Media statement by the Minister of Health Dr Aaron Motsoaledi: Government adopts breastfeeding-only infant feeding strategy

23 Aug 2011

Distribution of breast milk substitute through health facilities to be discontinued

First let me acknowledge the presence of Deputy Minister and thank all of you for making time to participate at this important gathering to chart the future for our country especially children and mothers. Let me also thank the Heads of Department for their presence and active participation and I know you are aware that you are going to be at the forefront of the implementation of the ground-breaking decisions we have taken over the past two days.

South Africa is one of only 12 countries in the world where infant mortality has been on the increase and as government we have committed ourselves to changing this unacceptable situation. We find ourselves in a space where no country would like to find itself, and this we cannot allow any longer. Hence reducing child mortality is one of the most important priorities in our country and central to this is breastfeeding as a child survival strategy.

This consultative conference has unanimously recommended that South Africa moves to an exclusive breastfeeding strategy and that we should discontinue the practice of providing milk formula through hospitals and clinics except when recommended by an authorised health practitioner.

The substantial benefits of breastfeeding extending to infants and mothers have long been recognised and proven. Breastfed babies are better protected against infections like diarrhoea, respiratory illnesses, allergies and ear infections, they are at much lower risk of malnutrition, and as adults are at lower risk of chronic lifestyle diseases such as obesity, coronary heart disease and type two diabetes. Mother-child bonding is also accelerated through breastfeeding. This means that breastfeeding is not just about nutrition!

Mothers who breastfeed also benefit. They have a reduced risk of developing breast and ovarian cancer. In addition, they will return to their pre-pregnancy weight more easily, and the likelihood of falling pregnant again while breastfeeding is reduced.

Those of you were present at the opening of the summit yesterday will recall that experts from United Nations Children's Fund and World Health Organisation (WHO) informed us that it has been conclusively proven that exclusive breastfeeding is a safe infant feeding option even for HIV-positive mothers – and that the benefits of them exclusively breastfeeding their children far outweigh any potential risks. Research has shown that if the baby of an HIV-positive mother is exclusively breastfed, the chances of it being infected with the virus are greatly reduced, but greatly increase if they practice mixed feeding.

All babies should be breastfed for at least the first six months of their lives. Babies of HIV-positive mothers should also be exclusively breastfed for the first six months, with complementary foods being introduced after six months. It is also recommended that both mother and infant undergo antiretroviral therapy throughout the breastfeeding period.

So how are we doing with respect to breastfeeding in South Africa? The 2003 Demographic and Health Survey showed an exclusive and extended breastfeeding rate of 8%, and only 1.5% of babies aged four to six months were exclusively breastfed. And a 2008 Human Sciences Research Council study found only 25.7% of children under six months were reported to be exclusively breastfed; by comparison, 51.3% were mixed-fed (feeding both breast and formula or other substances such as tea, water or porridge.) and the remaining 24% are on infant formula.

We have identified the following barriers to exclusive breastfeeding:

  • Aggressive promotion of formula by manufacturers
  • Challenges for working mothers to breastfeed in the workplace
  • Teenage mothers leaving their babies at home with relatives, who rely on formula feeding
  • A lack of family and community support for breastfeeding
  • The sub-optimal involvement of men in supporting breastfeeding
  • Practices in health facilities that do not support breastfeeding, such as delayed initiation of breastfeeding, issuing of formula to mothers who opt for breastfeeding, or poor infant feed counselling
  • National policies that obstruct the promotion of breastfeeding, such as the discharge of mothers soon after delivery, before breastfeeding has been established
  • Confusion around the risks of HIV transmission and breastfeeding
  • A lack of large-scale systemic efforts to promote exclusive breastfeeding due to limited understanding of its benefits.

It is undeniable that breastfeeding is the very best way to nourish babies – there is, literally, no substitute for it. This is why on the basis of this consultation meeting we will adopt the World Health Organisation's recommendations for a single infant feeding strategy, namely exclusive breastfeeding including for HIV positive mothers.

We will thus also be discontinuing the distribution of free breast milk substitutes through health facilities, as this cannot be reconciled with an exclusive breastfeeding strategy. It will only be recommended by an authorised health practitioner to those mothers who, for medical reasons cannot breastfeed.

In addition I will make regulations to enforce the international code of marketing of breast milk substitutes.

The promotion of sustained and exclusive breastfeeding should also be seen in the context of strengthening primary healthcare (PHC). To this end, the National Health Council has resolved, as part of National Health Insurance, to implement three systemic changes to promote breastfeeding, including ward-based PHC outreach teams, a strengthened school health programme, and district-based clinical specialist teams. These strategies must assist us to overcome some of the barriers to exclusive breastfeeding that I mentioned earlier.

I call on all three spheres of government, traditional leaders and healers, business and labour, non government organisations and civil society to fully commit and support exclusive breastfeeding.

We need to reposition, promote, protect and support breastfeeding as a key infant survival strategy in South Africa. It simply makes sense to do so, and it is imperative – but it will require the commitment and support of all sectors of society to succeed.

I invite the media to partner with us to ensure that we publicise this policy shift as widely as possible so that every mother, mother to be, granny, partner knows this policy and supports it. Mothers must be supported to exclusively breastfeed.

Let me take this opportunity once again to thank the media for continuously bringing to the public attention the many challenges that we are faced with in the sector. The death of babies is one such issue and I am confident that you will continue doing so while at the same time informing the public of the various initiatives that we put in place to respond to these challenges.

In conclusion I welcome the Tshwane declaration and I am confident that it will mobilise all of us to work hard in making exclusive breastfeeding a reality in our country.

Thank you very much.