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2.20 Breastfeeding practices

Why is it important?

Breastfeeding is one of the most important health behaviours for the survival, growth, development and health of infants and young children. Early initiation (within the first hour after birth) and exclusive breastfeeding during the first month is associated with a reduced risk of neonatal morbidity and mortality (Khan et al. 2014). Breast milk is uniquely suited to the needs of newborns, providing nutrients readily absorbed by their digestive system and conferring both active and passive immunity (NHMRC 2012). The National Health and Medical Research Council recommend exclusive breastfeeding for the first 6 months of life and that ideally breastfeeding continue until 12 months of age and beyond if the mother and child wish (NHMRC 2012).

Breastfeeding offers protection against many conditions, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections, middle ear infections and the development of diabetes in later life (Annamalay et al. 2012). Breastfeeding is associated with a lower risk of obesity later in childhood, and also provides health benefits for mothers including reduced risk of breast and ovarian cancer in premenopausal women (NHMRC 2012). For Aboriginal and Torres Strait Islander infants living in poor housing conditions (see measure 2.02), breastfeeding offers additional protection where hygiene practices required for sterilising bottles may not be easily achieved or maintained.

Findings

New findings from the 2012–13 Health Survey show that 83% of Indigenous children aged 0–3 years have been breastfed. While these rates were high, they remain significantly lower than the corresponding proportion of non-Indigenous children (93%). Indigenous infants were more than twice as likely as non-Indigenous infants to have never been breastfed (17% compared with 7%). Of those children aged 0–3 years who had been breastfed, Indigenous infants were more likely than non-Indigenous infants to have been breastfed for less than one month (16% compared with 10%). Likewise, Indigenous infants were less likely than non-Indigenous infants to have been breastfed for 12 months or more (12% compared with 21%). Breastfeeding rates of Indigenous children aged 0–3 years did not vary significantly by remoteness, with 82% in non-remote areas and 84% in remote areas having been breastfed. Note in 2004–05, breastfeeding rates were higher in remote areas; however, trends analysis is not possible. Breastfeeding rates of Indigenous children aged 0–3 years varied significantly between jurisdictions. In the ACT the proportion of Indigenous infants who had been breastfed (95%) was on par with the non-Indigenous rate (97%). In contrast, the gap was widest in SA where Indigenous rates were 76% and non-Indigenous rates 93%.

It is not possible to derive exclusive breastfeeding rates from the 2012–13 Health Survey results. In 2010, the Australian National Infant Feeding Survey found comparative rates of exclusive breastfeeding between Indigenous and non-Indigenous were similar when children were aged less than 1 month of age (59% of Indigenous children and 61% of non-Indigenous children). As infants increased in age the proportions of exclusive breastfeeding declined for both Indigenous and non-Indigenous children, but the Indigenous decline was steeper than the drop in non-Indigenous proportions. By the recommended age of up to 6 months, only 7% of Indigenous infants were exclusively breastfed compared with 16% of non-Indigenous infants. The Infant Feeding Survey found that almost a third (31%) of Aboriginal and Torres Strait Islander infants had received soft, semi-solid or solid food by the age of 3 months, compared with 9% of non-Indigenous infants of the same age. By age 5 months similar proportions of Indigenous and non-Indigenous infants had commenced weaning (70%).

In the 2012–13 Health Survey, Indigenous infants aged 0–3 years were more than twice as likely as non-Indigenous infants to be living with a current daily smoker (58% compared with 24%) and 19% of Indigenous infants lived in a household with a daily smoker who smoked at home indoors (see measure 2.03). For Indigenous infants the main reason given for ceasing breastfeeding was 'not producing any/adequate milk supply' (24%), followed by 'felt it was time' (17%) and 'baby not satisfied' (15%); non-Indigenous comparison is not available. Maternal and paternal/ family smoking is negatively associated with breastfeeding outcomes. Smoking affects the mother's supply of milk, while exposure to passive smoking is also a factor in reduced duration of exclusive breastfeeding (Baheiraei et al. 2014; NHMRC 2012). Research is required to determine whether exclusive breastfeeding duration among Indigenous mothers might be increased by health interventions to reduce exposure to tobacco smoke (see measure 2.21).

