A review of the literature on breast-feeding - Policy and research issues

Aim. To identify information that would support the development of a scienc e-based and locally relevant breast-feeding policy. Objectives. To describe the trends in infant feeding practices, examine the scientific evidence relating infant feeding to infant health, determine th e factors associated with choice and duration of feeding, examine the polic y implications of the HIV epidemic, describe codes and policies related to infant feeding, identify key research questions, and make policy recommenda tions. Methods. A literature review was conducted concentrating on papers publishe d after 1970. Results. Findings from this review that need to be considered in drawing up a comprehensive breast-feeding policy for South Africa include: (i) breast -feeding is associated with lower rates of gastro-intestinal illness and wi th a lower mortality from gastro-intestinal and respiratory infections; (ii ) developed countries appear to be experiencing an increase in breast-feedi ng initiation rates and duration of breastfeeding, while the rates and dura tion of breast-feeding appear to be decreasing in developing countries; ade quate documentation of national trends in breast-feeding is unavailable for South Africa; (iii) in South Africa, breast-feeding initiation rates are g enerally high; however, there does appear to be a problem with regard to th e duration of breast-feeding and with the early introduction of supplementa ry feeds; (iv) important reasons for terminating breast-feeding include mil k insufficiency, maternal work and breast problems; and (v) HIV is transmis sible through breastmilk - from a public health perspective, research that provides information on the factors needed to develop a local HIV breast-fe eding policy should receive high priority. Conclusion. This review assists in clarifying current scientific knowledge on certain aspects of breast-feeding. The challenge now is to utilise this information to ensure optimal infant nutrition.