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Global breastfeeding rates being are lowest in the World Health Organization's European region, with Serbia lagging behind many other Eastern European countries. What are the reasons for this, and what would increase the number of nursing mothers?

An overwhelming majority of Serbian mothers — nine out of 10 — start off breastfeeding their babies. Despite this high breastfeeding initiation rate, only an estimated 13.7% nurse their babies exclusively during the first six months of their lives, as the World Health Organization strongly recommends. Exclusive breastfeeding, after all, offers numerous health benefits, from reduced incidences of respiratory infections and diarrhea, to higher performance on intelligence tests in babies, and faster postpartum recovery and a reduced breast cancer risk in mothers.

What is behind the enormous disparity between breastfeeding initiation rates and numbers of mothers who are still nursing by the time their babies are half a year old in the former Yugoslav republic of Serbia? To find out, SteadyHealth conducted a survey of 200 Serbian mothers in October 2016, concentrating on large urban centers and the more rural areas immediately surrounding them.

Serbian Mothers' Experiences With Breastfeeding: Our Findings

A total of 92.26% of our respondents reported having breastfed for any length of time. Of these, 48.96% breastfed one child less than six months, 28.35% nursed more than one child less than six months, and 14.95% breastfed at least one of their children exclusively for six months in accordance with the guidelines set forth by the World Health Organization.

Nearly 8% of our participants reported that they never nursed their babies — however, when we asked participants to share why they ended up formula-feeding, those who breastfed for a short amount of time responded alongside those who didn't get started with breastfeeding at all.

While some mothers replied that they chose formula for personal reasons, like believing bottle-feeding to be more practical, wanting more time for themselves, or believing that breastfeeding didn't offer significant health benefits, most had more complex sociological reasons for turning to formula:

  • 10.4% reported that one of their main reasons for choosing formula was a social circle that was unsupportive of breastfeeding.
  • 26% of participating mothers shared that they decided to formula-feed because they "knew nothing about breastfeeding", a lack of knowledge the healthcare providers they encountered during their pregnancies and over the course of their stay in maternity hospitals clearly didn't succeed in helping them overcome.
  • Most interestingly, though, a very significant 27.1% said that they either didn't have breast milk at all, or not enough to feed their babies. (Likewise, when we asked Serbian mothers whether they believed that most women are physically able to breastfeed, 77% answered affirmatively, while a further 30.5% shared the opinion that many mothers do not have enough milk.)

With 28% of participants having heard the idea that "mother's milk can suddenly disappear" within their social circles and a further fifth encountering the idea that "mother's milk can go sour" (a belief that was voiced in much lower numbers in Bosnia and Herzegovina and Croatia, which we also surveyed), cultural opinions surrounding the sparsity of breast milk emerged as one of the main reasons for low breastfeeding rates in the Republic of Serbia.

Considering that pre-existing data suggests that "as many as 5% of women may have primary insufficient lactation because of anatomic breast variations or medical illness that make them unable to produce a full milk supply" — a much lower percentage than our Serbian participants believed — what are the origins of the prevalent idea, within Serbia, that many mothers simply can't breastfeed their babies?

One clue lies within the healthcare system itself: Only 7.69% of participating mothers were able to nurse their babies within their first hour of life, something the World Health Organization considers enormously important, as early initiation of breastfeeding confers crucial antibodies to the infant and helps prevent heavy postpartum bleeding in mothers. Furthermore, 17.48% of respondents shared their their newborns were fed formula within the maternity hospital without their consent, while 12.59% weren't able to nurse their babies on demand because they were placed within the hospital nursery.

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