With health benefits for both mother and child, it's important to examine why Irish mothers are turning away from breastfeeding, writes Dr Muiris Houston, Medical Correspondent.
It's natural, it's free and is available on demand. It has many health benefits for both mother and child. So why has the Republic got one of the lowest breastfeeding rates in the EU?
The rate of initiation of breastfeeding in Nordic States such as Norway, Sweden and Denmark is in the region of 98 per cent of new mothers. The UK manages 70 per cent breastfeeding rates, while even in France, more than 50 per cent of mothers breastfeed their babies. But here in Ireland, at 45 per cent, breastfeeding initiation rates prop up the European league table.
According to Maureen Fallon, national breastfeeding co-ordinator with the Health Service Executive (HSE), the fall-off in breastfeeding was more profound in Ireland in the 1940s, 1950s and 1960s than in other countries.
"The loss of a culture of breastfeeding is very difficult to reverse," she says.
"In this situation, mothers can doubt their ability to breastfeed and, when they don't see other mothers breastfeeding, can come to the conclusion that it is not 'normal' or achievable."
The focus of national breastfeeding week, which started yesterday, is on raising awareness of the various supports available for mothers who are considering breastfeeding.
Catherine Murphy, HSE assistant director of population health, who is also the chairwoman of the National Breastfeeding Implementation Committee, says the voluntary sector is key to supporting breastfeeding mothers.
"Peer support, such as that provided by voluntary groups like the La Leche League, Cuidiú - Irish Childbirth Trust, and the Community Mothers Programme draw on experienced breastfeeding mothers who have received best practice training to help and support new mothers," she says.
"This is a particularly powerful way of building confidence especially in communities where quite probably the newly breastfeeding mother knows no one else who has breastfed," she says.
The Community Mothers Programme is a support programme for first-time and some second-time parents of children up to two years, who mainly live in disadvantaged areas in the major cities. It especially targets lone parents, teenage parents, Travellers, asylum seekers and refugees.
Initially rolled out in 1988, the programme now supports almost 1,200 parents each year in Dublin and surrounding areas. Delivered by volunteers known as "community mothers" who visit parents in their homes, a key element of the scheme is that it reflects the ethos of each particular community. Community mothers typically spend a minimum of 13 hours each month visiting up to 15 families, focusing on nutrition, healthcare and child development.
But the survey of breastfeeding practices published yesterday by the HSE shows that just 25 per cent of mothers from lower socio-economic groups breastfed their youngest child.
The social class divide is underlined by the finding that 69 per cent of mothers from the highest socio-economic group had breastfed their last child.
The Strategic Action Plan for Breastfeeding, published in 2005, had set a target of increasing breastfeeding initiation rates by 4 per cent per year among mothers who live in disadvantaged areas.
At double the target for the general population, it is a recognition of the need to focus health promotion initiatives on lower socioeconomic groups.
How will the HSE achieve what is a challenging target? "The process starts with looking at how and when infant feeding decisions are made," Murphy says. "Local surveys suggest that approximately half of women in Ireland have made their infant feeding decisions prior to booking in for their antenatal care and possibly even before they become pregnant.
"So addressing the barriers to breastfeeding in society as a whole as well as providing information about breastfeeding long before pregnancy is even contemplated has been shown to be effective."
The HSE has developed a breastfeeding resource pack for junior cycle students as part of the Social Personal Health Education (SPHE) programme; the pack will be distributed to schools by the end of the year.
Other issues relevant to encouraging health promotion in disadvantaged areas include language and literacy levels as well as the provision of viable healthy alternatives appropriate to the communities in which you wish to bring about change.
Early childhood has been identified as the period of life at which intervention is likely to weaken the established association between health and class. The Black report in 1980 revealed that scale of health inequality in the UK; since then the Institute of Public Health and The Health Research Board Unit for Health Gain have clearly illustrated that if you are poor here, you are far more likely to die prematurely from heart disease, respiratory disease and some cancers.
In terms of bringing about change, Prof Stewart Forsyth of the Dundee longitudinal breastfeeding study, has shown that breastfed children from manual social classes have health outcomes equal to or better than bottle-fed babies from more affluent families. And we now know that good nutrition in early life helps prevent obesity, diabetes and other chronic disease.
So, campaigns such as National Breastfeeding Week are important for the future health of the nation. But only if they are backed by sufficient funding to ensure change happens, especially among those most exposed to health inequality.
La Leche League, 30 Idrone Close, Dublin. Tel: 01-4941279.
Cuidiú, Carmichael House, North Brunswick Street, Dublin. Tel: 01-8724501.
Breastfeeding information from the HSE www.breastfeeding.ie http://www.breastfeeding.ie and tel: 1850-24 1850.
Breastfeeding benefits
• Breast milk is always available and requires no preparation time.
• It avoids allergy and intolerance to formula milk.
• During the first year of life, breastfed infants have lower rates of otitis media (ear infection), pneumonia, meningitis and diarrhoea.
• Antibodies present in breast milk provide a natural immunity against infection.
• Breast milk contains all the necessary nutrients for a baby. Breastfed infants over six months require additional dietary iron.
• Breastfeeding is associated with a lower incidence of asthma, eczema, high cholesterol and high blood pressure in later life. The incidence of obesity and insulin-dependent diabetes is also reduced.
• Breastfeeding also has health benefits for the mother; it reduces the risk of breast and ovarian cancer later in life. The risk of osteoporosis is also lessened and a mother who breastfeeds has less chance of a haemorrhage after birth.
• There are psychological benefits for both mother and child.
Dr Muiris Houston.