Breastfeeding Saves Lives: Why Policy and Support Still Fall Short

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There are few public health interventions as powerful, accessible, and cost-effective as breastfeeding. It requires no manufacturing, no shipping, and no complex infrastructure. It is nature’s first immunisation—rich in antibodies, tailored to each child’s unique needs, and protective against illness and death.

And yet, in South Africa and much of sub-Saharan Africa, too many infants are still not being breastfed exclusively for the first six months of life. The science is irrefutable. The question is: why are we still struggling to support one of the most natural, and vital, practices for child health and survival?

Global and Regional Evidence: Still Not Good Enough

The World Health Organization (WHO) estimates that optimizing breastfeeding could save over 820,000 children’s lives annually—most of them in low- and middle-income countries.[1] Exclusive breastfeeding (EBF) significantly lowers the risk of diarrhoea, pneumonia, sudden infant death syndrome (SIDS), and undernutrition, especially in the neonatal period.

In a 2023 multi-country analysis, sub-Saharan Africa showed an average EBF rate of 49%—with significant drop-off after the first month.[2] Across the continent, early initiation of breastfeeding within the first hour was recorded in just 45-46% of deliveries, and exclusive breastfeeding often ends well before six months due to a complex mix of structural and cultural factors.

Source: Current breastfeeding status, supportive policies, strategies and implementation environment in South Africa (2024)

South Africa: Progress with Fragile Gains

South Africa has made some policy progress. The national breastfeeding policy aligns with WHO guidelines, and the Baby-Friendly Hospital Initiative (BFHI) has been implemented in many facilities, where sadly, only 14% of deliveries occur. Exclusive breastfeeding rates rose from just 8% in 2003 to about 32% in 2016, and recent estimates in select provinces show continued improvement in some pockets, with figures ranging from 34–39% in recent studies from Limpopo and Mpumalanga.[3][4]

However, early cessation of breastfeeding is still common. The average exclusive breastfeeding duration in South Africa is just 2.9 months.[5] Many mothers introduce solids, water, or formula by the second or third month—often because of inadequate support, misinformation and socio-cultural or financial pressure.

What’s Getting in the Way? The Real-World Barriers

The obstacles facing mothers are not a matter of knowledge or desire—most women know that breastfeeding is best. The barriers are deeply systemic and situational:

  • Returning to work or school was cited as a leading cause of early cessation in multiple studies, affecting over 27% of breastfeeding mothers in Limpopo and Gauteng.[3]
  • Inadequate postnatal support, especially after early discharge (6–48 hours postpartum, depending on birth modality), leads to latching problems, painful breastfeeding experiences, and early abandonment of EBF.[5]
  • Stigma and fear, including beliefs that breastmilk causes sagging, or concerns about transmission in HIV-positive mothers despite adequate ART, continue to influence decision-making, especially in rural and informal settlements.[4]
  • Despite Regulation R991, Formula marketing strategies continue to influence infant feeding choices. Informal sales and free samples still influence caregiver choices in both public and private facilities.
Source: Current breastfeeding status, supportive policies, strategies and implementation environment in South Africa (2024)

What Needs to Happen: Updated and Implementable Solutions

To protect and encourage exclusive and sustained breastfeeding, we need interventions that are not only evidence-based, but also practical, inclusive, and culturally responsive.

1. Strengthen Community-Based Support

  • Establish and expand peer-led breastfeeding support groups through clinics and community centres.
  • Include grandmothers, partners, and traditional leaders in education campaigns, as many feeding decisions are influenced by the wider household.

2. Extend and Adapt Postnatal Contact

  • Introduce post-discharge follow-up within 3–5 days of birth, particularly for first-time mothers.
  • Use community healthcare workers and WhatsApp groups to check in with mothers, provide guidance, and answer early challenges before they become reasons to stop breastfeeding.

3. Promote Workplace Flexibility—Low-Cost Interventions

  • Encourage flexible break times, private spaces for feeding or expressing, and shared refrigeration in both formal and informal work settings.
  • Recognize unpaid caregiving in national planning frameworks.

4. Normalize and Celebrate Breastfeeding

  • Use local radio and clinic-based storytelling to highlight successful breastfeeding journeys and address myths in a non-judgmental way.
  • Create breastfeeding corners in public spaces like libraries, malls, and taxi ranks to reduce stigma.

5. Enforce Existing Laws

  • Monitor compliance with Regulation R991, especially in urban hospitals and retail settings.
  • Train health workers on what counts as indirect marketing and how to respond appropriately.

Final Thought: Breastfeeding is Not Just a Health Choice—It’s a National Investment

When we support women to breastfeed, we’re not just preventing diarrhoea or pneumonia. We’re improving the mental and physical health of moms, reducing healthcare costs, and investing in better educational and economic outcomes down the line. Breastfeeding is one of the few interventions that offers direct, generational, and lifelong impact.

The policy groundwork is there. The evidence is undeniable. Now, we need the will, and the systems, to make breastfeeding work for every mother, everywhere.

Dr. Khutso N. Sebetseba is an HMI Senior Fellow for Infant Health, Nutrition and Equity with extensive experience and special interests in newborn care, allergies and respiratory conditions, infectious diseases (particularly paediatric HIV), Neonatology and paediatric ICU care.

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Footnotes:

  1.  Victora CG et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 2016.
  2. UNICEF. Global Breastfeeding Scorecard 2024.
  3. Makwela NS et al. Barriers to exclusive breastfeeding in Polokwane. Front Glob Women’s Health. 2024.
  4. Mdaka M et al. Facilitators and Barriers in Mpumalanga, South Africa. Int J Environ Res Public Health. 2023.
  5. Tuthill EL et al. Re-evaluating MBFI in SA: Early discharge and postnatal support gaps. Int Breastfeeding J. 2023.