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Printable Document

Breastfeeding Patterns in the Developing World

(1999) This wallchart offers information on breastfeeding patterns, child survival, and reproductive health information for more than 90 developing countries. It also includes information that highlights the benefits of breastfeeding, the Lactational Amenorrhea Method, and breastfeeding and HIV/AIDS.

Breastfeeding

Percent of Children Who Are

Ever breastfed

Breastfeed within one hour of birth

Exclusively breastfed at ages < 6 months
(a = < 4 months)

Breastfed with complementary  foods
(5–9 months)

SUB-SAHARAN AFRICA
Benin

97

24

10

97

Botswana

39a

Burkina Faso

99

30

5

59

Cameroon

97

38

12

77

Cape Verde

18a

Central African Rep.

97

34

3

Chad

98

24

2

81

Comoros

96

25

3

92

Congo, Dem. Rep. of

32a

40

Côte d'Ivoire

100

44

2

72

Eritrea

98

48

59

66

Ethiopia

74a

Gabon

57a

Ghana

99

16

31

79

Guinea

52a

Kenya

98

58

12

94

Lesotho

54a

47

Liberia

17

Madagascar

97

34

48

93

Malawi

97

59

2

87

Mali

95

10

8

50

Mauritania

95

5

10

94

Mauritius

72

20

29

Mozambique

95

81

30

86

Namibia

95

55

14

65

Niger

97

28

1

67

Nigeria

97

33

1

70

Rwanda

97

20

90

68

Senegal

97

16

13

69

Sierra Leone

94

Sudan

96

60

1

92

Swaziland

37a

51

Tanzania

97

59

29

93

Togo

97

19

10

Uganda

98

49

57

80

Zambia

98

58

19

95

Zimbabwe

99

40

11

96

   
MIDDLE EAST and NORTH AFRICA
Algeria

93

22

5

50

Bahrain

97

40

69

Egypt

95

41

56

78

Iran

98

56

84

Jordan

95

32

11

68

Lebanon

88

15

12

38

Libya

91

22

6

42

Morocco

95

43

25

61

Oman

99

83

28

85

Syria

92

22

13

60

Tunisia

94

38

5

70

Turkey

95

21

10

27

United Arab Emirates

93

25

52

Yemen

97

47

18

79

   
ASIA
Armenia

21a

34

Azerbaijan

53a

75

Bangladesh

97

13

45

69

Cambodia

60a

China

64a

India

95

10

43

31

Indonesia

96

8

42

81

Kazakstan

96

10

10

67

Kyrgyzstan

95

53

21

81

Laos

36a

Mongolia

93a

99

Myanmar

30a

40

Nepal

98

18

74

71

Pakistan

94

9

23

59

Philippines

88

42

37

60

Sri Lanka

24a

60

Thailand

4a

71

Turkmenistan

54a

Uzbekistan

96

19

2

83

   
LATIN AMERICA and the CARIBBEAN
Belize

90

46

17a

46

Bolivia

97

39

50

80

Brazil

93

32

29

40

Chile

77a

17

Colombia

95

49

9

66

Costa Rica

35a

47

Dominican Republic

93

63

19

47

Ecuador

95

38

29

53

El Salvador

94

15

15

76

Guatemala

96

55

46

77

Haiti

96

36

2

90

Honduras

96

43

33

72

Nicaragua

92

80

22

65

Panama

32a

38

Paraguay

94

30

5

59

Peru

97

44

53

83

Notes
Estimates are from the latest available sources between 1990 and 1998.
a Data refer to the percentage of children less than 4-months-old who are exclusively breastfed
Data not available

 

Median duration of any breastfeeding (in months)

Median age at introduction of complementary foods
(in months)

Baby-friendly health facilities

Number

Percent

State of Implementation of Int'l Code of Marketing of Breast Milk Substitutes

SUB-SAHARAN AFRICA 
Benin

23

23

22

P

Botswana

7

7

S

Burkina Faso

25

6

8

F

Cameroon

18

2

0

0

F

Cape Verde

1

2

Central African Rep.

