How One Country Went From 11% To 74% Exclusive Breastfeeding

How One Country Went From 11% To 74% Exclusive Breastfeeding

Australia’s leading health organisation, the National Health and Medical Research Council, recommends exclusive breastfeeding for around the first 6 months, and then for breastfeeding to continue alongside suitable complementary foods for at least one year.

The World Health Organisation recommends the same, only for two years, or as long as mother and baby are happy to continue.

Despite these recommendations, and while 96% of mothers start out breastfeeding, statistics show a sharp decline in exclusive breastfeeding with each month after birth:

  • 1 month – 56%
  • 3 months – 39%
  • 4 months – 27%
  • 5 months – 15%

By 1 year only 28% of children are still being breastfed and only 5% by 2 years.

How One Country Dramatically Increased Their Breastfeeding Rate

How did one country — within a decade — go from an exclusive breastfeeding rate of 11% to almost 74% (between 0 and 5.9 months)?

What country could do this?

And what can other countries learn from this?

The country that did this was Cambodia.

Cambodia – with a gross national income of only 2 international dollars per capita, and a total expenditure on health of only 229 international dollars per capita.

Australia, on the other hand, has a gross national income per capita of 42 international dollars and a total expenditure on health per capita of 4191 international dollars.

Cambodia isn’t the only country to show a staggering increase in exclusive breastfeeding rates – according to the National Demographic and Health Survey, Kenya also raised their low 13% rate (in 2003) to 61% in 2015.

Surely if Cambodia or Kenya can achieve such an incredible change in exclusive breastfeeding rates, Australia can too?

Especially given the amount of financial resources available for health.

So, how did Cambodia increase their exclusive breastfeeding rates so dramatically?

Cambodia Launched A Breastfeeding Media Campaign

One strategy Cambodia used to increase breastfeeding rates was a nationwide communication campaign. This campaign focused on encouraging exclusive breastfeeding to 6 months and continued breastfeeding to at least 2 years of age. It utilised mass media and interpersonal communication.

This campaign utilised a prime time TV spot to broadcast at least daily for a 3 month period, on three TV channels. Radio spots were also played daily during this period. Below is the TV advertisement Cambodia featured. It shows a mother speaking to her doctor, who advises her that she needs to feed her baby past 6 months of age, until two years of age.

Cambodia Implemented Extensive Health-Worker Training

It’s very clear that better breastfeeding education for many health professionals is absolutely essential.

In Cambodia, ten years ago it was normal practice for mothers during the first few days after birth to be kept warm by:

  • Staying in a small room on a bed over hot coals
  • Having layers of clothing placed over them
  • Consuming a wine and herb drink

This practice was referred to as ‘ang pleung’ or ‘roasting’. It was thought that this practice would help mothers recover faster from giving birth and pregnancy. However, this practice could also interfere with close mother baby contact to initiate breastfeeding.

Indeed, Cambodia has come a long way in a decade. The above practices are no longer done. Instead, early breastfeeding (within the first hour after birth) and exclusive breastfeeding for the first 6 months are encouraged, as well as continued breastfeeding until two years.

Cambodia Established Mother Support Groups

As a part of Cambodia’s Baby-Friendly Community Initiative, mother support groups that actively promote exclusive breastfeeding for the first 6 months were established.

Leaders of these groups received training from health centre staff to address issues such as child survival, nutrition, childhood illness and women’s reproductive health. This training enabled the leaders to provide vitally needed accurate information, advice and reassurance about breastfeeding to pregnant women and new mothers.

Australia’s leading breastfeeding mother support organisation, the Australian Breastfeeding Association (ABA) has been around since 1964. ABA’s mission is “As Australia’s leading authority on breastfeeding, we support, educate and advocate for a breastfeeding inclusive society.”

Joining the ABA can help you reach your breastfeeding goals.

In other parts of the world, there is the La Leche League which also works hard to support mothers in reaching their breastfeeding goals.

How Can Other Countries Increase Their Rates?

Considering how far Cambodia and Kenya have come, surely Australia and other countries can do so too.

There are many things that still need to happen to increase breastfeeding rates.

One thing that needs to happen is for all families should have access to IBCLC services. An IBCLC is an International Board Certified Lactation Consultant — the gold standard in lactation eduction. They are the breastfeeding specialists or experts mothers need to have access to for breastfeeding problems.

