Population sub-groups

Women's health - breastfeeding

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What do we know about breastfeeding among Indigenous women?

Introduction

Traditionally, Indigenous women breast-fed their babies for periods up to four years with the gradual introduction of nutritious bush foods [1]. Breastfeeding decreased with European settlement, and now, according to survey information, Indigenous Australians have lower breastfeeding levels than non-Indigenous Australians, except where more traditional lifestyles have been maintained.

According to the 2004-2005 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), 92% of Indigenous women aged 18-64 years living in remote areas who had had children reported having breastfed their babies, compared with 81% of those living in non-remote areas [2].

These figures include women whose breastfeeding occurred many years ago, and information about recent breastfeeding is restricted to women living in non-remote areas who had a child aged less than 4 years at the time of the survey. Based on the results from the 2004-2005 NATSIHS, 79% of Indigenous children aged less than 4 years living in non-remote areas had been breastfed for at least some period [2]. In comparison, 88% of non-Indigenous children aged less than 4 years living in non-remote areas had been breastfed for at least some period. The level of breastfeeding by Indigenous women living in non-remote areas appears to have improved slightly between 2001 and 2004-2005 with the overall proportion of breastfed babies increasing from 77 % to 79%, and the proportion breastfed for more than 6 months increasing from 24% to 30%.

Benefits of breastfeeding

The recommendation to 'encourage and support breastfeeding' was listed first in the National Health and Medical Research Council's (NHMRC) dietary guidelines for children and adolescents, thus stressing the unequivocal importance of breastfeeding [3]. Breast milk is the natural and the optimum food for babies - it contains proteins, fats and carbohydrates at levels that are appropriate for an infant's metabolic capacities and growth requirements [4]. The poor health status of many Indigenous infants is often related to inadequate nutrition and its synergistic relationship with infection. Breastfeeding is the natural way of providing a healthy start to life that addresses both these factors.

Breastfeeding is associated with reduced infant illness and mortality, and the effects of diet and nutrition in early life may have lifelong consequences [5]. Breast milk has anti-infective properties and contains immunoglobulins which provide some immunity against early childhood diseases [1]. The poor physical environment in which many Indigenous infants live means that they are susceptible to infections (particularly gastrointestinal and respiratory infections), and there is significant evidence that breastfeeding offers some protection to these common causes of morbidity and mortality [4].

There are other advantages of breastfeeding. Health benefits for mothers include the hastening of uterine involution after birth and some protection against pre-menopausal breast cancer, ovarian cancer, and osteoporosis [4]. There are financial benefits to individual households and the community also, as families do not have to purchase infant formula and feeding equipment, and breastfed babies are less prone to childhood ailments (thus saving medical costs). Breastfeeding also provides psychological benefits for mother and child [1].

Lifestyle and breastfeeding

A mother may need to make some lifestyle adjustments during the period she breastfeeds [4]. A healthy diet is recommended, and mothers need to increase their daily intake of nutrients. However, in many Indigenous communities, nutritious food is not always accessible.

It is advisable for breastfeeding mothers who smoke cigarettes to give up - or at least to reduce their levels - to eliminate or minimise harmful effects. According to the 2004-2005 NATSISS, 49% of Indigenous women aged 18 years or older reported to that they smoked daily [2].

It is also recommended that alcohol be avoided, or, if it is consumed, limited to a maximum of one or two drinks per day [4]. Surveys have indicated consistently that Indigenous people are less likely than non-Indigenous people to drink alcohol, but the 2004-2005 NATSISS found that 6% of Indigenous females consumed alcohol at a ‘high risk’ level (‘high risk’ for females is defined as daily consumption of more than four standard drinks)were 8% for Indigenous people and 6% for non-Indigenous people [2].

Barriers to breastfeeding

Sometimes breastfeeding is not possible - due to maternal illness and infections, alcohol or drug use, maternal separation or death [4] and some women choose not to breastfeed [6].

A number of socio-cultural, physiological and psychological factors have been identified as barriers to breastfeeding. Focus group discussions in a Melbourne Koori community found these factors included: embarrassment of feeding in public places; belief that feeding formula was as good as breast milk; sore and cracked nipples; perception that breast-feeding was painful and inconvenient; and poor milk supply [7].Contributing factors included: competing demands; lack of support and appropriate advice; lack of knowledge; and lack of confidence and low self-esteem.

