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Breast-feeding decline despite deteriorating socio-economic conditions
The impact of deteriorating socio-economic conditions on breast-feeding duration in Jamaica is examined In spite of dramatic increases in the consumer price index for food and drink and consequently in the cost of artificial feeding, breast-feeding duration declined by 10.6% during 19871991. This was apparently due to a reduction in postpartum visits by district midwives. It is concluded that breast-feeding promotion should receive increased support under conditions of severe economic hardship.
Breast-feeding is important for child health and development [1, 2], child survival, and reducing fertility . During the last decade Jamaica has experienced economic problems that have placed the economy under severe strain. However, the situation has worsened since 1990 as a result of the continuing depreciation of the Jamaican dollar. Between January 1990 and December 1991 it depreciated by more than 200% (January 1990 US$1=J$6.50, December 1991 US$1 = J$20.87). Moreover, there was a steady increase in the consumer price index for food and drink during the period 1988-1991 (see Figure. 1. Annual increase in the consumer price index for food and drink, Jamaica, 1988-1991 (Source: Ref. 5)) . In 1991 the increase was considerably higher than in previous years.
Under such circumstances one would expect to see a decline in bottle-feeding as women, particularly low-income women, resorted to breast-feeding. This study examines the impact of the rapid deterioration of the Jamaican economy on the pattern of breastfeeding among mothers.
The price of the most popular brand of infant formula was obtained from local shops throughout Jamaica during the months of February 1990 and December 1991. The costs of bottles, pots, and fuel were estimated on the basis of prices obtained from shops and informal interviews with mothers. The overall monthly cost of feeding a three-month-old infant artificially was calculated by adding the average costs of the formula, feeding bottles, pots, and fuel.
Data on the percentage of mothers fully breastfeeding at six weeks postpartum from 1987 to 1991 were obtained from the annual summary reports of clinic activities published by the Health Information Unit of the Ministry of Health . The cost of feeding a family of five (basic food basket) was obtained from quarterly estimates prepared by the Nutrition Department of the Ministry of Health .
The monthly costs of feeding a three-month-old infant artificially in February 1990 and December 1991 are shown in figure 2 (see Figure. 2. Cost of artificial feeding of a three-month-old infant for a month, in Jamaican dollarsFebruary 1990 (US$1 = J$7.00) and December 1991 (US$1 = J$20.87)). On the whole, infant formula accounted for more than 90% of the total feeding cost; the part played by bottles, pots, and fuel was minimal. The cost increased dramatically (149%) over the period; in February 1990 it was 90.3% of the minimum wage, whereas by December 1991 it had increased to 134.8%. Furthermore, during this period the cost of feeding a three-month-old infant artificially for a month was equivalent to the cost of feeding a family of five for approximately one week.
The percentage of mothers fully breast-feeding at six weeks postpartum decreased from 52.6% in 1987 to 47.0% in 1991. This represented a 10.6% decline.
In spite of the dramatic increase in the cost of artificial feeding, breast-feeding duration declined in Jamaica. Even when the cost of artificial feeding was out of reach of low-income mothers, they still resorted to this feeding pattern. In contrast, increases in the duration of breast-feeding and a dramatic decline in the importation of infant formula were reported in Honduras under similar severe economic conditions .
The decreases in the duration of breast-feeding in Jamaica appear to be related to a reduction of post-partum visits made on the third, fifth, seventh, and tenth days following delivery by district midwives and a reduction in the number of group educational sessions carried out by primary health care nurses at antenatal clinics. Hospitals may also have played a role in the decline in breast-feeding by continuing the practice of encouraging the use of prelacteal bottle-feeding. Thus, at the very time when mothers most needed guidance in breast-feeding, postnatal programmes were reduced. This experience suggests that breast-feeding promotion should be explicitly incorporated into programmes for the poor in conditions of severe economic hardship.
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