Amazing Data on The Benefits of Breastfeeding
As I embark on the first week of teaching a three week Preparing To Breastfeed Course for some wonder forces families expecting babies, I once again am amazed by the benefits of breastfeeding that so many women are never taught about in school biology lessons!
If you’re wondering why people end up so passionate about breastfeeding and supporting women to do so then let your mind be blown by some of the stats to come out of global research over the last 20 years! Below is a short summary paper I wrote during my training back in 2018.
If this really triggers your interest then I suggest you pop over to Amazon and pick up any book by Professor Amy Brown and start to dig into the cultural and social barriers we have developed for new Mums over the last few hundred years and how you can support a positive future change.
Nicola
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The Benefits of Breastfeeding- Nicola Flanagan
The benefits of breastfeeding are multiple and can be categorised into either short-term or long term for both mother and baby.
Benefits to Infants - The Short Term
In the short term, breastfeeding and immediate skin-to-skin helps mother and baby to bond and promotes their natural instinctive behaviours which in turn release oxytocin in both, which not only provides comfort and feelings of wellness and love, but also is vital for infant brain development (Moberg & Prime 2013).
Immediate breastfeeding after birth helps the baby regulate their new breathing rhythm, stabilise their blood sugar and heart rate and begin the flow of colostrum- which is the “early, concentrated milk that is full of nutrients and disease-fighting antibodies” (KellyMom) As a newborn baby’s stomach is very small at birth, they only need this highly concentrated milk in the small amounts that it is produced to meet their needs. It helps prepare them for the transition to mature breastmilk. La Leche League goes on to describe how colostrum “… is protective, coating the intestines to fence [harmful] germs out so they cannot be absorbed into your baby’s system. This barrier seals your baby’s insides, preparing your little one for a healthy life. Colostrum also kills harmful microorganisms and provides protection from inflammation. It is a laxative also and will help clear your baby’s system of the meconium (black stool) that has built up while baby was inside of you. Early clearing of meconium helps to reduce jaundice. In healthy full-term babies, colostrum helps to prevent low blood sugar. Colostrum is important for all babies, and it is particularly important to pre-term, immature babies. Premature babies receiving their own mother’s colostrum have significantly better health outcomes.”
The close contact required for breastfeeding at birth also helps transfer the mother’s microbial flora onto the infant, from her skin and in her milk. These microbes pass into the baby’s gut for the ‘seeding’ of their own microbiome and immune system development. It is the oligosaccharides (HMOs), bountiful in human milk, which function as prebiotics to support growth of these specific bacteria. Cesar et al (2016) in The Lancet explain that “ …there is specificity of the interaction between breastmilk and the infant microbiome, causing different bacterially induced effects on the infant’s metabolism and immunity……… abnormal colonisation patterns have a deleterious (harmful) long-term effect on immune and metabolic homoeostasis.”
The benefits of breastfeeding to babies in the prevention and protection against illness has been researched over the years in many different studies, and most of these since included in systematic reviews to measure the authenticity of their claims. Amy Brown, in Breastfeeding Uncovered, also points out that ‘breastfeeding can often affect a baby’s experience of an illness’ not just whether or not they get it. There has been shown to be significant impacts on reducing the risks of developing certain illnesses, as well as infant mortality, from studies looking at exclusive breastfeeding (EBF), any breastfeeding and the duration of breastfeeding.
A review in 2015 by Sankar et al. showed EBF infants in low-income countries had 12% the risk of death compared to those never breastfed (Lutter et al. 2011) and infants under 6 months old, who were not breastfed, had 3.5 and 4.1 times increases in mortality in boys and girls respectively compared to those who received any breastmilk (Victoria & Barros 2000). If all infants in low-income countries were breastfed, around half of all incidences of diarrhoea and a third of respiratory infections could be avoided, preventing hospital admissions (72% and 57% respectively) (Becker 2003) . These stark figures may be more linked to hygiene and the fact that breast feeding reduced the risk of exposure to pathogens, however the benefits are wider reaching.
