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Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 1
Essentials of Breastfeeding
Kathleen M. Rasmussen, ScD
ProfessorDivision of Nutritional SciencesCornell UniversityDecember 20, 2010 (updated 2017)
Objectives• To review the physiology of breastfeeding and the
important aspects of milk composition
• To describe 3 major recommended breastfeeding practices
• To describe potential benefits of breastfeeding forwomen and communities
Objectives• To review the physiology of breastfeeding and the
important aspects of milk composition
• To describe 3 major recommended breastfeeding practices
• To describe potential benefits of breastfeeding forwomen and communities
We will begin with some basic information about the breastfeeding process.
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN OXYTOCIN
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
MammaryGland
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 2
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
Suckling
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
Neuralarc
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
?
Prolactin release
?
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
?
Prolactin(in blood)
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
?
MammaryGland
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN
?
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 3
The amount of milk made and the releaseof milk are controlled by hormones
PROLACTIN OXYTOCIN
The amount of milk made and the releaseof milk are controlled by hormones
OXYTOCIN
The amount of milk made and the releaseof milk are controlled by hormones
OXYTOCIN
The amount of milk made and the releaseof milk are controlled by hormones
OXYTOCIN Oxytocin(in blood)
Uterus
The amount of milk made and the releaseof milk are controlled by hormones
OXYTOCIN
The let-down reflex is required!
• Worry
• Stress
• Pain
• Doubt
These hinder reflexThese help reflex
• Thinks lovingly of baby
• Sight & sounds of baby
• Touches baby
• Confidence
• Feeing relaxed, calm
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 4
Inhibitor in breast milk:supply and demand
FIL
Knight CH, et al. Rev Reprod 1998;3:104-12
Inhibitor in breast milk:supply and demand
If the breast remains full of milk, secretion stops because of an inhibitor in the breast.
FIL
Knight CH, et al. Rev Reprod 1998;3:104-12
Inhibitor in breast milk:supply and demand
If the breast remains full of milk, secretion stops because of an inhibitor in the breast.
If mother and infant are separated, milk removal must be continued to maintain its production.
FIL
Knight CH, et al. Rev Reprod 1998;3:104-12
Breast milk is an exceptional foodBioactive Components of Human Milk
Nutrients Protective Agents
Adaptive Immune System
• Humoral (sIgA, other Igs)• Cell-mediated
(macrophages, white cells, lymphocytes)
Non-specific Immune System
• Prebiotics• Multifunctional milk components• Cell surface receptor homologs• Immunomodulatory agents
Adapted from: Newburg DS. J Nutr 2005;135:1308
Breast milk is an exceptional foodBioactive Components of Human Milk
Nutrients Protective Agents
Adaptive Immune System
• Humoral (sIgA, other Igs)• Cell-mediated
(macrophages, white cells, lymphocytes)
Non-specific Immune System
• Prebiotics• Multifunctional milk components• Cell surface receptor homologs• Immunomodulatory agents
Adapted from: Newburg DS. J Nutr 2005;135:1308
Breast milk is an exceptional foodBioactive Components of Human Milk
Nutrients Protective Agents
Adaptive Immune System
• Humoral (sIgA, other Igs)• Cell-mediated
(macrophages, white cells, lymphocytes)
Non-specific Immune System
• Prebiotics• Multifunctional milk components• Cell surface receptor homologs• Immunomodulatory agents
Adapted from: Newburg DS. J Nutr 2005;135:1308
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 5
Breast milk is an exceptional foodBioactive Components of Human Milk
Nutrients Protective Agents
Adaptive Immune System • Humoral (sIgA, other Igs)• Cell-mediated (macrophages,
white cells, lymphocytes)
Non-specific Immune System
• Prebiotics• Multifunctional milk components• Cell surface receptor homologs• Immunomodulatory agents
Adapted from: Newburg DS. J Nutr 2005;135:1308
Breast milk is an exceptional foodBioactive Components of Human Milk
Nutrients Protective Agents
Adaptive Immune System
• Humoral (sIgA, other Igs)• Cell-mediated
(macrophages, white cells, lymphocytes)
Non-specific Immune System• Prebiotics• Multifunctional milk components• Cell surface receptor homologs• Immunomodulatory agents
Adapted from: Newburg DS. J Nutr 2005;135:1308
New
burg
DS
. J N
utr
2005
;135
:130
8
Breast milk protects against infectionEnteromammary Circulation
Breast milk protects against infectionEnteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8
Breast milk protects against infectionEnteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8
Breast milk protects against infectionEnteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 6
Breast milk protects against infectionEnteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8
Breast milk protects against infectionEnteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8Breast milk protects against infection
Enteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8
Breast milk protects against infectionEnteromammary Circulation
New
burg
DS
. J N
utr
2005
;135
:130
8
Breast milk helps to develop and sustain the infant’s gut microbiome
Individualized components of breast milk:
• Bacteria from the mother’s skin and the microbiome of her milk
• Carbohydrates that support the development of a healthy gut microbiome in her infant
Guran T. Nature’s first functional food. Science 2014;345:747-9
Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475-90
Verduci E, et al. Epigenetic effects of human breast milk. Nutrients 2014;6:1711-24
Mayer-Davis EJ, et al. Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Diabetes Care2006;29:2231-7
Common problems with artificial feeding
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Preparation with contaminated water
Infection
Bottles difficult to clean
Infant drinks from contaminated
bottle
Formula is expensive
Dilute preparation
Inadequate nutritionInfection
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 7
Recommended breastfeeding practices
• Immediate skin-to-skin contact and early initiation of breastfeeding (within first hour after delivery)
• Breastfeed exclusively for 6 months
• Continue breastfeeding to 24 months and beyond
Suboptimum breastfeeding and deaths of children <5
Black RE, et al, Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427-51
44.7%
19.4%
11.6%
2.3%
1.7%
12.6%
14.4%
14.7%
11.8%
0% 10% 20% 30% 40% 50% 60%
Proportion of total deaths of children <5 years
Fetal growth restriction (<1 month)
Stunting (1 to 59 months)
Underweight (1 to 59 months)
Wasting (1 to 59 months)
Zinc deficiency (12 to 59 months)
Vitamin A deficiency (6 to 59 months)
Suboptimum breastfeeding (0 to 23 months)
Joint effects of fetal growth restriction and sub-optimum breastfeeding in neonates
Joint effects of fetal growth restriction, suboptimum breastfeeding, stunting, wasting, and vitamin A and zinc deficiencies (<5years) 0% 10% 20% 30% 40% 50%
Recommended practice:
Initiate breastfeeding early
Nilsson L, Hamberger L. A Child Is Born. New York: Dell Publishing,1993
What is colostrum?
• First milk produced
• Higher nutrient density than mature milk– Protein, fat, vitamin A
• Rich in antibodies, growth factors
• Amount of colostrum produced matches the newborn’s stomach capacity
www.newborn.stanford.edu
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 8
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Effect of breastfeeding regimen on the continuation of lactation
Treatment group
Timing of lactogenesis
(% < 48 hours)
Proportion still breastfeeding (%)
6 weeks 12 weeks
Early/2 hour*
(n = 29)55 69 64
Early/4 hour
(n = 27)22 74 56
Late/2 hour*
(n = 27) 52 70 56
Late/4 hour
(n = 28)14 54 46
*Significantly different from the corresponding 4-hour group
Salariya EM, et al. Lancet 1978;ii:1141-3
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 9
Early initiation saves lives
Mullany LC, et al. J Nutrition 2008;138:599-603
Early initiation saves lives
20% of neonataldeaths
Mullany LC, et al. J Nutrition 2008;138:599-603
Early initiation saves lives – NEOVITA study
NEOVITA Study Group. Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials. Lancet Glob Health 2016;4:e266-75
Compared to infants who were put to the breast within 1 hour of birth,
• the risk of dying in the first 28 days of life was 41% higher for those infants who were breastfed within 2-23 hours
• and 79% higher for those infants who initiated breastfeeding after 1 day
How does early initiation save lives?
• Colostrum (first milk) is rich in immune and non-immune components that fight infection and accelerate intestinal maturation
• Promotion of warmth and protection may reduce risk of death from hypothermia
• The alternative, prelacteal feeding, may disrupt normal physiologic gut priming
Edmond KM, et al. Pediatrics 2006;117:e380-6
Beyond saving lives:other benefits of early initiation
• Earlier onset of ample milk production
• Longer duration of breastfeeding
• Improved mother/infant bonding
• Decreased infant distress
• Stronger uterine contractions that reduce uterine bleeding
Anybreastfeeding
Exclusive breastfeeding
Avoid prelacteal feeds:they shorten breastfeeding duration
Pérez-Escamilla R, et al. Prelacteal feeds are negatively associated with breast-feeding outcomes in Honduras. J Nutr 1996;126:2765-2773
Water-basedprelacteal feeds
Milk-basedprelacteal feeds
714 Honduran infants, 0-6 months old
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 10
Anybreastfeeding
Exclusive breastfeeding
Avoid prelacteal feeds:they shorten breastfeeding duration
Water-basedprelacteal feeds
Milk-basedprelacteal feeds
714 Honduran infants, 0-6 months old
81% reduction
Pérez-Escamilla R, et al. Prelacteal feeds are negatively associated with breast-feeding outcomes in Honduras. J Nutr 1996;126:2765-2773
Anybreastfeeding
Exclusive breastfeeding
Avoid prelacteal feeds:they shorten breastfeeding duration
Water-basedprelacteal feeds
Milk-basedprelacteal feeds
714 Honduran infants, 0-6 months old
81% reduction
Pérez-Escamilla R, et al. Prelacteal feeds are negatively associated with breast-feeding outcomes in Honduras. J Nutr 1996;126:2765-2773
Anybreastfeeding
Exclusive breastfeeding
Avoid prelacteal feeds:they shorten breastfeeding duration
Water-basedprelacteal feeds
Milk-basedprelacteal feeds
714 Honduran infants, 0-6 months old
81% reduction
79% reduction
Pérez-Escamilla R, et al. Prelacteal feeds are negatively associated with breast-feeding outcomes in Honduras. J Nutr 1996;126:2765-2773 Source: UNICEF Global Databases. 2016
Few women initiate breastfeeding early
Percent of newborns put to the breast within one hour of birth, by country and region, 2015
Why aren’t women initiating early?