21

6

4

5

N

Chad

21

2

7

N

Comoros

20

3

19

100

Congo, Dem. Rep. of

0

0

P

Côte d'Ivoire

20

6

85

99

F

Eritrea

22

46

100

S

Ethiopia

0

0

P

Gabon

2

S

Ghana

19

1

S

Guinea

3

9

P

Kenya

21

6

232

66

S

Lesotho

7

39

S

Liberia

2

4

Madagascar

21

7

50

7

F

Malawi

21

2

7

15

S

Mali

22

12

20

S

Mauritania

21

1

<1

S

Mauritius

6

67

S

Mozambique

22

5

0

0

P

Namibia

17

6

35

100

S

Niger

21

5

20

20

S

Nigeria

20

5

1,036

16

P

Rwanda

28

7

2

...

S

Senegal

21

5

0

0

P

Sierra Leone

3

<1

S

Sudan

19

25

12

S

Swaziland

5

83

Tanzania

22

45

24

F

Togo

24

6

1

3

S

Uganda

20

7

11

3

S

Zambia

20

5

47

24

S

Zimbabwe

19

6

38

18

F

   
MIDDLE EAST and NORTH AFRICA 
Algeria

10

2

<1

P

Bahrain

15b

6

21

F

Egypt

19

6

95

2

S

Iran

22

418

89

F

Jordan

12

3

3

5

S

Lebanon

7

18

13

F

Libya

8

0

0

S

Morocco

15

17

17

S

Oman

19b

51

100

S

Syria

13

11

8

S

Tunisia

14

141

93

P

Turkey

12

3

83

P

United Arab Emirates

12b

4

P

Yemen

18

5

0

0

P

   
ASIA    
Armenia

0

0

S

Azerbaijan

5

25

Bangladesh

33

8

170

25

P

Cambodia

0

0

S

China

6,312

47

P

India

24

1,250

25

F

Indonesia

24

7

91

5

P

Kazakstan

5

5

4

<1

N

Kyrgyzstan

17

5

0

0

Laos

6

4

P

Mongolia

93

26

P

Myanmar

210

30

S

Nepal

31

8

7

7

F

Pakistan

20

35

4

S

Philippines

13

3

1,047

58

F

Sri Lanka

97

21

F

Thailand

780

87

S

Turkmenistan

0

0

Uzbekistan

17

5

0

0

   
LATIN AMERICA and the CARIBBEAN
Belize

12b

0

0

Bolivia

18

5

20

20

S

Brazil

7

4

116

3

F

Chile

21

13

P

Colombia

11

2

53

10

P

Costa Rica

5b

5

20

F

Dominican Republic

8

2

8

3

F

Ecuador

16b

95

67

S

El Salvador

18b

23

88

S

Guatemala

20

7

17

30

F

Haiti

18

4

5

5

S

Honduras

17b

3

13

S

Nicaragua

12

4

9

39

S

Panama

3

9

F

Paraguay

11b

18

67

S

Peru

20

6

91

70

F

Notes
Estimates are from the latest available sources between 1990 and 1998.
b Data refer to mean (arithmetic average) rather than median
Data not available

Exclusively breastfed: Infants who are receiving nothing other than breast milk, with the exception of medicines and vitamins.

Breastfed with complementary foods: Infants who are receiving breast milk and solid foods.

Median duration of any breastfeeding: Figures refer to the age of children in months at which half have stopped being breastfed.

Median age at introduction of complementary foods: Figures refer to the age of children (who were still breastfed at the time of the survey) in months at which half had begun taking solid food.

Baby-friendly health facility: A health facility is designated as "baby friendly" if it adheres to the "Ten Steps to Successful Breastfeeding" promoted by the World Health Organization (WHO) and UNICEF as part of their Baby-Friendly Health Initiative. For information on the Baby-Friendly Health Initiative, see the WHO (www.who.org) or UNICEF (www.unicef.org) Web sites.

State of the implementation of the International Code of Marketing of Breast Milk Substitutes: In 1981, the World Health Assembly adopted the International Code of Marketing of Breast Milk Substitutes as part of the WHO Constitution. It calls on countries to regulate the marketing of breast milk substitutes to prevent interference with breastfeeding. More than 160 countries and territories agreed to take steps to implement the Code. The Code is in the form of recommendations and its enforcement is a matter for each government to decide, according to its social and legislative framework. Letters shown in this column refer to the status of implementation by each country, as reported by UNICEF in the Progress of Nations 1997 and personal communication, UNICEF, June 30, 1999:

F Full Compliance — legislation or other legally enforceable measures have been enacted that implement the Code in its entirety.

