History of breastfeeding

For most of human history, breastfeeding has been the natural and normal means of feeding infants. There have also been attempts at introducing substitutes for breast milk, some of which have achieved a measure of success.



Early history
Breasfeeeding is a defining characteristic of being a mammal and for most of human history, breastfeeding was universal as there were no alternative foods for infants. The mother, or other lactating females, would have to breastfeed the children for them to survive. Shared breastfeeding is still practised in many developing countries when mothers need help in feeding their children.

In the Egyptian, Greek and Roman empires, women usually fed only their own children. However, breastfeeding began to be seen as something too common to be done by royalty, and wet nurses were employed to breastfeed the children of the royal families. This was extended over the ages, particularly in western Europe, and saw women of noble birth (or who married into nobility) making use of wet nurses.

According to some Brahminical literature, breastfeeding in 2nd century India was commonly practised but not until the fifth day, allowing the colostrum to be discarded and the true breast milk to flow.

Developing alternatives
Alternatives first became popular in the late 15th century with many parents substituting cow or goat's milk for their own breast milk. This was particularly necessary for those families working the land whereby time could not easily be taken out to regularly breastfeed the child. Such trends soon faded when the problems associated with these milks started to show, and by the mid to late 16th century breastfeeding once again became the preferred feeding method for most families. In 1582, the Italian physician Geronimo Mercuriali wrote in De morbis mulieribus (On the diseases of women) that women generally finished breastfeeding an infant exclusively after the third month and entirely around 13 months of age.

The feeding of flour or cereal mixed with broth or water, became the next alternative in the 19th century but once again quickly faded. Around this time there became an obvious disparity in the feeding habits of those living in rural areas and those in urban areas. Most likely due to the availability of alternative foods, babies in urban areas were breastfed for a much shorter length of time, supplementing the feeds earlier than those in rural areas.

Though first developed by Henri Nestlé in the 1860s, infant formula received a huge boost during the post World War II "Baby Boom". When business and births decreased, and government strategies in industrialised countries attempted to highlight the benefits of breastfeeding, Nestlé and other such companies focused their aggressive marketing campaigns on non-industrialised countries. In 1979 the International Baby Food Action Network (IBFAN) was formed to help raise awareness of such practices as supplementary feeding of new babies with formula, inappropriate promotion of baby formula and to help change attitudes that discourage or inhibit mothers from breastfeeding their babies.

Japan
Traditionally, Japanese babies were born at home and breastfed with the help of breast massage. Weaning was often late, with breastfeeding in rare cases continuing until early adolescence. After World War II Western medicine was taken to Japan and the women began giving birth in hospitals, where the baby was usually taken to the nursery and fed formula. In 1974 a new breastfeeding promotion by the government helped to boost the awareness of its benefits and the uptake has sharply increased. Japan became the first developed country to have a Baby-friendly hospital (and as of 2006 has another 24 such facilities).

Canada
A 1994 Canadian government health survey found that 73% of Canadian mothers initiated breastfeeding, up from 38% in 1963. It has been speculated that the gap between breastfeeding generations in Canada contributes to lack of success of those who do attempt it: new parents cannot look to older family members for help with breastfeeding since they are also ignorant on the topic. Western Canadians are more likely to breastfeed; just 53% of Atlantic province mothers breastfeed, compared to 87% in British Columbia. More than 90% of women surveyed said they breastfeed because it provides more benefits for the baby than does formula. Of women who did not breastfeed, 40% said formula feeding was easier (the most prevalent answer). Women who were older, more educated, had higher income, and were married were the most likely to breastfeed. Immigrant women were also more likely to breastfeed. About 40% of mothers who breastfeed do so for less than three months. Women were most likely to discontinue breastfeeding if they perceived themselves to have insufficient milk. However, among women who breastfed for more than three months, returning to work or a previous decision to stop at that time were the top reasons.

A 2003 La Leche League International study found that 72% of Canadian mothers initiate breastfeeding and that 31% continue to do so past four to five months.

A 1996 article in the Canadian Journal of Public Health found that, in Vancouver, 82.9% of mothers initiated breastfeeding, but that this differed by Caucasian (91.6%) and non-Caucasian (56.8%) women. Just 18.2% of mothers breastfeed at nine months; breastfeeding practices were significantly associated with the mothers' marital status, education and family income.

Cuba
Since 1940, Cuba's constitution has contained a provision officially recognising and supporting breastfeeding. Article 68 of the 1975 constitution reads, in part: ''During the six weeks immediately preceding childbirth and the six weeks following, a woman shall enjoy obligatory vacation from work on pay at the same rate, retaining her employment and all the rights pertaining to such employment and to her labour contract. During the nursing period, two extraordinary daily rest periods of a half hour each shall be allowed her to feed her child''.

Developing nations
In many countries, particularly those with a generally poor level of health, malnutrition is the majority cause of death in children under 5, with 50% of all those cases being within the first year of life. International organisations such as Plan International and La Leche League have helped to promote breastfeeding around the world, educating new mothers and helping the governments to develop strategies to increase the number of women exclusively breastfeeding.