• Lack of support in hospital
• Traditional beliefs– Dirty because of color
– Milk has “gone bad” (been in the breasts too long)
• Women who deliver at home don’t receive adequate support
• Prelacteal feeds are givenLatin America and the Caribbean
Eastern and Southern Africa
CEE/CIS
West and Central Africa
South Asia East Asia and the Pacific
Middle East and North Africa
Other
Skilled birth attendant(e.g., doctor, nurse, midwife)
Skilled birth attendants can provide vital support for early initiation – we need to seize this opportunity
Untraditional birth attendant (e.g. traditional) or others (e.g., relatives) t
Source: UNICEF Global Databases. 2016
Percent of newborns put to the breast within one hour of birth by birth delivery attendant, by region, 2015
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 11
Latin America and the Caribbean
Eastern and Southern Africa
CEE/CIS
West and Central Africa
South Asia East Asia and the Pacific
Middle East and North Africa
Other
Skilled birth attendant(e.g., doctor, nurse, midwife)
Skilled birth attendants can provide vital support for early initiation – we need to seize this opportunity
Untraditional birth attendant (e.g. traditional) or others (e.g., relatives) t
Source: UNICEF Global Databases. 2016
Percent of newborns put to the breast within one hour of birth by birth delivery attendant, by region, 2015
Recommended practice: Breastfeed exclusively for 6 months
Source: UNICEF
Any woman can breastfeedExclusive breastfeeding saves lives
0
2
4
6
8
10
12
14
16
Diarrhoeamortality
Pneumoniamortality
Diarrhoeaincidence
Pneumoniaincidence
All causemortality
Rel
ativ
e ris
k co
mp
are
d t
o e
xclu
sive
b
rea
stfe
ed
ing
for
0-5
mo
nth
s
Predominant breastfeeding Partial breastfeeding Not breastfeeding
Black RE, et al. Lancet 2008;371:243-260
Sankar MJ, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 2015;104:3-13
Exclusive breastfeeding saves lives
0
2
4
6
8
10
12
14
16
Diarrhoeamortality
Pneumoniamortality
Diarrhoeaincidence
Pneumoniaincidence
All causemortality
Rel
ativ
e ris
k co
mp
are
d t
o e
xclu
sive
b
rea
stfe
ed
ing
for
0-5
mo
nth
s
Predominant breastfeeding Partial breastfeeding Not breastfeeding
Exclusive breastfeeding
Black RE, et al. Lancet 2008;371:243-260
Sankar MJ, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 2015;104:3-13
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 12
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 13
Weight-for-age z-scores from 0 to 6 months: breastfed infants, USA v. Honduras.
Exclusively breastfed children grow just as well
Cohen RJ, et al. Lancet 1994;334:288-293
Early child development
• Emotional bonding– Close, loving relationship
between mother and baby
– Mother is more emotionally satisfied
– Baby cries less– Baby may be more
emotionally secure
• Cognitive development– Children perform better
on intelligence testsSource: UNICEF
Few women breastfeed exclusively for 6 months
Source: UNICEF Global Databases. 2016
Percent of infants 0‐5 months of age exclusively breastfed, by country and region, 2015
Why don’t women exclusively breastfeed for 6 months?
• Cultural and social myths– Not enough milk!
