5 Lessons about breastfeeding from South Africa’s moms
World Breastfeeding Week (WBW) is a global campaign coordinated by the World Health Organization (WHO) and partners to highlight the importance of a whole-of-society approach to promoting and protecting breastfeeding.
This year’s international theme, “Breastfeeding for a Sustainable Start in Life: Strengthen What Works,” calls on all of us to build on proven interventions that support breastfeeding. In 2022, WHO and the United Nations Children’s Fund (UNICEF) published a multi-country report examining how the marketing of formula milk influences infant feeding decisions. The report found that most mothers want to breastfeed, noting that this desire exists “across all countries, ranging from 49% of women in Morocco to 98% in Bangladesh”, but that many encounter a lack of support and enabling environments that prevent them from doing so.
In South Africa, despite comprehensive national policies and guidelines on infant and young child feeding, the latest nationally reported data show that only 31.6% of infants are exclusively breastfed, with an average exclusive breastfeeding duration of just 2.9 months. This raises an important question: if most mothers want to breastfeed, what stands in the way of achieving their breastfeeding goals? Why are so many unable to breastfeed for as long as they intend?
The evidence points to a simple but often overlooked reality: strengthening breastfeeding outcomes requires more than awareness campaigns. It requires coordinated action across government, healthcare, workplaces, civil society, families and communities to create environments where mothers are supported, rather than expected to succeed despite systemic barriers. The answer lies in ensuring that mothers receive the practical, emotional and structural support they need.
As a movement, we start by listening to mothers. We believe that mothers are the experts in their own lives and that listening to their experiences helps ensure that the policies, programmes and interventions designed to support maternal and child health are shaped by the lived realities and needs of the mother-child dyad.
A couple of years ago, Embrace launched the Let-down Line – a month-long campaign inviting mothers to anonymously share their breastfeeding stories in the language of their choice. A play on the let-down milk reflex, it was a dedicated WhatsApp line where mothers could share the moments that defined their breastfeeding journeys: the good, the hilarious, the embarrassing, the heartwarming, and everything in between. We listened without judgement. This is what we learned from the intimate stories mothers entrusted to us:
1. Mothers ultimately want what is best for their children
“She’s not only healthy but clever as well.”
It was clear from the voice notes shared through The Let-down Line that mothers understood the factors influencing their children’s physical health and cognitive development. Recalling a time when her child became ill, one mother shared, “Even if she catches the flu, in two days, it’ll be gone,” reflecting scientific evidence that breastmilk helps strengthen infants’ immune systems. Mothers also spoke fondly about how breastfeeding fostered a strong emotional bond with their children. As one mother explained, “As my baby would suckle, I’d talk about my day or read a story, and I’d feel so connected with my baby, and baby loved it!”
2. SA Workplace remains unaccommodating
“I actually enjoyed breastfeeding, but then I had to go back to work after six weeks because the Department of Labour decided to pay me R327. Eventually, I had to stop breastfeeding because my job involved travelling. When I travelled to Johannesburg for the first time, my boobies were so sore for three days because I had to stop pumping so that I could stop producing milk.”
This mother’s story echoes those of many others shared through The Let-down Line and aligns with local evidence. South African researchers conducted a study to gain an in-depth understanding of the experiences of working mothers in maintainingexclusive breastfeeding after returning from maternity leave. The study found that South African workplaces remain largely unaccommodating to breastfeeding employees, even though the Code of Good Practice on the Protection of Employees during Pregnancy and after the Birth of a Child protects employees’ right to breastfeed or express breastmilk at work. As a result, many mothers are forced to stop breastfeeding earlier than they intended when they return to work.
3. Food insecurity affects breastfeeding experiences
Another mother spoke about the importance of a nutritious diet while breastfeeding.
“I know that my baby gets everything she needs through breastfeeding from whatever I eat. You only have to eat healthy food and drink more water.”
Breastfeeding is often described as nature’s great equaliser. Breastmilk is free, nutritionally complete and readily available, making it one of the most powerful tools we have to improve food security for babies during the first six months of life.But mothers remind us that “free” does not mean without cost. While breastmilk comes at no financial cost, breastfeeding places significant nutritional demands on mothers. Producing milk requires additional energy, and women need access to sufficient nutritious food to sustain both themselves and their babies. For mothers experiencing food insecurity, this can be a difficult balancing act. As one mother told researcher Dr Wanga Zembe-Mkabile, “When I breastfeed my baby, I feed her my hunger.”
