Despite the continuous research findings about the advantages and the benefits of breastfeeding, both for infants and mothers, statistics still indicate that some countries are unable to implement intervention programs in order to promote breastfeeding. That is the case for Greece whose rates upon breastfeeding are still low compared to the other European countries. According to a recent report that has being handled out in 2011 by the International Baby Food Action Network (IBFAN) Greece rates of exclusive breastfeeding at 0 months are 37-47% whilst in other European countries fluctuate between 52-95%. Most shocking are the rates of exclusive breastfeeding at the 3rd month where only 9.5-11% of infants breastfeed while in the rest of Europe these rates are…higher 35-79%.
This can be attributed to the lack of coordinated programs specifically designed for the infant and child nutrition, as well as, to the absence of governmental support. Apart from that, the inadequacy of information regarding the International Code of Marketing of Breast milk Substitutes has led doctors, nurses as well as pediatric hospitals and private clinics to a continuing violation of the Code(IBFAN, 2011).
As a result, parents of newborn babies are lacking of information concerning the right choices they have to make in order their child to be healthy developed. What is more, babies face the danger to become ill in the first few days of birth, putting their lives into serious trouble.
The current assignment will try to discuss and in some extend analyze some of the issues concerning breastfeeding, will focus on the difficulties that pregnant mothers are faced with in Greece, and finally will try to suggest ways of implementing and promoting breastfeeding.
Breastfeeding and its importance
Optimal nutrition, for infants and young children, from birth till the second
year of their life is considered to be crucial for the promotion of their health, for optimum growth and for behavioral and cognitive development. That means that mothers must be educated and willing to exclusively breast feed their infants from the first hour of birth till the sixth month and then with a combination of an appropriate supplement to continue until the second year or more(ADA, 2009, WHO, 2003, UNICEF, 2003, Bernardo L. Horta, 2007, Adriano Cattaneo, 2004).
According to the World Health Organization (WHO) breastfeeding is considered to be the normal way of supplying infants with all the necessary nutrients for a healthy growth and development(WHO., 2012.).
Human milk contains all the appropriate nutrients that the infant needs in a balanced and digestible form(ADA, 2009). These includes carbohydrates, essential fatty acids, saturated fatty acids, medium-chain triglycerides, long chain polyunsaturated fatty acids, cholesterol, as well as low protein content that makes it harmless for the immature kidneys(ADA, 2009, Kim Fleischer Michaelsen, 2000). In addition to that, it contains the right proportion of sodium and the exact ratio of calcium to phosphorus (2:1), ideal for the right absorption(ADA, 2009).
The are numerous evidence supporting that breastfeeding reduces infant mortality and morbidity(Kim Fleischer Michaelsen, 2000, ADA, 2009, WHO, 2003, Kenneth Brown, 1998, Bernardo L. Horta, 2007).Apart from that, breastfeeding benefits both infants and mothers(Stanley Ip, April 2007, Alfredo Pisacane, 2005, Arthur I. Eidelman, 2012). For children, some of these benefits include lower rates of otitis media and gastroenteritis (Stanley Ip, April 2007, Indu B. Ahluwalia, 2005, ADA, 2009, Kim Fleischer Michaelsen, 2000, Jessica R. Jones, 2011, Arthur I. Eidelman, 2012), lower rates of upper respiratory infection(Indu B. Ahluwalia, 2005, Jessica R. Jones, 2011), reduced risk of sudden infant death syndrome(ADA, 2009, Kim Fleischer Michaelsen, 2000, Fern R. Hauck, 