• Breastfeeding is perceived to be difficult– Lack of social support– Lack of adequate maternity leave– Lack of workplace support
• Widespread marketing of breast milk substitutes
• Obesity
Recommended practice: Continue to breastfeed for 24
months and beyond
Martine Korpel and her son Quinten (2 years)© Argos Fotoburo
Breast milk is an important sourceof nutrients
Savage King F, Burgess A. Nutrition for Developing Countries. New York: Oxford University Press,1993
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 14
Breast milk provides energy
Dewey KG, Brown K. Food Nutr Bull 2003;24:5-28
615686
894
413379
346
202
307
548
0100200300400500600700800900
1000
6-8 months 9-11 months 12-23 monthsEst
ima
ted
en
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equ
irem
en
ts
(kca
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)
Total energy Energy from breastmilk Energy from complementary food
Breast milk provides energy
615686
894
413379
346
202
307
548
0100200300400500600700800900
1000
6-8 months 9-11 months 12-23 monthsEst
ima
ted
en
erg
y r
equ
irem
en
ts
(kca
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)
Total energy Energy from breastmilk Energy from complementary food
Dewey KG, Brown K. Food Nutr Bull 2003;24:5-28
Breast milk provides fat
Recommended% of total
dietary energy from fat
Level of breast milk
intake
Energy (%) needed from fat in complementary foods,
by level of breast milk intake
6-8 months 9-11 months 12-23 months
35 Low 27 30 33
35 Medium 4 16 25
35 High 0 0 2
Joint FAO/WHO Expert Consultation on Fats and Fatty Acids in Human Nutrition. Interim Summary of Conclusions and Dietary Recommendations on Total Fat and Fatty Acids 2008. www.who.int/nutrition/topics/FFA_interim_recommendations/en/index.html
Breast milk provides fat
Recommended% of total
dietary energy from fat
Level of breast milk
intake
Energy (%) needed from fat in complementary foods,
by level of breast milk intake
6-8 months 9-11 months 12-23 months
35 Low 27 30 33
35 Medium 4 16 25
35 High 0 0 2
Joint FAO/WHO Expert Consultation on Fats and Fatty Acids in Human Nutrition. Interim Summary of Conclusions and Dietary Recommendations on Total Fat and Fatty Acids 2008. www.who.int/nutrition/topics/FFA_interim_recommendations/en/index.html
Breast milk provides fat
Recommended% of total
dietary energy from fat
Level of breast milk
intake
Energy (%) needed from fat in complementary foods,
by level of breast milk intake
6-8 months 9-11 months 12-23 months
35 Low 27 30 33
35 Medium 4 16 25
35 High 0 0 2
Joint FAO/WHO Expert Consultation on Fats and Fatty Acids in Human Nutrition. Interim Summary of Conclusions and Dietary Recommendations on Total Fat and Fatty Acids 2008. www.who.int/nutrition/topics/FFA_interim_recommendations/en/index.html
Continued breastfeeding and growth
• Good growth after infancy depends on breastfeeding, intake of complementary foods and illness in a complex manner– Women continue to breastfeed children who
are perceived to be too small, especially when they are ill or consume too little complementary food
– In contrast, women wean children who are growing well, consume adequate amounts of complementary foods and are not ill
Marquis GS, et al. Int J Epidemiol 1997;26:349-56
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 15
Globally, less than half of children are still breastfed at 2 years
Source: UNICEF Global Databases. 2016
Percent of children 20‐23 months of age who are breastfed, by country and region, 2015
Why don’t women breastfeed to 24 months?
• Conflict with work
• Cultural beliefs – Nursing during another
pregnancy
– Loss of milk’s nutritional value
• Family and peer pressure to stop, especially after 12 months
Benefits of breastfeeding for the mother, family, and community
Lazarov M. Zero to Three. 2000;21:15
Benefits of breastfeeding for the mother
• Delays the return of fertility
• More rapid return to prepregnancy weight; lower postpartum weight retention
• Lowers risk of postpartum depression
• Lowers risk of pre-menopausal breast cancer and ovarian cancer
• May reduce the risk of hip fracture
Benefits of breastfeeding for the family and community
• Decreases absence in the workplace because of decreased family illness
• Lowers expenditures for food and health care
• Provides a safe food in emergency and disaster situations
• Supports the environment, reducing use of fuels, pharmaceuticals, plastic, and waste from the dairy industry
Recommended breastfeeding practices
• Immediate skin-to-skin contact and early initiation of breastfeeding (within first hour after delivery)
• Breastfeed exclusively for 6 months
• Continue breastfeeding to 24 months and beyond
Essentials of Breastfeeding. E‐Course on Programming for IYCF. © UNICEF and Cornell University. 2017. 16
© A
rt M
edia
Co.
, Ltd
. (T
haila
nd)
Thank you!
This training course was jointly developed by the
Infant and Young Child Feeding Unit,
Nutrition Section, UNICEF Headquarters,
and
Cornell NutritionWorks, Division of Nutritional Sciences,
Cornell University.
Copyright 2017
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