Breastfeeding: The science, law, and country report

Breastfeeding: The science, law, and country report

The first week of August marked the 25th anniversary of World Breastfeeding Week.


When: August 1 to 7, 2017
Theme: Sustaining Breastfeeding Together. Now in its 25th year, this year’s theme calls for the world to work together for the common good of its children. The week is marked by more than 170 countries.

The first week of August marked the 25th anniversary of World Breastfeeding Week, a week-long fete to honour the gains made in promoting breastfeeding as well as highlighting its challenges. Exclusive human milk feeding for the first six months of a baby’s life, coupled with continued breastfeeding for one to two years of life or longer, is recognised as the normative standard for infant feeding. But a new report by United Nations Children’s Fund and World Health Organisation in collaboration with the Global Breastfeeding Collective states that despite the inroads made in promoting exclusive breastfeeding, no country in the world fully meets recommended standards. The Global Breastfeeding Scorecard, which evaluated 194 nations, found that only 40 per cent of children younger than six months are breastfed exclusively, and only 23 countries have exclusive breastfeeding rates above 60 per cent.

A child can feed on breast milk exclusively for the first six months and still get all nutritional needs, and breastfeeding is still very important beyond the first six months. Once complementary foods are introduced, breast milk continues to provide important nutrients and growth factors up to two years. The World Health Organisation recommends that breast milk should continue to be part of a child’s diet to two years of age and beyond.


Colostrum: This is the secretion produced during the first few days (one to seven days) after birth and contains a higher amount of protein, less fat and a number of immunising factors for the newborn. Colostrum is highly nutritious and contains antibodies that provide natural immunity to the infant. It is recommended that children be fed colostrum immediately after birth (within one hour) and that they continue to be exclusively breastfed even if the regular breast milk has not yet started to flow.

Transitional milk: This stands in the space between colostrum and mature milk, where lactation is established and production of milk begins in the breast tissue. Transitional milk is produced from approximately day 8 to 20.

Mature milk: This is produced from 20 days after birth, onwards. It can vary in and between individuals and the energy can vary between 270 and 315 kJ per 100ml. This is largely due to the variation in the fat content, as the fat of the milk received by the infant increases as the feeding progresses. Mature milk continues to provide immune factors and other important non-nutritional components to the infant.


Human milk contains hundreds to thousands of distinct bio-active molecules that protect against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonisation. Mature human milk contains:

3%—5% fat
0.8%—0.9% protein
6.9%—7.2% carbohydrate (calculated as lactose)
0.2% mineral constituents (expressed as ash)
Its energy content is 60—75 kcal/100 ml

Breastmilk contains all the nutrients the infant needs for proper growth and development. These include:

Proteins: Protein accounts for 75% of the nitrogen-containing compounds, and the non-protein nitrogen substances include urea, nucleotides, peptides, free amino acids, and DNA
Fats: These are necessary for brain, eye, and nervous system development
Vitamins: The amount and types of vitamins in breast milk are directly related to the mother’s vitamin intake. Essential vitamins include A, C, E, and K. For vitamin D, a child needs exposure to sunlight to generate it
Carbohydrates: The principal carbohydrate of human milk is lactose.
Natural drugs: Breast milk also contains important non-nutritional components, such as antimicrobial factors, digestive enzymes, hormones and growth factors

Can’t do it?

Medical literature suggests that between one and five per cent of women cannot produce enough milk to feed their baby. Dr Beth Maina, a paeditrician, adds that mothers on treatment for mental illness, cancer or those who suffer post-delivery complications may not be able to breast feed their babies. “Others may have problems because they are anxious, exhausted or depressed and are not given enough support in the early days,” she adds.

Risk of HIV

Breastfeeding can transmit HIV, while other environmental contaminants and medications such as anti-depressants can end up in the baby’s system through breast milk. If no antiretroviral drugs are being taken, breastfeeding for two or more years can double the risk of the baby becoming infected to around 40 per cent. Kenya has adopted Option B+, a programme by Unicef and Unaids where mothers and their newborns receive ARVs, and which helps keep the baby HIV-negative while still enjoying all the benefits of breast milk. Unicef, Unaids and WHO recommend that wet-nursing be considered only when a potential nurse is informed of her risk of acquiring HIV from the infant in question; she has been offered HIV counselling and testing; she voluntarily takes a test and is found to be HIV-negative; and when wet-nursing takes place in a family context with no payment involved

Baby formula and the law

Breastfeeding is not an easy sell as companies have come up with breast milk substitutes such as infant formula, which they push to mothers with aggressive marketing tactics. In 1981 the WHO came up with an international code of marketing of infant formula and other products used as breast milk substitutes. It stated that member States should give priority to preventing malnutrition in infants and young children by supporting and promoting breastfeeding, taking legislative and social action to facilitate breastfeeding by working mothers, and regulating inappropriate sales promotion of infant foods that can be used to replace breast milk.