Meta-analysis of studies in high-income countries showed a 36% reduction in SIDs (Dearden et al. 2002) and a 58% decrease in necrotising enterocolitis (the death of the cells in a section of the bowl lining which can be fatal in infants) (Ong et al. 2001).
The Long Term
When looking the longer-term preventative benefits of breastmilk against other illness in infants, there is strong evidence to support its protective qualities in a range of conditions.
Breastfeeding gives infants a 23% lower risk of developing ear infections (Becker 2003), and never being breastfed increased the risk by 50% compared to at least 3 months of breast feeding (Kramer & Kakuma 2012). Dewey et al. (1995) also showed that the chance of a baby having an ear infection that lasted over 10 days was 80% reduced if they were breastfed.
Respiratory Infection is also an area where research is strong: showing that babies who are mix-fed compared to EBF are three times more likely to get a respiratory infection; and solely formula-fed babies four times more likely (Koch 2003). The protective qualities of breastfeeding can be seen by the fact that only 5% of breastfed babies develop more serious responses to respiratory syncytial virus, compared to 8% of babies who are not (Howie 1990), with babies EBF for at least four months 72% less likely to be hospitalised due to severe responses (Ip et al 2007).
Gastrointestinal infections also saw an increase in formula fed babies, 2-3 times more infections were recorded by Scariati et al (1997) compared to those who were EBF, and Horta Et al (2013) reviewed 15 studies around the incidence of diarrhoea which found that breastfeeding could prevent 72% of hospital admissions for diarrhoea.
The Lancet’s systematic review of 29 studies into Asthma showed a reduction with breastfeeding by 5-9% compared to formula feeding (The Lancet). It went on to review a further 113 studies on obesity and found that longer periods of breastfeeding were associated with a reduction in the prevalence of overweight or obesity of 13%. The Lancet also reviewed 18 studies around Lukemia and found that breastfeeding was associated with a 19% reduction in the incidence of childhood lukemia (Amitay & Keinan-Boker 2015).
Benefits to Mothers
The above figures show some of the many benefits of breastfeeding for infants. However, when it comes to the mother there are also significant wins, from the inverse association between breastfeeding and breast cancer (each 12 months breastfeeding saw a 4.3% reduction in the incidence of invasive breast cancer (The Lancet 2002, Brown 2016)), to the 30% reduction in ovarian cancer associated with longer periods of breastfeeding- “less than 6 months reduced risk by 17%, 6-12 months by 28% and 12 months by 37%” (Brown 2016; Chowdhury et al 2015). And although as an antenatal teacher I would never advise women to rely on it, amenorrhoea and natural birth spacing (Kramer & Kakuma 2012; Chowdhury et al. 2015) are advantageous for women in developing countries where access to birth control is not as easy. I will also mention the not insignificant benefit to mothers and infants around bonding and comfort, through time spent feeding their baby at the breast.
Benefits to Global Communities
The final area I would like to mention, is the associated increase in IQ of breastfed children (reported as an average of 7 points at 6.5 years for children breastfed compared to now (Karmer, Aboud et al 2008), and 5.9 points for children breastfed at 6 months compared to 4 (Ip at al. 2009). Alongside these figures sits the economic case for investing in promoting breastfeeding discussed in the Unicef Baby Friendly Initiative where modelling estimated that global economic losses of lower cognition from not breastfeeding reached US$302 billion in 2012, equivalent to 0.49% of world gross national income. “Furthermore, the authors calculate that boosting breastfeeding rates for infants below 6 months to 45% in the UK would cut treatment costs of common and childhood illnesses (eg pneumonia, diarrhoea, and asthma) and save healthcare systems at least US$29.5 million [£22.7 million.” Yet in the Baby Friendly Initiative, Professor Cesar Victoria explains how breastfeeding is one of the few positive health behaviours more common in poor than richer countries, reducing the rich-poor gap in child survival (UNICEF 2016).
