Breastfeeding within the first hour of birth has been linked to a 20 per cent reduction in infant mortality. Infants who are exclusively breastfed until the age of six months have been found to experience diarrhoea 11 times less than those fed with formula and pneumonia 15 times less.
Despite overwhelming scientific evidence pointing towards the importance of breastfeeding, the practice has been on the decline in Cambodia for some time now.
Breastfeeding declined from 73.5 per cent in 2010 to 65 per cent in 2014, dropped to just 51 per cent in 2021, predominantly in urban areas, according to the 2022 Cambodia Demographic and Health Survey (CDHS).
Exploring the decline
Nuth Sambath, president of the Institute of Medicine, Biology and Agriculture of the Royal Academy of Cambodia, said there were three main factors behind the decline.
He believed that first, mothers worry about their beauty, fearing that breastfeeding will cause their breasts to lose their shape. Secondly, more mothers are working, and do not have access to dedicated breastfeeding or breast pumping facilities. Finally, excessive advertising of baby formula has led many parents to believe it is superior and turn to it rather than the natural alternative.
Hou Kreun, director of Helen Keller International Cambodia (HKI), noted that about 70 per cent of women in Cambodia are working.
“Most mothers decide to give up breastfeeding within three months of giving birth. This is when they return to work following maternity leave, as they lack breastfeeding support from their employers.
Crisis arising from non-breastfeeding
Cambodia loses approximately $326.8 million annually, or two per cent of its total national income, due to the reduction in breastfeeding, according to an estimate from the Ministry of Health.
According to the ministry’s guidelines, the use of breast milk substitutes increases the risk of diarrhoea, lung diseases, asthma, a reduced IQ, diabetes and obesity in infants.
Seng Rath Pisey, a mother who used to feed her infant exclusively with formula, understands this firsthand. Her child began experiencing problems such as anaemia, frequent vomiting and even unconsciousness.
“I’ve only realised that my child’s problems were caused by formula milk when I took my child to Kantha Bopha Children’s Hospital,” she said.
Chan Phalkun also experienced this issue. Her child’s health was poor, and developed anaemia and a weak immune system after two to three months on formula.
Enhancing the rate of breastfeeding
Breast milk is an important source of protein, sugar, lactose, fat, water and is rich in nutrients and minerals such as vitamins A, B, C, D, iron, potassium and calcium. These nutrients are essential to help an infant grow and develop during its first six months of life.
“Breast milk is valuable and provides excellent nutrition for infants in all circumstances. The WHO says that there is no product, including baby formula, which is superior to breast milk,” said HKI director Kreun.
UNICEF’s “advocacy and social behaviour change towards breastfeeding” campaign suggested that breastfeeding saves the life of more than 820,000 children under the age of five worldwide each year, while also preventing nearly 20,000 life threatening cases of breast cancer in mothers each year.
Thanks to an understanding of the benefits of breastfeeding, the health ministry and several of its partner organisations have taken steps to promote it and address its decline.
Kreun believed that Cambodia needs a specific, comprehensive solution to promote breastfeeding. In the past, stakeholders and the health ministry launched a document titled “Communication approaches to change the behaviour of women, infants and children”, to pave the way for this work.
Sub-Decree No133 on the Marketing of Products for Infant and Young Child Feeding was published in October 2017. It aims to contribute to providing adequate and safe nutrition for infants and young children by protecting and promoting breastfeeding and by encouraging appropriate complementary feeding.
Calls for extended maternity leave
An April joint statement from Scaling Up Nutrition (SUN) Movement Cambodia and several other civil society organisations requested an increase in maternity leave in Cambodia as a means to increase the rate of breastfeeding. It noted that 70 percent of Cambodian women over the age of 15 are employed.
SUN and its partners called on the government to amend the law on maternity leave, in line with global standards. This would mean extending maternity leave to 180 days with full salary payments. It also suggested the introduction of paternity leave.
Prak Sophoan Neary, health ministry secretary of state, expressed her full support for an increase in maternity leave. She suggested that limited leave has placed women and babies at a disadvantage, as breastfeeding to the age of six months – in line with health ministry and WHO outlines – is difficult for many working mothers.
All of the officials and civil society representatives working in the field concurred that breastfeeding is very important for infants’ health, and that addressing the decline requires the full participation of all stakeholders, especially the government.