P Partial Compliance — legislation or other legally enforceable measures have been enacted encompassing some of the Code's provisions.

S Some Action — legislation or other legally enforceable measures implementing the Code have not been enacted, but are in the process, or governments have taken other measures.

N No Action — no steps to implement the Code have been taken.

Child Survival

Child Survival

Population

Infant mortality rate

Deaths of children under 5 years per 1,000 births

Estimated number of births, 1999
(in 1,000)

SUB-SAHARAN AFRICA
Benin

94

167

273

Botswana

56

110

48

Burkina Faso

105

219

541

Cameroon

77

151

609

Cape Verde

52

60

15

Central African Rep.

97

157

132

Chad

110

194

386

Comoros

77

104

21

Congo, Dem. Rep. of

106

161

2,411

Côte d'Ivoire

112

181

674

Eritrea

66

139

171

Ethiopia

128

185

2,715

Gabon

87

152

45

Ghana

56

107

764

Guinea

134

215

317

Kenya

74

112

1,004

Lesotho

80

133

70

Liberia

106

147

124

Madagascar

96

159

628

Malawi

134

234

416

Mali

123

238

515

Mauritania

68

107

105

Mauritius

20

22

20

Mozambique

135

201

778

Namibia

68

120

60

Niger

123

274

535

Nigeria

73

106

4,849

Rwanda

85

150

319

Senegal

68

139

378

Sierra Leone

136

215

247

Sudan

70

113

956

Swaziland

72

100

41

Tanzania

88

137

1,298

Togo

80

146

188

Uganda

81

147

1,097

Zambia

109

197

408

Zimbabwe

53

77

357

 
MIDDLE EAST and NORTH AFRICA
Algeria

44

49

923

Bahrain

8

10

14

Egypt

52

65

1,740

Iran

26

33

1,100

Jordan

29

34

142

Lebanon

28

32

92

Libya

24

30

141

Morocco

37

46

655

Oman

14

20

107

Syria

35

42

532

Tunisia

35

44

212

Turkey

43

61

1,423

United Arab Emirates

11

13

67

Yemen

75

105

655

 
ASIA
Armenia

15

18

44

Azerbaijan

20

23

135

Bangladesh

82

116

3,332

Cambodia

103

134

450

China

31

40

20,103

India

79

109

27,300

Indonesia

46

58

5,041

Kazakstan

40

46

227

Kyrgyzstan

61

72

105

Laos

104

149

207

Mongolia

34

45

50

Myanmar

83

109

1,423

Nepal

79

118

864

Pakistan

91

128

5,713

Philippines

35

49

2,165

Sri Lanka

17

21

353

Thailand

25

28

1,113

Turkmenistan

38

51

103

Uzbekistan

49

59

623

 
LATIN AMERICA and the CARIBBEAN
Belize

42

53

7

Bolivia

67

92

246

Brazil

39

49

3,578

Chile

12

13

299

Colombia

28

36

1,003

Costa Rica

14

16

81

Dominican Republic

47

57

66

Ecuador

40

51

335

El Salvador

35

43

167

Guatemala

51

68

453

Haiti

74

131

264

Honduras

36

48

197

Nicaragua

40

50

188

Panama

22

25

64

Paraguay

27

33

169

Peru

43

59

740

Notes
Estimates are from the latest available sources between 1990 and 1998.

Reproductive Health

Reproductive Health

Total fertility rate

Median duration of postpartum amenorrhea (in months)

Percent of births attended by trained health personnel

Percent of married women using contraceptives

Any method Modern method

Adults (15-49) with HIV/AIDS
(per 10,000)

SUB-SAHARAN AFRICA
Benin

6.3

13

60

16

3

206

Botswana

4.1

2,510

Burkina Faso

6.7

15

42

8

4

717

Cameroon

5.2

11

64

19

7

489

Cape Verde

5.3

54

Central African Rep.

