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The extent of bottle-feeding in Bahrain

Abdulrahman Obaid Musaiger
Nutrition Unit, Ministry of Health, Directorate of Public Health, Manama, Bahrain

BACKGROUND

Bahrain is one of the seven Arab Gulf States, and is composed of a group of about 30 islands with a total area of 669.26 square kilometers It is situated half-way down the Arabian Gulf and lies 24 square kilometers from the east coast of Saudi Arabia. According to the latest census (1981), the population of Bahrain it 350,798, of whom about two-thirds are Bahraini, the rest expatriates.

INTRODUCTION

In recent years, companies producing infant formulas have had a strong negative influence on breast-feeding in the developing world, particularly in areas where illiteracy and poverty predominate. Because most of the countries involved have no protective food legislation, promotion of commercial formulas has gone largely unchecked.

The result has been that more and more mothers, perfectley capable of breast-feeding, have intead begun to Us formula to the detriment of their infants' health and development. For example, in Lebanon, Harfouche (1) reported that over 30 different brands of milk and 18 different varieties of special baby foods were used by low-income mothers In Jamaica, Demorales and Larkin (2) found that 27 per cent of mothers used two types of commercial milk products, and 14 per cent used three or more. In Kenya, Santrolli (3) reported that half of the babies were bottle-fed. Four out of every ten tins of baby milk were sold in rural areas and the rest in towns. The present study was carried out to determine the extent of bottle-feeding in urban areas of Bahrain.

METHOD

A national census in 1971 showed that Manama City, the capital of Bahrain, is divided into nine census districts Among 315 households sampled, 2 per cent of mothers from each district were randomly selected for this study. Mothers were interviewed in their homes and asked about their infant feeding practices and the social background of their families. In this study, the socioeconomic level of the family was classified on the basis of educational level of the head of the family, educational level of the mothers, monthly family income, and family size.

RESULTS

Table 1 shows age of infant at introduction of bottle-feeding according to social class About 34.9 per cent of the mothers did not bottle-feed during the infants' first eight months of life. Bottle-feeding was introduced early at less than one month by high and middle social classes compared to the lower class (16.7, 13.2, and 1 per cent, respectively).

TABLE 1. Age of infants at Introduction of Bottle-Feeding According to Social Class

The author was a United Nations University fellow at the institute of Nutrition, Ramathibodi Hospital, Bangkok,

Table 2 presents the sources recommending bottle-feeding to mothers according to social class. The table shows that 68.8 per cent of the mothers thought that they were told to use bottle-feeding by health practitioners. Others said it was recommended by relatives and friends (8.8 per cent) or other sources (22.4 per cent).

The quantity of baby milks used per month by mothers according to social class is given in Table 3. The majority of the mothers (65.4 per cent) used four to six tins of powdered milks monthly to feed their infants. About eight per cent used seven to nine tins per month.

Table 4 shows types and brands of baby milk used by mothers according to social class. Similac was the predominant brand of milk used (36.6 per cent), followed by Nido (16.6 per cent), and Nestogen (13.2 per cent). High social class mothers were more likely to use Similac (53 per cent) compared to middle (40 per cent) and low. income (30 per cent) social classes.

DISCUSSION

Breast-feeding has declined gradually in Bahrain. Amine (5) reported that the rates of breast-feeding during the period 1970 to 1980 decreased to 22.7 and 14.8 per cent in rural and urban areas of this country, respectively.

Bahraini mothers are not aware of the benefits of breast-feeding either through ignorance, or exposure to misleading advertising and ineffective current health and nutrition education programmes. The mothers seem to consider it to be unsophisticated and fear that it may adversely affect the shape of their breasts.

TABLE 2. Source of Recommendation of Use of Bottle-Feeding According to Social Class.

* Excluding mothers who are breast-feeding
** Other sources include: press, previous experience, television, advice of salesmen, and store image

TABLE 3. Quantity of Baby Milk Used per Month by Mothers According to Social Class.

* Excluding mothers who are breast-feeding

TABLE 4. Types and Brands of Baby Milk Used by Mothers According to Social Class

*Carnation and Rainbow
**Include: S.M.A., Mamex, Pelargon, Klim, Bebelac, Nan, and Enfamil

Autret and Miladi (I) reported that the distribution of baby food through the different health centres in Bahrain is indirectly promoting the use of these foods, and is consequently contributing to reduced breast-feeding. Amine (5) stressed that, unless an active nutrition education programme is initiated to advise and convince mothers to breast-feed their infants, breast-feeding will become a historical method of infant feeding in Bahrain.

Surprisingly, health practitioners play an important role in recommending that mothers use formulas. This may be due to two factors: First, many health practitioners in Bahrain have been trained in Western medical schools, where the possibilities of bottle-feeding are taught Second, advertisements are widely used to encourage health practitioners to recommend many infant formulas.

Today, companies producing infant foods are an important source of infant feeding information both for the health practitioners and the public. Pharmaceutical and infant food companies supply the consumers with leaflets, book. lets, and free samples to encourage the use of their products. Hence, it is recommended that infant food advertisements publicized throughout different mass-media be regulated and censored. Also, the distribution of free infant foods in health centres should be controlled.

An effective nutrition education programme is also recommended to emphasize the advantages of breast-feeding and to promote sound infant-feeding practices.

ACKNOWLEDGEMENTS

The author is grateful to Dr. Jamal K. Harfouche of American University, Beirut, Lebanon, and Dr. Robert D. Brittain of Manchester Area Health Authority, England, for their valuables comments.

REFERENCES

1. J.K. Harfouche, "The Importance of Breast-Feeding." J. Prop. Pediat. 16: 156 (1970).

2. A. Demorales and F.A. Larkin, "Influence of the Availability of Commercial infant Foods on Feeding Practices in Jamaica." Ecol. Food Nutr. 1 131 (1972).

3. L. Santrolli, "The Bottle-Feeding Revolution in Less Developed Countries." Cajanus 10: 78 (1977).

4. Ministry of Finance, Statistics of the Population Census, 1971, Bahrain (1972).

5. E.K. Amine, Bahrain, Nutrition Status Survey, UNICEP, Gulf Area Office, Abu-Dhabi: 43-45 (1980).

6. M. Autret and S. Miladi, Report on the Food and Nutrition Situation in the State of Bahrain, Report of a Joint UNICEF and FAO Survey, Beirut, p. 25 (1979).

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