Abstract

PIP: Worldwide, the major health problems of mothers and children and high rates of morbidity and mortality result from 3 interrelated problems: malnutrition, infections, and closely spaced pregnancies. These problems are often associated with other unfavorable social and environmental factors and are closely related to breastfeeding practices. Breast milk provides the balanced nutritional requirements to meet the needs of infants and also plays a vital role in the prevention of infection. In most cases, supplemental foods should be introduced at 4-6 months, and progresssively increased and varied until the child can eat the regular family diet at age 18-30 months. Changes in breastfeeding habits have direct implications for infant health and well-being. Evidence from individual surveys on the prevalence and duration of breastfeeding are collated to quantify trends. Large disparities in breastfeeding practices are revealed among regions, countries and population groups. In Africa, nearly all of the 21 million infants are breastfed for a usual duration of 20 months for rural and urban poor groups and 6 months among the urban elite. Supplementation begins between 3-6 months postpartum. In Middle and Western South Asia, breastfeeding is almost universal, although supplementation for rural and urban poor groups is late. In Eastern South Asia and East Asia, rural prevalence is high, but durations are lower for both rural and urban groups. Declines in prevalence among the urban elite are evident. In the Latin American region, prevalence is high but duration is variable. For rural populations, duration longer than 1 year is rare and supplementation begins early, except in parts of South America. Breastfeeding prevalence and duration fell steadily until about 1970 in all parts of Europe. As in North America, prevalence rates in Europe have shown recent increases. Comparatively, the rates in Australia and New Zealand are much higher, 70-80%. The data indicate that among groups that tend to supplement early, durations tend to be short. 3 phases emerge from viewing the data: the traditional phase with high prevalence and duration, the transformation phase with prevalence falling and durations shorter, and the resurgence phase with rising prevalence and duration. One theory suggests that within countries, breastfeeding practices tend to follow the lead of elite groups, and developing countries tend to follow developed countries. Another theory suggests that industrialization and socioeconomic change forces a change in lifestyles. Understanding the trends in breastfeeding practices can help to identify junctures at which interventions are likely to be necessary.