In 2020, a national mobile survey found that women who had gone to bed hungry were less likely to breastfeed because of food insecurity. During the COVID-19 lockdown, many mothers also reported worrying about their ability to produce enough breastmilk or access baby food and adequate nutrition for themselves and their families.
4. Breastfeeding is a learned skill
Breastfeeding is a relationship between two people in a thrilling yet highly vulnerable new chapter: a mother and her newborn. But it is also a skill that both mother and baby learn together. Our work frequently brings us into contact with first-time mothers who face a dearth of education and support at the very beginning of their breastfeeding journeys.
In South Africa’s public health system, nurses and midwives are largely responsible for providing breastfeeding information, counselling and support to pregnant and breastfeeding women. However, a local study found that nurses often do not have enough time to provide adequate breastfeeding support because they are short-staffed and overworked.
We need adequate investment to fulfil the state’s commitments to improving national breastfeeding rates, particularly through the training and deployment of qualified healthcare providers who are also sensitive to cultural and linguistic needs. For example, multilingual specialist lactation consultants should be readily available immediately after birth and remain accessible throughout the first 14 weeks postpartum. Evidence shows that integrating breastfeeding support into routine health services up to, and beyond, the 14-week mark leads to improved breastfeeding outcomes. Improving breastfeeding rates also delivers long-term cost savings for the public health system through disease prevention and health promotion.
It is also worth noting that a systematic review examining the determinants of breastfeeding behaviour found that shame-based messaging that evokes feelings of guilt, embarrassment, regret and failure does not encourage pregnant women or postpartum mothers to initiate or continue breastfeeding. Likewise, external pressure, including social stigma or a perceived moral obligation to breastfeed, has limited influence on breastfeeding behaviour. Instead, mothers need positive, realistic messaging and reliable information that reflects the realities of breastfeeding.
To help meet this need, Embrace developed a free breastfeeding booklet in partnership with registered dietitian and certified lactation consultant Carey Haupt. Breastfeeding Basics and Beyond is available to download and share from the Embrace website. It offers practical guidance and answers to some of the most frequently asked questions about breastfeeding and is our gift to mothers and mother-supporters this World Breastfeeding Week.
5. Supporting breastfeeding mothers is a social justice imperative
“I had paid maternity leave, access to a hospital-grade breast pump, lactation consultant, physiotherapist, all the gadgets and creams, a supportive partner and family who lived nearby. The start that I had, though it wasn’t perfect, was so much better than a lot of women get, and that’s not fair. I have access to certain class privileges. My child has a start to life that is defined by arbitrary things like history, culture, and whether or not a mom happens to be working for an employer who is understanding and can facilitate her breastfeeding journey as a working mom, and then we turn around after that and point the finger at moms – moms, breastfeed!”
Breastfeeding support is, fundamentally, an issue of equity. The mothers who are most likely to achieve their breastfeeding goals are often those with access to paid maternity leave, flexible work arrangements, lactation support, safe spaces to express breastmilk, and strong family or community networks. For mothers working in the informal economy, returning to work within weeks of giving birth, or navigating poverty and food insecurity, these supports are often out of reach.
What we learned from listening to mothers is that breastfeeding journeys are shaped not by a lack of commitment or desire, but by unequal access to the conditions that make breastfeeding possible and sustainable.
Strengthening what works begins with listening to mothers
“My breastfeeding journey started very differently from what I had expected. Both of my babies were born very prematurely, so my dreams of lying in a hospital bed, watching them root and latch, were never realised. Instead, I became very well acquainted with my breast pump, expressing milk eight times a day at home while my babies were in the NICU. With each of them, I had to wait two to three weeks before we could even begin breastfeeding.”
Ultimately, The Let-down Line affirmed what mothers have been telling us all along: every day, across the country, mothers are putting the needs of their infants first despite painful latching, food insecurity, difficult or traumatic birth experiences, and the heartbreak of being separated from their premature babies after birth.
Supporting breastfeeding requires more than encouraging mothers to breastfeed. It requires ensuring that every mother, regardless of her circumstances, has equitable access to the practical, emotional and structural support she needs. This is the principle behind the Warm Chain: recognising that breastfeeding thrives when mothers are surrounded by a continuum of support from families, healthcare providers, communities, employers, lawmakers and regulatory bodies. It shifts the conversation from what mothers should do to what society must do to enable them to make the feeding decisions that are right for themselves and their babies.
Strengthening what works begins with listening to mothers and then acting on what they have been telling us all along.