Services

It has been demonstrated that, with encouragement, many barriers to breastfeeding can be overcome. Input from health professionals and voluntary workers, and a positive environment (including the provision of information, support, demonstrations of practical skills and locally relevant strategies) can provide valuable assistance for breastfeeding mothers [4]. The Government's National Breastfeeding Strategy is a multi-faceted approach which includes an Indigenous perspective. A review of current interventions and identification of best practice currently used by community-based Aboriginal and Torres Strait Islander health service providers in promoting and supporting breastfeeding and appropriate infant nutrition details the need for multiple strategies to achieve substantial and sustained increases in breastfeeding levels [1]. Community ownership, empowerment and participation, sustained program funding, and specially trained health workers were seen as essential for overcoming barriers to breastfeeding for Indigenous women.

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References

1. Engeler T, McDonald M, Miller M, Groos A, Black M, Leonard D (1998) Review of current interventions and identification of best practice currently used by community based Aboriginal and Torres Strait Island health service providers in promoting and supporting breastfeeding and appropriate infant nutrition. Canberra: Commonwealth Department of Health and Family Services.
2. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. (ABS catalogue no. 4715.0) Canberra: Australian Bureau of Statistics.
3. National Health and Medical Research Council, Binns C, Davidson G (2003) Dietary guidelines for children and adolescents in Australia, incorporating infant feeding guidelines for health workers. Canberra: National Health and Medical Research Council.
4. National Health and Medical Research Council (2000) Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: National Health and Medical Research Council.
5. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2001) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2001. (ABS catalogue no. 4704.0) Canberra: A joint program of the Australian Bureau of Statistics and the Australian Institute of Health and Welfare.
6. Rae CJ (1994) Breast feeding policy and strategic plan 1994-2000. Darwin: Northern Territory Department of Health and Community Services.
7. Holmes W, Thorpe L, Phillips J (1997) Influences on infant feeding beliefs and practices in an urban Aboriginal community. Australian and New Zealand Journal of Public Health;21(5):504-510.

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Policies and strategies

Department of Health and Ageing
National Breastfeeding Strategy
View details

Lessons learned

Currently no information available.

Case studies

Currently no information available.

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Published Resources

Journal articles

2004

Gilchrist D, Woods B, Binns CW, Gracey M, Scott J, Smith H (2004)
Breastfeeding and health promotion: the experience of Aboriginal and non-Aboriginal mothers.
Health Promotion Journal of Australia;15(3):226-230
View abstract: Health Promotion Journal of Australia

Gilchrist D, Woods B, Binns CW, Scott JA, Gracey M, Smith H (2004)
Aboriginal mothers, breastfeeding and smoking.
Australian and New Zealand Journal of Public Health;28(3):225-228
View article: Australian and New Zealand Journal of Public Health (PDF - 37KB)
View website: Public Health Association of Australia

2001

Gracey M (2000)
Infant feeding and weaning practices in an urbanizing traditional, hunter-gatherer society.
Pediatrics;106(5):1276-1277.
View abstract

Hayman N, Kanhutu J, Bond S, Marks GC (2000)
Breast-feeding and weaning practices of an urban community of Indigenous Australians.
Asia Pacific Journal of Clinical Nutrition;9(3):232-234.
View abstract

Reports and publications

Engeler, T., McDonald, M., Miller, M., Groos, A., Black, M., & Leonard, D. (1998).
Review of current interventions and identification of best practice currently used by community based Aboriginal and Torres Strait Islander health service providers in promoting and supporting breastfeeding and appropriate infant nutrition.
Canberra: Office for Aboriginal and Torres Strait Islander Health Services.

View full-text

Groos, A., Miller, M., Engeler, T., & McDonald, M. (1998).
Audit of current training in breastfeeding support and infant nutrition for Aboriginal and Torres Strait Islander health workers and other health professionals providing health care to Aboriginal and Torres Strait Islander women.
Canberra: Office for Aboriginal and Torres Strait Islander Health Services.
View report


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Theses

Tasseron, M. (1993).
Breast feeding patterns of Aboriginal and non-Aboriginal women in the Northern Territory and factors associated with early cessation.
Unpublished Master of Science (Nutrition and Dietetics) thesis, University of Wollongong, Wollongong.

Conference abstracts

Currently no information available.

Other resources

Currently no information available.

Programs & projects

Currently no information available.

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Guidelines

The Australian Breastfeeding Association
View details

National Health and Medical Research Council
Infant feeding guidelines for healthworkers
View details

References

Key references

Currently no information available.

Bibliography

You may wish to search through the HealthInfoNet bibliographic database for references about breastfeeding

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Organisations

The Australian Breastfeeding Association
View details

Other web-based materials

Department of Health and Ageing
Information is provide on breastfeeding.
View information

 

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Last updated: 29 March 2007