Paper
Thursday, July 12, 2007
Promoting longer-term exclusive breastfeeding in different socio-cultural contexts: A critical examination of current WHO breastfeeding guidelines
Sonia Semenic, RN, PhD, IBCLC, School of Nursing, McGill University, Montreal, QC, Canada
| Learning Objective #1: ...discuss determinants of breastfeeding exclusivity as well as evidence-based strategies for promoting and supporting a longer duration of exclusive breastfeeding. |
| Learning Objective #2: ...critically evaluate the relevance and feasibility of the WHO’s current breastfeeding guidelines for different socio-cultural contexts. |
Breastfeeding is universally recognized as the optimal method of infant feeding, and maternal-child nurses play an integral role in breastfeeding promotion and support. The World Health Organization recently extended the recommended duration of exclusive breastfeeding (i.e., breastfeeding with no other liquids or foods) from 4 months to a full 6 months postpartum, based on limited evidence related to the infant health benefits of prolonged exclusive breastfeeding in low-income countries (WHO, 2003). However rates of exclusive breastfeeding to 6 months remain very low around the world, and marked inequities in breastfeeding initiation and duration persist. In developed countries such as Canada, women are more likely to breastfeed if they are better educated and more affluent, yet only 17% of Canadian women exclusively breastfeed to 6 months as recommended. Health professional interventions have had little impact on rates of longer-term exclusive breastfeeding, underscoring the need to identify modifiable biological, psychosocial and health system factors influencing exclusive breastfeeding duration. Breastfeeding advocates also need to better understand the broader socio-cultural determinants of breastfeeding behaviors, as well as the relative health benefits of prolonged exclusive breastfeeding in developing versus developed countries. By advising exclusive breastfeeding for 6 months in the absence of adequate health system, workplace, and societal support for this practice, nurses may inadvertently set unrealistic infant care goals for new mothers and undermine parenting confidence. The objectives of this presentation are to: 1) discuss the WHO’s internationally-promoted breastfeeding recommendations; 2) review evidence-based strategies for prolonging the exclusive breastfeeding period; 3) address the need for broader, multi-sectoral action and policy initiatives to support longer-term exclusive breastfeeding in developed countries such as Canada; and 4) challenge nurses to critically evaluate the relevance and feasibility of the WHO’s breastfeeding guidelines for different socio-cultural contexts. WHO (2003). Global strategy for infant and young child feeding. Geneva: WHO.