In Kenya, the Breastmilk and Substitutes (Regulation and Control) Act of 2012 regulates the marketing and distribution of breast milk substitutes and champions for exclusive breastfeeding.

Science behind the suckle: By suckling at the breast, the baby triggers tiny nerves in the nipple which cause hormones to be released into the mother’s bloodstream. One of these hormones (prolactin) acts on the milk-making tissues while the other (oxytocin) causes the breast to push out, or ‘let down’, the milk. Cells around the areola contract and squeeze out the milk, pushing it down the ducts towards the nipple. Oxytocin also makes the milk ducts widen, making it easier for the milk to flow down them. The let-down may happen if you see or hear your baby, or even just think about the child.


New analysis shows an annual investment of $4.70 per newborn (about Sh490) is required to increase the global rate of exclusive breastfeeding among children under six months to 50 per cent by 2025. Meeting this target could save the lives of 520,000 children under the age of five and potentially generate $300 billion (Sh30 trillion) in economic gains over 10 years. Globally, investment in breastfeeding is far too low. Each year, governments in lower- and middle-income countries spend approximately $250 million on breastfeeding promotion; and donors provide only an additional $85 million.
1.5 million
Number of baby deaths that would be avoided every year if every child was breastfed within an hour of birth for their first six months of life, according to Unicef. Only 40% of children under six months of age are fed on breast milk exclusively.

Distribution of children under six months who are living with their mothers, by breastfeeding status
are not breastfed at all

feed on breast milk and complimentary foods
are fed in accordance with the three recommended infant and young child feeding practices

are fed breast milk mixed with water, other milk, or other non-milk liquids
of children aged less than six months are exclusively breastfed

Initiation of breastfeeding in the first hour after birth varies somewhat by background characteristics
81% of children in the North Eastern region are breastfed within one hour of birth, compared with 48% of children in the Central region
Mothers with no education are more likely (76%) to initiate breastfeeding in the first hour than those with some education (65% or less)
Mothers in the lowest wealth quintile (67%) are more likely to initiate early breastfeeding than those in higher wealth quintiles (64% or less)


Sh63 ($0.61) was allocated per child by donor funding in 2013
Legislation mandates 13 weeks of maternity leave with 100% of previous earnings paid for by employer funds.
3.5% of births occur in baby-friendly hospitals and maternities.

Benefits to the baby

Mouth: Subtle changes in the taste of breast milk over time prepare the baby to accept a variety of solid foods. Suckling also helps jaw and teeth development while moulding facial and jaw structure.
Ears: Babies suffer fewer ear infections, thus have better hearing.
Eyes: Better visual acuity. Vision is improved with breastfeeding as the milk has vitamin , necessary for retinal development and colour vision.

Hair: The protein in breast milk is essential for the growth and repair of hair cells, thus your baby will have healthier, glossier hair.
Immune system: The antibodies in breast milk provide protection to the child and ward off infections, injuries, and diseases. It is also beneficial to the heart and circulatory system as it lowers cholesterol and allows optimum heart rates.
Respiratory system: Fewer upper respiratory infections, less wheezing, less pneumonia and influenza.
Brain: Fats and good cholesterol in the milk are essential for development of the brain and growth of nerve tissue.

Benefits to the mother

While most of the benefits are on the baby, Dr Beth Maina, a paediatrician, explains that the mother also benefits. For starters, she explains, breastfeeding time is equal to bonding time as “psychologically, the baby and the mother grow closer to each other”.
Early suckling stimulates the release of two hormones, prolactin (which helps in the production of milk) and oxytocin (which is responsible for the ejection of milk), which, Dr Maina explains, are beneficial to the mother.

“Production of oxytocin stimulates contraction of the uterus after childbirth, which helps your uterus return to its pre-pregnancy size and may reduce uterine bleeding. On the other hand, prolactin acts as a natural contraceptive, helping to prevent conception for as long as the mother is breastfeeding,” says Dr Maina.

She also explains that breastfeeding burns extra calories, helping the mother to lose the baby weight faster.

“It has also been proven that breastfeeding also lowers the mother’s risk of breast and ovarian cancer.”

During breastfeeding, the skin-to-skin contact between mother and child transfers healthy bacteria from mum to baby. This bacteria, Dr Maina explains, is important in the development of the baby’s immunity.

“Soon after delivery the baby is usually placed on the mother’s chest not only to get the mother’s warmth but also to help the sterile gut to absorb these good bacteria which will protect the baby from diseases. We call this passive immunity,” says Dr Maina, adding that this type of interaction is the first method of helping a baby build its immunity.

''Breastfeeding gives babies the best possible start in life and works like a baby’s first vaccine, protecting infants from potentially deadly diseases and gives them all the nourishment they need to survive and thrive.'' World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus in the Global Breastfeeding Scorecard.