Prevalence and Causes of Exclusive Breastfeeding Failure in 6 Months After Birth in Iranian Infants

Dear Editor:

Exclusive breastfeeding means feeding the infant with breastmilk without any food or liquid. This feeding method is recommended by the World Health Organization (WHO) for the first 6 months after birth, which has an important role in reducing infantile morbidity and mortality and also can act as a contraception method. ¹ Exclusive breastfeeding compared with other methods could lead to a fivefold reduction in the rate of acute respiratory tract infections and decrease the rate of diarrhea 25 times. It confers benefits to the mother and child such as family planning, immunization, uterine contracture and decreased bleeding, and prevention of breast cancers in mothers and prevention of asthma, allergy, and eczema in infants. Exclusive breastfeeding also is cost-effective and helps to an improved emotional relationship between the mother and baby. ²

The key role of exclusive breastfeeding in healthy survival of children has been confirmed scientifically in recent years. Therefore global action has begun to return to exclusive breastfeeding and prevent the usage of formula for children younger than 2 years old. In developed countries mothers have turned to exclusive breastfeeding, and their percentage has greatly increased; for example, in Norway, Sweden, and Finland this number has risen from 30% to 90%. Other developed countries such as the United States, the United Kingdom, and Japan have tried to expand exclusive breastfeeding to prevent mortality and morbidity in children. ²

Follow-up has determined that in Mashhad, Iran, the main cause of exclusive breastfeeding failure was breastmilk insufficiency, which was divided into two categories: inadequate growth due to not receiving enough milk and mothers' concept about breastmilk insufficiency. The most common cause of exclusive breastfeeding failure in the pediatrics department or for neonatal intensive care unit–admitted infants was inadequate growth.

WHO has declared that about 98% of mothers have the ability to exclusively breastfeed for 6 months after birth, and there are a few women who cannot feed their children, ³ but statistics reveal that among six WHO regions, our area in the east Mediterranean region has the lowest exclusive breastfeeding rate, despite the fact that the majority of its population are Muslims and Islam emphasizes the importance of breastmilk. ²

According to Iranian Health Ministry statistics, exclusive breastfeeding increased from 9% to 43.3% between 1370 and 1376.^4,5 The exclusive breastfeeding index was 45% in 1379, but this uptrend was not continued, so the percentage fell to 29% in 1385 and finally came to 20–25% in 1387. ⁶

Studies conducted in different areas in the world^3–5 and even in various parts of our country showed different incidences of exclusive breastfeeding failure, which represents plenty of factors affecting exclusive breastfeeding.

Our study showed that exclusive breastfeeding failure is more common in neonatal intensive care infants. A study done in Rasht in 1373 had the same results as ours and introduced multiple pregnancies as a risk factor for this failure. ⁶ Research at Imam Reza Hospital in Mashhad confirmed our results and concluded that the longer nothing peroral duration could affect exclusive breastfeeding. ⁷ Maternal employment is a controversial issue in exclusive breastfeeding and be a factor with a positive or negative effect.

We recommend that health team members should concentrate on better educational programs for both parents. Sustaining support for exclusive breastfeeding in mothers with neonatal intensive care unit–admitted children is another guideline for breastfeeding failure.