp, 1986; Palloni and Millman, 1986; Grant, 1984; Knodel and Kintner, 1977; Wray, 1977). A survey of 33 comparative studies of breast- and bottle-feeding in different parts of the world has concluded that the risk of death in infancy is three times higher for “mixed-fed” babies (both breast- and bottle-fed) and five times higher for babies who are exclusively bottle-fed (Grant, 1984) relative to exclusively breast-fed babies.

In the context of East and South-east Asia, the Philippines is an underachieving country; living standards have not improved much in recent years. (Table 1 provides some relevant data about the Philippines.) In this setting, breast-feeding is especially important for child health and child nutrition as well as child spacing. The Philippines is one of several developing countries having comparable national data on breast-feeding trends for the past several decades.

Despite the well-documented benefits of breast-feeding for both infant and mother, breast-feeding has, until recently, been given little support. World Health Organization data (WHO, 1981) support the conclusion that, as countries undergo socio-economic development, there is a tendency for the incidence of breast-feeding to decline (Kent, 1981). Many factors contribute to such changes in breast-feeding behaviour. Whilst urbanization and industrialization have been associated historically with declines in breast-feeding (and indeed still appear to be in certain developing countries), the proportion of mothers now returning to breast-feeding in some industrialized countries, e.g. Sweden and the United States of America, is increasing.

Thailand is in a relatively advantageous position compared with most other countries in the region with respect to data to document trends and patterns of breast-feeding and related infant feeding practices. Relevant questions, even if not always strictly comparable, have been included in a series of nationally representative surveys conducted during the last two decades. The information provided by these surveys makes clear that a trend towards a decline in the duration of breast-feeding was underway during the decade of the 1970s, but that during the 1980s the decline halted. In addition, the proportion initiating breastfeeding was high throughout the two-decade period and appears to have recently increased to the point where, at the national level, it is now close to universal.

Breast-feeding averts an average of 28 per cent of the total potential fertility (fecundity) per woman of reproductive age in Indonesia, the fifth most populous country in the world. Contraception controls another 35 per cent, and age at marriage and other factors inhibit an additional 15 per cent of the total fecundity. Only about 22 per cent of the total fecundity is realized in actual births, representing a total fertility rate of about 3.4 per woman in 1987.

This note presents the prevalence and duration of breast-feeding in Nepal and discusses some of the socio-demographic factors influencing breast-feeding as well as the determinants of breast-feeding.