Abstract
The most recent (2020) estimate of the magnitude of the international migrant population sets the number as over 280 million, representing 3.6% of the total world’s population. This dramatic continued increase is attested to by contrasting the 2020 total to the size of the 1980 migrant population, which represented 2.3% of the world population, while in 2000 this rose to 2.8%. 1
This number only relates only to cross border migration and does not account for the millions (particularly in China and India) who migrate intercountry from rural to urban settings, with inevitably no less a disturbance and disruption of their culture, work patterns, medical care availability, and family relatioships. 2
Of particular interest is the impact of the migration process and the “adjustment” of mothers to their new setting on their breastfeeding practices. This subject was recently summarized in a scoping review by Murcia-Baquero, 3 who emphasized that there is major heterogeneity in the resulting breastfeeding practices that reflect the culture and practices of the mother’s “home” country as it adjusts to a new and most often different set of variables, values, and routines of the “host” country.
By and large the initial migrant mother’s rate of initiation and duration of breastfeeding reflects the home country practices and is mostly at a higher rate than those of the native-born mothers. However, as the interval time of the birth from the migration date increases, the breastfeeding rates of the migrant mothers converge towards those of the native-born mothers.4,5
This month’s issue of Breastfeedig Medicine features a study by Stanhope and colleagues of breastfeeding initiation and duration rates in a “Hispanic/Latino population. Data were obtained mothers from representative and varied geographic locations in the United States (US). The investigators compared the results from those mothers who were born in the US to those who emigrated before age 18 and to those who emigrated as adults (above age 18.) The results noted that the mothers who were born in a country other than the US or who arrived to the US as a child (i.e., under age 18) initiated breastfeeding nearly three times more often as compared with those Latino mothers who were born in the US. Even those who immigrated after age 18 initiated at a higher rate than that of the native-born others.
The complexity of analyzing consequences of the migrant status of mothers is best exemplified by the phenomenon of what has been termed “left behind children”. 6 This is a situation where women who live in rural China migrate to urban centers for employment opportunities, but who are required, if they become pregnant, to return to their rural villages to deliver their infants. After a short postpartum period (weeks), under the economic pressure of keeping their jobs, they return to their urban work setting. In turn, they “leave behind” their newborn child in the care of grandmothers or similar non breastfeeding caretakers.
The limited data about this phenomenon (estimated to be at least one third of the infants born in rural China setting) document a general improvement in the physical growth of these infants (i.e., less stunting). Unfortunately, there are no data as to the consequences of not breastfeeding on other short- and long-term health outcomes. As noted, conventional standard data as to the health impact of migrant status does not include or refer to this phenomenon of internal migration, let alone the “left behind” infants.
Migrants, open borders, and the like have become political footballs reflecting racial and ethnic attitudes, pervasive xenophobia, economic priorities, and cultural values beyond the specifics of medical care and breastfeeding per se. What is clear, is that until the complexity of the issue is acknowledged and addressed, the needs and priorities of the individual maternal–infant dyad will all too often be lost in heat of political controversy.