Implications

Opportunities to promote breastfeeding in partnership with Aboriginal and Torres Strait Islander families and communities exist in educational settings and within the health sector, particularly in antenatal and postnatal care. The Australian National Breastfeeding Strategy 2010–2015 was endorsed by Health Ministers in 2009. The strategy aims to protect, promote, support and monitor breastfeeding in Australia, and recognises the importance of breastfeeding support especially for priority groups. The strategy recognises the contribution of the New Directions: Mothers and Babies Services initiative for supporting breastfeeding and parenting skills.

The New Directions: Mothers and Babies Services provides Aboriginal and Torres Strait Islander children and their mothers with access to antenatal care, standard information about baby care, practical advice and assistance with breastfeeding, nutrition and parenting; monitors developmental milestones, immunisation status and infections; and undertakes health checks for Indigenous children before starting school. The 2014–15 Federal Budget provides funding of $54 million from July 2015 to increase the number of sites providing New Directions: Mothers and Babies Services from 85 to 136.

The More Targeted Approach campaign is aimed at reducing smoking prevalence among high-risk and hard-to-reach groups. Materials featuring Indigenous women have been included in the Quit For You, Quit For Two component, targeting pregnant women and their partners.

Figure 2.20-1 Children aged 0–3 years who were breastfed, by Indigenous status and remoteness, 2012–13
Children aged 0–3 years who were breastfed

Figure 2.20-1 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous children who were breastfed, by remoteness category. Breastfeeding rates of Indigenous children aged 0–3 years did not vary significantly by remoteness, with 82% in non remote areas and 84% in remote areas having been breastfed.

Source: AIHW and ABS analysis of 2012–13 AATSIHS

Figure 2.20-2 Children aged 0–3 years by Indigenous status and breastfeeding duration, 2012–13
Children aged 0–3 years by Indigenous status

Figure 2.20-2 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous children who were breastfed for specific durations (less than one month, less than 6 months, 6 to 12 months, or 12 months plus). Of those children aged 0-3 years who had been breastfed, Indigenous infants were more likely than non-Indigenous infants to have been breastfed for less than one month (16% compared to 10%). Likewise, Indigenous infants were less likely than non-Indigenous infants to have been breastfed for 12 months or more (12% compared to 21%).

Source: AIHW and ABS analysis of 2012–13 AATSIHS

Table 2.20-1 Children aged 0–3 years, breastfeeding status by Indigenous status and state/territory, 2012–13
NSW Vic Qld WA SA Tas NT ACT Australia
Currently breastfeeding
Indigenous ‡ 12% ‡ 15% 16% 31% ‡ 13% 20% 45% n.p. 19%
Non-Indigenous 19% 19% 22% 16% 15% 12% 29% 17% 19%
Total breastfed
Indigenous 83% 84% 81% 85% 76% 89% 85% 95% 83%
Non-Indigenous 94% 93% 91% 93% 93% 89% 93% 97% 93%
Total Number
Indigenous children 0–3 years 20,457 4,316 19,200 7,299 3,356 2,187 5,495 534 62,843
Non-Indigenous children 0–3 years 358,263 273,850 228,242 112,569 75,321 24,091 7,769 19,496 1,099,601

‡ estimates with a relative standard error of 25% to 50% should be used with caution.

* All differences between Indigenous/non-Indigenous children are statistically significant at the p<0.05 level.

Source: AIHW and ABS analysis of 2012–13 AATSIHS

Figure 2.20-3 Duration of exclusive breastfeeding to each month of age, by Indigenous status, 2010
duration of exclusive breastfeeding to each month of age

Figure 2.20-3 shows the proportion of different durations of exclusive breastfeeding (to each month of age) among Aboriginal and Torres Strait Islander children and non-Indigenous Australian children in 2010. Data is presented for exclusive breastfeeding to less than 1, 2, 3, 4, 5 and 6 months of age. Refer to the findings section of this measure for a description of key results found in this figure.

Source: 2010 Infant Feeding Survey