Breastfeeding and complementary feeding

Maternal and child nutrition contributes to more than one-third of child mortality and 10% of the total global disease burden. Of the nutrition factors associated with child mortality, stunting, severe acute malnutrition and intrauterine growth retardation constitute the major risk factors. Therefore, reducing infant and young child stunting is essential for achieving the Millennium Development Goals (MDGs) related to child survival (MDG 4) as well as that related to the eradication of extreme poverty and hunger (MDG 1).

Key facts

Breastfeeding is good for the economy

The positive impact of breastfeeding on the economy, both at macro and micro level, is often not acknowledged, even if the benefits afforded by breastfeeding to the health of the mother and child are well known. Expenditure on health care can be significantly reduced. For example, in the US the direct health care costs for children associated with the low rates of breastfeeding were estimated to be $ 2.2 billion in 2007[1]. In Mexico, the estimated direct and indirect costs associated with no breastfeeding ranged from $455.7 to $2,126.6 million in 2012[2]. Moreover, a healthier workface will result from breastfeeding[3].

The benefits for the work place may not be as visible but include:

  • Loyalty with the company as a result of gratitude and satisfaction
  • Reduced absenteeism because babies get sick less often and less severely[4]• Retention of employees (reducing the need of training and the loss of qualified personnel)
  • Improved productivity

Depending on the insurance policies of the country, it may affect insurance costs substantially. In addition, it con-tributes to a better corporate image. One example is CIGNA Insurance Company, which saves $240,000 a year in health care expenses with women who breastfeed[5]

Ways to support breastfeeding by working mothersPromotion and support of breastfeeding by mothers that work outside the house take into account the World Health Organization recommendations to breastfeed exclusively for six months and to continue breastfeeding for at least two years or more[6]. To comply with these recommendations, employers should provide breastfeeding women the following workplace accommodations:• Maternity leave• Nursing room • Reduced work hours or flexible schedule while breastfeeding

Fact sheet

Maternity leave

The International Labor Organization (ILO) Convention 183 states that every woman should be entitled to maternity leave of at least 14 weeks. Recommendation 191, signed by several countries in the Region, says that countries should aim at providing maternity leave of at least 18 weeks [7].

Nursing room

A room that is private, comfortable and hygienic should be provided so that breastmilk can be expressed during work hours. In addition, a chair, a refrigerator, a sink and an electric outlet (in case electrical pumps are used) are necessary.

Reduced hours and flexible time

ILO Convention 183 provides a woman the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child[7]. Breastfeeding mothers need to ex-press milk every 3 to 4 hours, otherwise they will feel uncomfortable, and breastmilk production may be affected, since it works on a supply-demand basis.

Situation on the implementation of the ILO recommendations in the Americas Maternity leave in the Americas: 10 out of 38 countries (Belize, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Panama, Peru and Venezuela) provide at least 14 weeks of maternity leave, as established by ILO Convention 183 (Table). This represents 28% of the countries for which information is available (Figure). Of these 10 countries, only three follow ILO’s Recommendation 191 of providing 18 weeks or more – Chile with 24 weeks, and Cuba and Venezuela with 18.

Most countries provide 100% of salary, with others providing between 60% and 65%. Paternity leave is rare with only Argentina, Bahamas, Brazil, Chile, Colombia, Ecuador, Guatemala, Paraguay, Peru, Uruguay and Venezuela having provisions.

What can governments, employers, co-workers, mothers and fathers do to support breastfeeding?

Governments can:

  • Ratify, implement and monitor ILO Convention 183 and in addition implement Recommendation 191, which calls for maternity leave of at least 18 weeks and at least one nursing break a day or reduced work hours and provisions for private rooms for milk expression or breastfeeding.
  • Stipulate even longer maternal leave, as have some countries in the Region.
  • Have a political commitment to regulate and ensure compliance with legislation to protect breastfeeding by work-ing mothers

Employers can:

  • Have a policy that is communicated to all staff that the company or organization supports breastfeeding by their employees
  • Provide conditions to facilitate compliance with the WHO recommendations for breastfeeding• Ensure that the workplace has a nursing room that is private, comfortable, hygienic and easily accessible.
  • Be flexible with respect to breaks to breastfeed or extract milk

Co-workers can:

  • Cover tasks when their co-worker needs to take a break to breastfeed or extract breastmilk• Motivate the mother to persist breastfeeding and abstain from using formulas
  • If feasible, offer help with transportation of baby or breast-milk

Mothers can:

  • Know their rights with regard to maternity leave and their employers’ breastfeeding policies, including the availability of a private room to extract breast milk or breastfeed
  • If there is not breastfeeding policy, inform her employer about the need for breaks to express milk and a private room for expressing breastmilk or breastfeeding• Practice extracting and freezing breast milk while on ma-ternity leave to have milk already stored when returning to work.
  • Work with their employer and fellow employees to find a solution together.

Fathers can:

  • Encourage and support the mother to continue breastfeed-ing after going back to work • Practice feeding the baby expressed breastmilk with a cup before the mother returns to work
  • Do their part of the household chores• If realistic, take the baby to nurse at the mother’s workplace

References

1. Bartick, M. and A. Reinhold, The burden of suboptimal breast-feeding in the United States: a pediatric cost analysis. Pediatrics, 2010 May. 125(5): p. e1048-56. Epub 2010 Apr 5.

2. Colchero, M.A., et al., The costs of inadequate breastfed-ing of infants in Mexico. Am J Clin Nutr, 2015. doi: 10.3945/ajcn.114.092775.

3. World Health Organization., Breastfeeding Policy Brief. 2014, WHO: Geneva.

4. Cohen, R., M.B. Mrtek, and R.G. Mrtek, Comparision of ma-ternal absenteeism and infant illness rates among breastfeeding and formula-feeding women in two corporations. Am J Health Promot, 1995. 10(2): p. 148-53.

5. Office of Wome’s Health and US Health and Human Services. http://www.womenshealth.gov/breastfeeding/employer-solu-tions/business-…. Accessed July 17, 2015.

6. WHO, Global Strategy for Infant and Young Child Feeding. 2003, World Health Organization: Geneva.

7. International Labour Organization, Maternity and paternity at work. Law and practice across the world. 2014, ILO: Geneva.