2011, Arthur I. Eidelman, 2012). Some of the long-term outcomes include lower blood pressure(Richard M. Martin, 2004, Bernardo L. Horta, 2007, Britton C, 2009), reduction in cholesterol levels(Bernardo L. Horta, 2007), reduced incidence of obesity(Kim Fleischer Michaelsen, 2000, WHO, 2003, ADA, 2009, Elsie M. Taveras, 2006, Ruowei Li, 2008, Sylvia Guendelman, 2009, Arthur I. Eidelman, 2012, Bernardo L. Horta, 2007), lower risk for type 2 diabetes mellitus(Christopher G Owen, 2006, Bernardo L. Horta, 2007, Britton C, 2009) and increased cognitive development(Kim Fleischer Michaelsen, 2000, ADA, 2009, WHO, 2003, Arthur I. Eidelman, 2012, Bernardo L. Horta, 2007, Fergusson, 1998, Britton C, 2009). On the other hand, mothers, are more likely to be amenorrhoeic, which decrease the risk for iron deficiency(ADA, 2009, Kim Fleischer Michaelsen, 2000, WHO, 2003, Arthur I. Eidelman, 2012), decreased incidence for breast cancer, if breastfeeding continuous for up to 12 months(ADA, 2009, Arthur I. Eidelman, 2012, Britton C, 2009, Gesouli- Voltyraki Eftihia, 2009), decreased risk for developing type 2 diabetes mellitus(ADA, 2009, Arthur I. Eidelman, 2012), greater levels of weight loss postpartum(ADA, 2009, Kim Fleischer Michaelsen, 2000, WHO, 2003, Arthur I. Eidelman, 2012), lower blood pressure and decreased incidence of depressive symptoms(ADA, 2009, Arthur I. Eidelman, 2012).
Other benefits include the economic one's, both for families and for the society, due to the reduced health care related expenses, reduced absence from work and reduced expenses to treat a sick child(ADA, 2009).
Factors affecting breastfeeding rates
As mentioned earlier, exclusive breastfeeding rates in Greece are quite low compared to the other European countries(IBFAN, 2011). Many reasons contribute to the decision and duration of the mother to breastfeed. Some of them include the educational level of the mother, the support from the family, friends and the father, the socio-economic classification, the age of pregnancy, the employment status and the marital status.
More analytically, concerning the education, it has been found that as the level of education gets higher the rates of breastfeeding improve. Specifically, it has been found that girls who continue education until 19 years old are more likely to breastfeed than the ones who leave education at 16 years old (Samir Arora, 2000, Tarrant, 2009, Gesouli- Voltyraki Eftihia, 2009, IBFAN, 2011, Gatrell, 2008, R Flacking 2007, Ban Al-Sahab, 2010, Singh, 2010). In a study carried out in Greece in 2009 reverse trends were observed, but the results are doubtful due to the small number of participants (Gesouli- Voltyraki Eftihia, 2009). Same results were found as well by (Koosha A, 2008) in a study that took place in Iran.
Socio-economic status was also found to play a vital role in the initiation of breastfeeding (IBFAN, 2011) (Figure 1). Studies have shown that women in the higher social class tend to initiate breastfeeding more than the ones of lower social class (Gatrell, 2008, Veghari, 2012, Katherine E Heck, 2006a). What is more, women in the higher social class is possible to have a more supportive workplace in terms of breastfeeding (Katherine E Heck, 2006b, Katherine E Heck, 2006a). On the contrary, there are studies suggesting that the rates of duration and initiation of breastfeeding are higher in women with lower socio-economic status and that's because the economic background of these women does not allow them to buy supplementary food (Singh, 2010).
Age of pregnancy is also another factor that affects breastfeeding initiation, as the results of many researches indicate that older mothers are more likely to initiate and extend the duration of breastfeeding than the younger ones(Jessica R. Jones, 2011, Ban Al-Sahab, 2010, Singh, 2010, Amanda R Cooklin 2008, Koosha A, 2008).