There is a lot of research into breastfeeding and many studies and analyses show the clear benefits in the prevention of illnesses, both short term and long term in offspring and mothers, and the severity to which they are experienced in infants. Breastfeeding must become a key public health issue, and if prioritised by governments, policy makers and communities as such, could help prevent communicable diseases, reduce the prevalence of non-communicable diseases, reduce infant mortality and lessen inequality.
REFERENCES
· Amitay EL, Keinan-Boker L. (2015) Breastfeeding and childhood leukemia incidence: a meta-analysis and systematic review. JAMA Pediatr 2015; 169: e151025.
· Becker S, Rutstein S, Labbok MH. (2003) Estimation of births averted due to breast-feeding and increases in levels of contraception needed to substitute for breast-feeding. J Biosoc Sci 2003; 35: 559–74.
· Chowdhury R, Sinha B, Sankar MJ, et al. (2015) Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr Suppl 2015; 104: 96–113
· Collaborative Group on Hormonal Factors in Breast Cancer.(2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96973 women without the disease. Lancet 2002; 360: 187–95.
· Dearden KA, Quan N, Do M, et al. (2002) Work outside the home is the primary barrier to exclusive breastfeeding in rural Viet Nam: insights from mothers who exclusively breastfed and worked. Food Nutr Bull 2002; 23 (suppl): 101–08.
· Horta BL, Victora CG. (2013) Short-term eff ects of breastfeeding: a systematic review of the benefits of breastfeeding on diarrhoea and pneumonia mortality. Geneva: World Health Organization, 2013.
· Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CD. (1990) Protective Effect of Breastfeeding Against Infection. BMJ. 1990 Jan 6;300(6716):11-6
· Ip S, Chung M, Raman G, et al. (2007) Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD, USA: Agency for Healthcare Research and Quality.
· Ip S, Chung M, Raman G, Trikalinos TA, Lau J.(2009) A Summary of The Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeeding Medicine 2009 Oct 1;4 (S1):S-17
· KellyMom (2018) When Will My Milk Come In?
https://kellymom.com/ages/newborn/when-will-my-milk-come-in/
· Koch A,Molbak K, Homoe P, Sorensen P, Hjuler T, Olesen ME, Pejl J, Pedersen FK, Olsen OR, Melbye M. (2003) Risk factors for acute respiratory tract infections in young Greenlandic children. American Journal of Epidemiology. 2003 Aug 15;158(4):374-84
· Kramer MS, Aboud F, Mironova E, et al, (2008) The Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 2008; 65: 578–84.
· Kramer MS, Kakuma R. (2012) Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012; 8: CD003517.
· La Leche League international (2010) Colostrum: General
https://www.llli.org/breastfeeding-info/colostrum-general/
· Lutter CK, Chaparro CM, Grummer-Strawn L, Victora CG. (2011) Backsliding on a key health investment in Latin America and the Caribbean: the case of breastfeeding promotion. Am J Public Health 2011; 101: 2130–36.
· Moberg & Prime (2013) Oxytocin effects in mothers and infants during breastfeeding. Infant Journal 2013; Vol 9; Issue 6
http://www.infantjournal.co.uk/pdf/inf_054_ers.pdf
· Ong G, Yap M, Li FL, Choo TB. (2005) Impact of working status on breastfeeding in Singapore: evidence from the National Breastfeeding Survey 2001. Eur J Public Health 2005; 15: 424–30
· Scariati PD, Grummer-Strawn LM, Fein SB. (1997) A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Paediatrics. 1997 Jun 1;99 (6):e5
· UNICEF (2016) The Baby Friendly Initiative
https://www.unicef.org.uk/babyfriendly/lancet-increasing-breastfeeding-worldwide-prevent-800000-child-deaths-every-year/
· Victora C, Bahl R, Barros , França G, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins N (2016) Breastfeeding Series Group* Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet 2016
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01024-7.pdf
· Victoria C, Barros A. (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries. The Lancet 2000. Feb 5; 355(9202): 451-5