Traditional beliefs in many developing countries give different advice to women raising their newborn child. In Ghana babies are still frequently fed with tea alongside breastfeeding, reducing the benefits of breastfeeding and inhibiting the absorption of iron, important in the prevention of anaemia.

Publicity, promotion and law
In response to public pressure, the health departments of various governments have recognised the importance of encouraging women to breastfeed. The required provision of baby changing facilities was a large step towards making places more accessible for parents and in many countries there are now laws in place to protect the rights of a breastfeeding mother when feeding her child in public.

The World Health Organization (WHO), along with grassroots non-governmental organisations like the International Baby Food Action Network (IBFAN) have played a large role in encouraging these governmental departments to promote breastfeeding. Under this advice they have developed national breastfeeding strategies, including the promotion of its benefits and attempts to encourage mothers, particularly those under the age of 25, to choose to feed their child with breast milk.

Government campaigns and strategies around the world include:
 * National Breastfeeding Week in the UK
 * The Department of Health and Ageing Breastfeeding Strategy in Australia
 * The National Women's Health Information Center in the U.S.
 * World Breastfeeding Week

However, there has been a long, ongoing struggle between corporations promoting artificial substitutes and grassroots organisations and WHO promoting breastfeeding. The International Code of Marketing of Breast-milk Substitutes was developed in 1981 by WHO, but violations have been reported by organisations, including those networked in IBFAN. In particular, Nestlé took three years before it initially implemented the code, and in the late 1990s and early 2000s was again found in violation. Nestlé had previously faced a boycott, beginning in the U.S. but soon spreading through the rest of the world, for marketing practices in the third world (see Nestlé boycott).

Breastfeeding in public
A breastfeeding mother in public with her baby will often need to breastfeed her child. A baby's need to feed cannot be determined by a set schedule so legal and social rules about indecent exposure and dress code, are often adapted to meet this need. Many laws around the world make public breastfeeding legal and disallow companies from prohibiting it in the workplace but the reaction of some people to the sight of breastfeeding can make things uncomfortable for those involved. Also some breastfeeding mothers can feel reluctant to breastfeed in public.

USA
In the U.S. an United States House of Representatives appropriations bill (HR 2490) with a breastfeeding amendment was signed into law on September 29, 1999. It stipulated that no government funds may be used to enforce any prohibition on women breastfeeding their children in Federal buildings or on Federal property. Further, U.S. Public Law 106-58 Sec. 647 enacted in 1999, specifically provides that "a woman may breastfeed her child at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location." A majority of states have enacted state statutes specifically permitting the exposure of the female breast by women breastfeeding infants, or exempting such women from prosecution under applicable statutes, such as those regarding indecent exposure.

Most, but not all, state laws have affirmed the same right in their public places. By June 2006, 36 states had enacted legislation to protect breastfeeding mothers and their children. Laws protecting the right to nurse aim to change attitudes and promote increased incidence and duration of breastfeeding. Recent attempts to codify a child's right to nurse were unsuccessful in West Virginia and other states. Nowhere is breastfeeding in public illegal.

In November 2006, Emily Gillette, a 27-year-old from Santa Fe, New Mexico was refused service in Burlington, Vermont after being asked to leave a Freedom Airlines flight by a flight attendant after Gillette refused to breastfeed her child under a blanket.

UK
A UK Department of Health survey found that 84% (about 5 out of 6 people) find breastfeeding in public acceptable if done discreetly, however 67% (2 out of 3) mothers are worried about general opinion being against public breastfeeding. To combat these fears in Scotland, a bill safeguarding the freedom of women to breastfeed in public was passed in 2005 by the Scottish Parliament. The legislation allows for fines of up to £2500 for preventing breastfeeding in legally permitted places.

Canada
In Canada, the Canadian Charter of Rights and Freedoms gives some protection under sex equality. Although Canadian human rights protection does not explicitly include breastfeeding, a 1989 Supreme Court of Canada decision (Brooks v. Safeway Canada) set the precedent for pregnancy as a condition unique to women and that thus discrimination on the basis of pregnancy is a form of sex discrimination. Canadian legal precedent also allows women the right to bare their breasts, just as men may. In British Columbia, the British Columbia Human Rights Commission Policy and Procedures Manual protects the rights of female workers who wish to breastfeed.

Cultural conflicts
When a Peruvian immigrant in the USA had a photograph taken of the act of breastfeeding, American police forces alerted by a photo lab technician briefly considered it to be sexual abuse and production of child pornography, resulting in the mother's arrest and the seizure of her children:


 * Victor Jaeger...says he was prepared to testify on the couple's behalf and explain what appears to him to have been a cultural misunderstanding. Jaeger, who grew up in Peru, says breast-feeding is culturally important in his native country and considered acceptable to do in public, particularly in the country's jungle regions. "My cousin sent me a picture of her newborn, and it was of the baby being breast-fed," he says. "As someone who has lived here for 20 years, I asked myself, 'Why did she send me that picture?' To her, it was nothing."


 * 1-Hour Arrest, Thomas Korosec, Dallas Observer, Apr 17, 2003

Recent global uptake
The following table shows the uptake of exclusive breastfeeding.