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Montenegrin mothers often manage to keep breastfeeding despite bad healthcare provider advice, a SteadyHealth survey finds, but do the patriarchal attitudes they then encounter in their surroundings get them down?

A recent in-depth SteadyHealth report showed that mothers in the ex-Yugoslav nations of Serbia, Bosnia and Herzegovina, and Croatia are eager to breastfeed, but also that a myriad of complex challenges — ranging from cultural attitudes to poor healthcare provider support and the subtle promotion of formula in hospitals — often get in the way.

Wondering what the situation is like in Montenegro, another ex-Yugoslav country, SteadyHealth once again surveyed 200 mothers to find out how they view breastfeeding, what attitudes they were met with in their social circles, and how they perceived breastfeeding-related maternity care. The survey was conducted in December 2016.


Montenegrin Mothers' Personal Attitudes Towards Breastfeeding

Eight-five percent of our Montenegrin respondents shared that they believe breast milk to be nutritionally superior to formula, with five percent saying they believe formula is the better option.

A majority of mothers in Montenegro held the following beliefs about breastfeeding:

  • Breastfeeding leads to lower incidences of illness in infants (75 percent)
  • Breastfeeding has health benefits for mothers (61 percent)
  • Breastfeeding promotes mother/infant bonding (83 percent)
  • Most mothers are physically able to breastfeed (68 percent)
  • Mothers should have the right to breastfeed in public (66 percent)

Just how important is breastfeeding, according to mothers from Montenegro? A total of 81 percent believed that breastfeeding is so important that it should be a priority even when a mother encounters challenges, while 28 percent agreed that though breastfeeding offers health benefits to mothers and babies, they are not so great that mothers who choose to formula-feed should be judged negatively.

Given these personal attitudes towards breastfeeding among Montenegrin respondents, what were their personal experiences with nursing?

Breastfeeding Among Montenegrin Respondents

The overwhelming majority of Montenegrin respondents initiated breastfeeding — nearly 97 percent. Of these, 27.37 percent reported that they nursed at least one baby exclusively during the first six months of their life, in accordance with the guidelines set forth by the World Health Organization.

Both those who never breastfed and those who breastfed for only a very short amount of time shared their reasons for turning to formula. The most popular reason was that a doctor advised them to do so, with nearly 26 percent of mothers answering this way. Meanwhile, 18.52 percent shared that "medical challenges", including mastitis and having undergone a c-section, were the reason they stopped breastfeeding quickly.

Over a fifth of respondents cited "I didn't know anything about breastfeeding" as their primary reason for ceasing to breastfeed soon after their babies were born or never starting.

While between 19.30 percent and 36.36 percent of mothers from Bosnia, Croatia, and Serbia reported that they gave up on breastfeeding because they simply "didn't have (enough) breast milk", the same was not true among Montenegrin respondents by any means. Surprisingly, only 3.7 percent of those Montenegrin moms who didn't breastfeed or turned to formula soon after having their babies shared that lacking breast milk was the reason. This finding potentially shows some very interesting cultural differences, especially given the fact that these Differing answers can't possibly be explained by Montenegrin mothers having "better genes for milk production" — ethnically, the four countries SteadyHealth surveyed are not at all dissimilar. 

Sharing their experiences within Montenegrin maternity hospitals, just over a fifth of respondents said that they received practical tips on initiating lactation and help in overcoming challenges, respectively. While 20.71 percent of mothers indicated that their babies were fed formula without their consent and 15 percent were unable to nurse their babies on demand as they were placed in the hospital nursery, 18.57 percent received the chance to nurse their newborns within their first hour of life. 

We asked Ana Vujnovic of the non-profit organization "Parents", which established a peer-to-peer breastfeeding support group in Montenegro two years ago, to comment on this situation. Ana told SteadyHealth that healthcare providers "often recommend formula feeding, without assessing a baby’s latch, positioning, or signs of development other than weight gain". She added:  "When a mother shows any sign of illness, such as a common cold, high temperature, or mastitis, they often recommend them to stop breastfeeding."

Though "Parents" has been unable to find evidence of any breaches of the code on marketing of breast milk substitutes, they do "suspect doctors to be influenced by formula distributing companies". Another great problem, however, is the lack of Baby-Friendly practices in Montenegrin hospitals. Ana shared:

"There is no Baby Friendly program in most Montenegrin hospitals, including the biggest, the Clinical Center of Montenegro, where half of Montenegrin babies are born annually. Babies are separated from mothers and routinely fed formula in the days following delivery. There is some progress in terms of providing skin to skin contact between mother and baby right after delivery in some hospitals in recent years, but mothers are still forced to express their milk and throw it away in the situation of being separated from their babies, when, for instance, a baby has newborn jaundice or is losing weight in the days following birth."
The lack of support by health providers, combined with the lack of support by families, is the main reason for the huge drop in breastfeeding, as well as the early introduction of solids and water to babies in Montenegro.

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