5.1

14

46

15

3

1,077

Chad

6.6

16

15

4

1

272

Comoros

5.1

7

52

21

11

14*

Congo, Dem. Rep. of

6.6

8

3

435

Côte d'Ivoire

6.1

12

45

11

4

1,006

Eritrea

6.1

14

21

8

4

317*

Ethiopia

7.0

4

3

931

Gabon

5.4

425

Ghana

5.4

41

22

13

238

Guinea

5.7

31

2

1

209

Kenya

4.7

9

45

39

31

1,164

Lesotho

4.3

50

23

19

835

Liberia

6.2

365

Madagascar

6.0

11

47

19

10

12

Malawi

5.9

12

55

22

14

1,492

Mali

6.7

14

25

7

5

167

Mauritania

4.9

47

4

1

52

Mauritius

2.0

2b

97

75

60

8*

Mozambique

5.6

14

44

6

5

1,417

Namibia

5.1

8

67

29

26

1,994

Niger

7.5

16

15

8

5

145

Nigeria

6.2

15

31

15

7

412

Rwanda

6.0

17

26

21

13

1,275

Senegal

5.7

13

47

13

8

177

Sierra Leone

6.3

317

Sudan

4.6

31

10

7

99*

Swaziland

5.2

56

21

19

1,850

Tanzania

5.7

12

38

18

13

942

Togo

5.4

14

50

24

7

852

Uganda

6.9

13

38

15

8

951

Zambia

6.1

12

47

26

14

1,907

Zimbabwe

4.0

13

69

48

42

2,584

     
MIDDLE EAST and NORTH AFRICA
Algeria

4.1

77

51

43

7*

Bahrain

2.8

98

62

31

15*

Egypt

3.3

5

56

55

52

3

Iran

2.6

86

73

56

<1

Jordan

4.4

4

97

53

38

2*

Lebanon

2.5

85

61

37

9*

Libya

4.1

81

45

26

5*

Morocco

3.1

3

52

58

49

3*

Oman

7.1

93

24

18

11*

Syria

4.2

54

40

28

1*

Tunisia

2.8

79

60

49

4*

Turkey

2.6

4

76

64

38

1

United Arab Emirates

4.9

99

28

24

18*

Yemen

6.7

6

43

21

10

1*

ASIA
Armenia

1.5

96

1

Azerbaijan

2.1

99

<1

Bangladesh

3.3

8

8

49

42

3

Cambodia

5.2

31

240

China

1.8

89

83

81

6

India

3.4

9

34

41

36

82

Indonesia

2.8

6

54

57

55

5

Kazakstan

1.8

5

100

59

46

3

Kyrgyzstan

2.8

7

98

60

49

<1

Laos

5.6

25

21

4

Mongolia

2.7

100

57

41

1

Myanmar

3.8

56

17

14

179

Nepal

4.6

10

9

29

26

24

Pakistan

5.6

6

18

18

13

9

Philippines

3.7

5

64

46

28

6

Sri Lanka

2.2

94

66

44

7

Thailand

2.0

72

70

223

Turkmenistan

2.6

96

20

1

Uzbekistan

3.2

5

98

68

65

<1

     
LATIN AMERICA and the CARIBBEAN 
Belize

3.9

79

47

42

189

Bolivia

4.2

10

47

48

25

7

Brazil

2.3

3

92

77

70

95

Chile

2.4

100

20

Colombia

3.0

4

85

72

59

36

Costa Rica

2.7

98

75

65

55

Dominican Republic

3.2

4

96

64

59

189

Ecuador

3.3

8b

64

57

46

28

El Salvador

3.6

87

60

54

58

Guatemala

5.1

11

35

31

27

52

Haiti

4.8

11

21

18

14

517

Honduras

4.4

9b

61

50

41

146

Nicaragua

3.9

5

61

60

57

19

Panama

2.7

86

61

Paraguay

4.4

61

51

41

13

Peru

3.5

8

56

64

41

56

Notes
Estimates are from the latest available sources between 1990 and 1998.
Estimates of HIV/AIDS prevalence are as of December 1997, except those estimates with an asterisk, which are for 1994 (Weekly Epidemiological Report, 1995, 70: 353-360)
… Data not available

Total fertility rate: The average number of children a woman would have assuming that current age-specific birth rates remain constant throughout her childbearing years (usually considered to be ages 15 to 49).

Postpartum amenorrhea: The period of time following birth during which a woman's menstrual cycle has not yet resumed.

Contraceptive use: The percentage of currently married or in-union women of reproductive age who are currently using contraception. "Any method" includes traditional and modern methods. The most commonly used traditional method is withdrawal. Modern methods include clinic and supply methods such as oral contraceptives, IUDs, condoms, and sterilization.