Unfortunately, the availability of financial rebates for clients using IBCLC services is inconsistent, with few private health funds recognising IBCLCs as independent providers.

Indeed, many low income and disadvantaged families cannot afford IBCLCs, and so are less likely to reach their breastfeeding goals. There is also a need for additional breastfeeding support (that can be provided by IBCLCs) for regional and remote areas which have lower breastfeeding rates too.

Medicare rebates for IBCLC services were identified in the 2007 Parliamentary Inquiry into Breastfeeding, as one strategy to improve breastfeeding rates in Australia. Several submissions to the Inquiry provided evidence to support this recommendation.

In order for more mothers to achieve their breastfeeding goals, IBCLC services must be covered under Medicare. This will enable more mothers to receive affordable, individual, un-timed, specialised and ongoing breastfeeding management support as required.

Cambodia has accomplished what much of the world aims to do. They did so with much less financial resources than some other countries, and in a short period of time. Cambodia has set a wonderful example for the rest of the world and we can hope to follow their example.

Mass education is key, for health professionals and parents. Bringing similar information to our television screens will not only educate mothers, but partners too, whose support has been cited in studies as being very important for mothers to reach their breastfeeding goals.

 
Last Updated: August 3, 2015

CONTRIBUTOR

Renee Kam is mother to Jessica and Lara, an International Board Certified Lactation Consultant (IBCLC), a physiotherapist, author of 'The Newborn Baby Manual' and an Australian Breastfeeding Association Counsellor. In her spare time, Renee enjoys spending time with family and friends, horse riding, running and reading.


6 comments

    1. Unfortunately I can only see ads that are targeted to Australia, as it’s where I live. I can’t see other countries, and I don’t know all the brands. If you could either email or post the link in here, I am able to ban them via the link. Unfortunately this is the only way. I do not accept formula advertising, but it slips through google’s targeted advertising program. Email: [email protected].

  1. This cannot be right. Currently approx 80% of the population of Cambodia is poor rural. It’s inconceivable that 10 years ago, when the poverty rate was even higher, that 89% of the babies were formula fed. How could this be possible? Even today, the expense of formula is beyond reach of the vast majority of Cambodians. If the per capita income is currently $1080, how could a poor family 10 years ago afford a minimum of $50/month for formula unless they absolutely had to for the survival of their child?

    It is also inconceivable, that in one of the worlds poorest developing countries with a very poor healthcare system ( with vast corruption ), and that also applies to the training of doctors and nurses that such a countrywide support system for breastfeeding is largely at best, on paper or non existent. My wife is Cambodian and has breastfed our son exclusively for over 15 months. At no time was she encouraged or counsel about breastfeeding. She did, however receive a nice gift bag from the hospital with samples of formula. Among the dozens of new mothers in Phnom Penh we have met ( largely middle class ) since the birth of our son, we have rarely met or seen a mother who has, or is currently breastfeeding their child. We are constantly hearing incorrect information about breastfeeding being passed on from family members and quite often, health professionals. We have not heard of any support groups anywhere for nursing mothers or clinics providing education or support for new mothers. As an example, when my wife ( who is working ) told our Cambodian midwife that she was pumping milk, the midwife informed her that breastmilk could only be stored in the refrigerator for a few hours before it goes bad. And this is at one of the better hospitals in Phnom Penh. Where is the training for one of the top midwives at one of the most modern clinics Phnom Penh? Currently the momentum in Phnom Penh is towards formula for most middle class Cambodian families and the concern is that this is going to influence the lower income Cambodians despite the financial burden to the family. To our knowledge, there are no educational resources or lactation counselors working through the medical clinics in Phnom Penh and we have never heard of any such support outside of Phnom Penh.

    The three month educational video your refer to is far outweighed by the vast amounts of money the formula companies are spending in Cambodia.

  2. Edit to above post: Cambodia is one of the worlds poorest developing countries with a very poor healthcare system ( with vast corruption ), and that also applies to the substandard training of doctors and nurses. We have seen no evidence of a countrywide system of education and support for new mothers that you refer to in your article.

    “Cambodia has set a wonderful example for the rest of the world and we can hope to follow their example. ” Unfortunately, this is not the case.

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