In addition to that, the social circle of a pregnant woman such as the partner, the mother and friends has being found to have a positive correlation to the initiation of breastfeeding(Tarrant, 2009, Alfredo Pisacane, 2005, Ban Al-Sahab, 2010). Thus, education should be focused not only to the pregnant mothers but to their partners as well, as they seem to play a vital role in the decision of the mother to start and continue breastfeeding
Last but not least, employment and marital status affect the initiation of breastfeeding. Unmarried mothers are less likely to breastfeed (Gesouli- Voltyraki Eftihia, 2009, Tarrant, 2009, Ban Al-Sahab, 2010, Singh, 2010), while the ones who have to return to their work immediately and cannot stay at home are less likely to continue breastfeeding too (Tarrant, 2009, Sylvia Guendelman, 2009, ADA, 2009, Gatrell, 2008, Katherine E Heck, 2006b, Singh, 2010, Amanda R Cooklin 2008). On the other hand, unemployed women or women whose income was the lowest level were also found to have difficulty in continuing breastfeeding (R Flacking 2007, Donath, 2008).
Apart from all the above mentioned factors that contribute to the initiation and the duration of breastfeeding, there are some other factors related to the inner policy of every country, such as, the infrastructure of the Health System and the ethics of the ones who represent it, the planning tactics and the governmental financial support in order to promote campaigns. In Greece some of them, if not all, are absent or operate problematic.
In 2007, the Minister of Health announced a series of plans in order to promote the "rights of the child". Within this plan there was nothing referring to the promotion of breastfeeding or even to the nutrition for children(IBFAN, 2011).
Information regarding breastfeeding is limited only to two state hospitals, which are the closest to the Baby-friendly status, in the capital of Greece, in Athens. In order for a hospital or clinic to be considered Baby Friendly must fulfill some requirements ( Figure 2). Apart from these two hospitals there is also the Hellenic Lactation Consultant Association, Galaxias, who tries to inform the public and promote breastfeeding. No other Baby Friendly hospital or clinic exists in Greece. That is why rooming-in rates and percentages of breastfeeding during the first hour of birth are extremely low. Efforts were made for some courses to take place in some rural areas of Greece but they were boycotted both from doctors and nurses who did not attend the course as well as by the midwives (IBFAN, 2011).
As a result, the inadequacy of information regarding the International Code of Marketing of Breast milk Substitutes has led doctors, nurses as well as pediatric hospitals and private clinics to a continuing violation of the Code(IBFAN, 2011). These include, instructions to parents for the use of infant formulas instead of breast milk without a reason for its use, infant feeding with breast milk substitute by the hospital staff without the consensus of the parents, and finally, instructions by healthcare professionals to the parents to use breast milk substitutes while they are still at the hospital(IBFAN, 2011). Probably some of these violations were made due to the lack of information, but some of them had economic incentives for the healthcare professionals individually or to the department as a whole (IBFAN, 2011). The role of the healthcare professional is of vital importance regarding the initiation and the duration of breastfeeding.
Another barrier that pregnant mothers, as well as fathers, have to face is the absence from work. Parental leave does not entitle financial compensation. That means that parents are able to leave their work only for 3.5 months until the baby reaches 3.5 years old, provided that their previous employment was at least one year with the same employer (IBFAN, 2011).
Putting evidence in practice
But how tactics, concerning breastfeeding, could be carried out in Greece when the biggest of the obstacle is the unawareness of healthcare professionals just because they want to satisfy their own interests? How can the Greek government set rules, that other countries have already done, to protect the rights of the Child? How all these could occur when apart from the lack of internal policy, Greece has to face the economic crisis as well?
First of all, health authorities should enforce breastfeeding policies so that more hospitals in Greece can acquire the title "baby-friendly". This should be done by a proper certification of this units in order to avoid misleading use of the term "baby-friendly hospital" from units that they do not try to implement this necessary ten steps of breastfeeding.
Support groups should be developed in every community in order to inform mothers about breastfeeding. What is more, these groups should not only target to the education of the mother, but to the father as well as it was found that fathers opinion is an important factor to the initiation and duration of breastfeeding. Apart from that, programs focused on more disadvantaged groups such as of illiterate mothers or of lower economical status should be implemented in order to educate about the benefits of breastfeeding and how to manage difficult situations.
Recruitments in the health system of professionals specialized in the area of lactation could be another way of informing and educating future mothers.