The Benefits of Breastfeeding

Exclusive breastfeeding of infants is recommended for the first six months of their lives and breastfeeding with complementary foods thereafter. Breastfeeding has many physical and psychological benefits for children and mothers as well as economic benefits for families and societies.

Benefits of Breastfeeding to the Infant

  • Provides a nutritionally complete food for the young infant
  • Strengthens the infant's immune system, preventing many infections
  • Reduces the infant's exposure to infections
  • Safely rehydrates and provides essential nutrients to a sick child, especially to those suffering from diarrheal diseases
  • Contributes to child spacing (see box on the Lactational Amenorrhea Method-LAM), which increases the probability of child survival

Benefits of Breastfeeding to the Mother

  • Reduces a woman's risk of excessive blood loss after birth
  • Provides a natural method of delaying pregnancies (see box on LAM)
  • Reduces the risk of ovarian and breast cancers and osteoporosis (bone disease)

Benefits to the Household and the Community

  • Conserves funds that otherwise would be spent on breast milk substitutes, supplies, and fuel to prepare them
  • Saves medical costs to families and governments by preventing illnesses and by providing immediate postpartum contraception

Lactational Amenorrhea Method (LAM)

The Lactational Amenorrhea Method (LAM) is a method of contraception that depends on the natural effect of breastfeeding to delay another pregnancy after a birth. ("Lactational" means related to breastfeeding. "Amenorrhea" means not having menstrual bleeding.) A woman using LAM correctly is more than 98 percent protected against pregnancy, which is higher than the protection offered by the diaphragm or male condoms.

Three conditions define the Lactational Amenorrhea Method:

  • the mother's menstrual periods have not resumed, AND
  • her baby is fully* or nearly fully breastfed, AND
  • her baby is no more than 6 months old.

The probability of pregnancy increases if any of the three criteria is no longer met, particularly if menstrual bleeding begins. At this point, a woman wishing to prolong child spacing should immediately begin another family planning method, choosing one that does not interfere with breastfeeding.

* The baby receives at least 90 percent of his/her feedings from breast milk.

Breastfeeding and HIV/AIDS

HIV-positive mothers may transmit the virus to their infants during pregnancy or delivery.

Some may also transmit the virus via breast milk. However, the majority of infants of HIV-positive women do not become infected from their mothers, whether or not they are breastfed.

  • If a mother knows she is infected, if breast milk substitutes are affordable and can be used safely, and if adequate health care is available and affordable, then the infant's chances of survival are greater if the substitutes are used.
  • If these conditions are not met, for example, where hygiene and sanitation are poor and access to adequate health care is limited, breastfeeding may be the safest feeding option even when the mother is HIV-positive.
  • The best way of protecting children from HIV is to help women avoid HIV infection. Most new infections (85 percent) are passed through unprotected sexual contacts and the risk of infection can be substantially decreased by practicing safer sex (e.g., by using condoms).

Main Sources

Demographic and Health Surveys (DHS), country survey reports; MEASURE DHS+, special tabulations (May 1999); Centers for Disease Control and Prevention, country survey reports; League of Arab States, special tabulations of the Pan Arab Project for Child Development (PAPCHILD) surveys (May 1999); Iran Ministry of Health and Medical Education, special tabulation (May 1999); UNICEF, State of the World's Children 1999; UNICEF, Progress of Nations 1998; Population Reference Bureau, 2000 World Population Data Sheet; www.unaids.org, "Report on the Global HIV/AIDS Epidemic-June 1998" (May 1999); LINKAGES Project, Frequently Asked Questions on: BREASTFEEDING AND HIV/AIDS, October 1998.

Selected studies of mother-to-child HIV transmission: P. Msellati, et al., "Zidovudine and Reduction of Vertical Transmission of HIV in Africa," American Journal of Public Health, Vol. 89(6), June 1, 1999.

E.A. Preble and E.G. Piwoz, HIV and Infant Feeding: A Chronology of Research and Policy Advances for Programs, LINKAGES Project, September 1998.

V. Leroy, et al., "International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection," The Lancet, Vol. 352, August 22, 1998.

D.T. Dunn, et al., "Risk of Human Immunodeficiency Virus Type-1 through Breastfeeding," The Lancet, Vol. 340, September 5, 1992.


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