South Africa needs “dedicated investments” to increase breastfeeding rate

By Ronda Naidu

South Africa needs “dedicated investments” to increase breastfeeding rate

With the first week of August being declared World Breastfeeding Week, attention has turned to how South Africa is measuring up to the World Health Organization’s global target of reaching 70% exclusive breastfeeding (EBF) by 2030.

According to key findings from the South Africa Demographic and Health Survey in 2016, although breastfeeding was initiated among two-thirds of children within one hour of birth, only 32% of infants under the age of six months were exclusively breastfed.

Statistics South Africa estimates that, in 2021, the infant mortality rate in the country was 24.1 per 1,000 live births, down from 25.11 deaths per 1,000 live births in 2020.

Initiating breastfeeding within an hour of birth is in line with the recommendations of UNICEF which also states that by continuing the practice exclusively for six months and then complementarily feeding beyond that period promotes survival, wellbeing, healthy brain development, growth, and protects against life-threatening and chronic illnesses.

Within the South African context, the low rate of EBF – reportedly one of the lowest on the continent – can be viewed through several macro-lenses. Research conducted by Professor Debra Jackson, et al, from the School of Public Health, University of the Western Cape, noted that contributing factors stopping or preventing EBF include:

  • the use of formula to treat malnutrition for babies of HIV+ positive mothers
  • the free provision and marketing of formula milk
  • urbanization
  • women returning to work

The research further notes that the shift in national policy to promoting EBF in 2011, regardless of HIV status, as well as the withdrawal of free formula milk from the Prevention of Mother-to-Child [HIV] Transmission program resulted in a “remarkable increase in early EBF (4-8 weeks) from 2010 to 2013”.

Today, South Africa has regulations in place for the marketing of infant formula but the effects of free formula being provided by government health institutions and as samples from manufacturers continue to linger. Researchers say women are also targeted through marketing on pregnancy-tracking apps, baby clubs, and through competition giveaways used to promote formula-feeding information to mothers.

According to Maria van der Merwe, the President of the Association for Dietetics, South Africa is still dealing with the consequences of unregulated marketing in the early 2000s. This extends to health professionals and marketing messages which have promoted the view that breastfeeding and infant formula can be viewed as an equal option for infant health and development. She believes that the country requires a holistic approach and multi-level advocacy to promote breastfeeding.

Dr. Chantell Witten, from the Centre of Excellence for Food Security at the University of the Western Cape who is also a member of the Health Ministerial Committee on Morbidity and Mortality in Children under 5 years, agrees. She notes that industry players in the infant formula sector continue to market their products through conference sponsorship and social media.

Witten is also the project lead for the Infant and Young Child Feeding Advocacy project which comprises representatives from the University of the Western Cape, the Family Larsson-Rosenquist Foundation, and the World Health Organization. According to her, South Africa’s efforts to promote a culture of EBF need to be expedited and funded.

“If South Africa – a country with the lowest breast-feeding rates in Africa – is to meet the United Nations’ nutrition target of 50% exclusive breast-feeding by 2025, accelerated efforts are needed, and dedicated investments from multiple sources will be needed. Perhaps even a tax such as the sugar tax will be warranted,” she said.