I read with interest the article by Betrán et al (2001) on breast-
feeding and infant mortality in Latin America. This article reminds us to
continue vigilant efforts on the basics. The article concluded with a
challenge for efforts to improve the rate of prolonged exclusive breast-
feeding and not to solely focus on initiation. In a recent study in a
poor urban district of Santo Domingo, Dominican Republic, we found high
rates of breast-feeding initiation (97%), but found most mothers did not
breast feed for a year (McLennan, 2001). In asking mothers directly about
their reasons for early suspension of breast-feeding we found the typical
responses given in most studies, such as “the breast-milk dried up” or
“the child no longer wanted it”. However, when we asked mothers to
indicate common reasons for other women in the community, additional
responses, not raised as personal reasons, emerged. These included that
mothers were “fearful of the loss of breast shape or the breasts falling”
with prolonged breast-feeding, in addition to mothers “not wanting to
breast-feed”. These were reported by up to a third of mothers. These
additional barriers need to be better understood in order to guide
effective health promotion efforts aimed at improving rates of prolonged
breast-feeding.
This article can be found posted on the Pan American
Health Organization website (www.paho.org), along with an excellent
editorial on breast-feeding by Dr. Rafael Pérez-Escamilla.
Sincerely,
John D. McLennan, MD, MPH
McMaster University, Canada
Betrán A, de Onís M, Lauer J, Villar J (2002) Ecological study of
effect of breast feeding on infant mortality in Latin America. BMJ 323
(7308):303.
McLennan J (2001) Early termination of breast-feeding in periuban
Santo Domingo, Dominican Republic: mothers’ community perception and
personal practice. Revista Panamericana de Salud Pública/Pan American
Journal of Public Health 9(6): 362-367
Rapid Response:
New barriers to prolonged breast-feeding
Dear BMJ,
I read with interest the article by Betrán et al (2001) on breast-
feeding and infant mortality in Latin America. This article reminds us to
continue vigilant efforts on the basics. The article concluded with a
challenge for efforts to improve the rate of prolonged exclusive breast-
feeding and not to solely focus on initiation. In a recent study in a
poor urban district of Santo Domingo, Dominican Republic, we found high
rates of breast-feeding initiation (97%), but found most mothers did not
breast feed for a year (McLennan, 2001). In asking mothers directly about
their reasons for early suspension of breast-feeding we found the typical
responses given in most studies, such as “the breast-milk dried up” or
“the child no longer wanted it”. However, when we asked mothers to
indicate common reasons for other women in the community, additional
responses, not raised as personal reasons, emerged. These included that
mothers were “fearful of the loss of breast shape or the breasts falling”
with prolonged breast-feeding, in addition to mothers “not wanting to
breast-feed”. These were reported by up to a third of mothers. These
additional barriers need to be better understood in order to guide
effective health promotion efforts aimed at improving rates of prolonged
breast-feeding.
This article can be found posted on the Pan American
Health Organization website (www.paho.org), along with an excellent
editorial on breast-feeding by Dr. Rafael Pérez-Escamilla.
Sincerely,
John D. McLennan, MD, MPH
McMaster University, Canada
Betrán A, de Onís M, Lauer J, Villar J (2002) Ecological study of
effect of breast feeding on infant mortality in Latin America. BMJ 323
(7308):303.
McLennan J (2001) Early termination of breast-feeding in periuban
Santo Domingo, Dominican Republic: mothers’ community perception and
personal practice. Revista Panamericana de Salud Pública/Pan American
Journal of Public Health 9(6): 362-367
Competing interests: No competing interests