Wealthier mothers tend not to breast-feed babies

A thesis by two 2012 graduates of AB Economics at Ateneo de Manila University may provide policymakers and advocates of breast-feeding information to achieve a breast-feeding rate of more than 34 percent among infants aged up to 6 months.

Nyla Caras and Yssa Quiambao’s study used data from women respondents of the 2008 National Demographic and Health Survey (NDHS), who had infants that were 0-6 months old at the time of the interview.

The study did not merely focus on exclusive breast-feeding practice but also on other infant-feeding choices like mixed feeding (infants were breast-fed and fed with breast-milk substitutes and complementary foods), and not breast-feeding (infants who were only fed with breast-milk substitutes and complementary foods).

Of the 697 respondents with infants aged up to 6 months, 32.7 percent exclusively breast-fed their baby, 50.9 percent mixed-fed their baby, and 16.4 percent did not breast-feed their baby.

After controlling for demographic factors and characteristics (e.g. age, education and employment status) of the mothers and spouses/partners, the study found that the wealthier the mothers, the more likely they would mix-feed their children or not breast-feed at all.

Even if these mothers were aware of the physiological, psychological and economic benefits of exclusive breast-feeding, the reality is that breast-feeding may be inconvenient and time-consuming for them. They would prefer to use their time doing other productive or leisure activities.

Their economic status allowed them to purchase complementary food that they believed would provide adequate nutrition for their infants. Caras and Quiambao also mentioned that for wealthier mothers, “it seems inevitable for infants to be introduced to complementary foods even before 6 months of age,” especially if the mothers could not breast-feed due to insufficient milk, nipple or breast problem, or workload.

Here are some statements that mothers [names have been withheld] have posted on an Internet forum for mothers about breast-feeding:

“It really frustrates me. My baby boy is less than 2 months old but my milk supply is too little. That’s because he doesn’t breast-feed directly from me. He got used to taking milk from a bottle. So what I do is just pump every night. I take Natalac but my milk production is still dropping. It’s sad.”

“It was I who insisted on breast-feeding and my husband is very supportive of this but he also understands that if we can’t make it work, we will have to just depend on formula.”

“My goal is at least six months of exclusive breast-feeding. But I can’t imagine how I would do it if I return to my job … The office doesn’t have a breast-feeding room. So I don’t know how I could pump there. Haaay. I hope I can do it…”

If insufficiency of milk or breast/nipple problems are not present, designing new strategies may be needed to convince wealthier mothers to practice exclusive breast-feeding. For instance, strict implementation of the provisions of Republic Act No. 10028 of 2009 should be pushed. To date, there are very few offices that have facilities that encourage mothers to breast-feed their children.

Another finding of the study was that mothers of 0- to 6-month-old infants in urban areas were more likely to opt not to breast-feed or choose to mix-feed their children. Urban living is highly stressful and stress may adversely affect the production of milk.

Cost of living in urban areas is usually higher than in rural areas, so the practice of not exclusively breast-feeding the child may result in more financial burden on the mother, especially if she belongs to the low-income bracket. This implies that campaigns for exclusive breast-feeding must be further intensified in urban areas.

A third major finding of the study was that a mother who gave birth in the past three years would more likely choose to feed the child only with breast milk. The reason behind this might be economic. With more young children to feed, practicing mixed feeding can  drain one’s financial resources.

If the mother is able to produce adequate milk for the infant, then this practice allows her to allocate the limited household income to feeding other young children. One of the mothers in a public health facility in Surigao del Sur said: “I have two other children. It would cost me less if I breast-feed my baby.”

She would choose to exclusively breast-feed the baby, rather than mix-feed or not breast-feed at all because this practice can result in lesser chances for the mother to have more children. Efforts made by proponents of exclusive breast-feeding practice to target women with large families, is thus appropriate.

The 2008 NDHS is the most recent data available to the public that contain information on maternal and child health. Admittedly, access to more recent data is imperative.

The National Statistics Office recently conducted the Family Health Survey of 2011, a nationwide survey designed to “provide information on maternal and child health, family planning and other health-related concerns in order to assist policymakers and program managers in evaluating and designing strategies for improving health and family planning services in the country.”

Hopefully, this data will be made available to the public as soon as possible, so that the findings mentioned above can be reexamined and interventions can then be appropriately revised, if needed. Aleta C. Domdom