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.
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.
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.
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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.
Breastfeeding In Patriarchal Montenegro: The Good, The Bad, And The Ugly
Montenegrin Healthcare Staff 'Ill-Informed About, Or Disinterested In, Breastfeeding'
Considering that such large percentages of mothers reported experiencing practices that defy evidence-based medicine in maternity hospitals, such as formula being offered to babies without parental consent and babies being separated from their mothers through the nursery system, how competent did our respondents think their healthcare providers were when it comes to breastfeeding?
- 27.12 percent was confident that their healthcare providers were thoroughly informed about the benefits of breastfeeding, possible challenges, and how they can be overcome.
- 30.51 percent deemed that their healthcare providers were insufficiently informed about breastfeeding.
- A quarter believed that their healthcare providers were well-informed, but lacked motivation to actually help mothers overcome breastfeeding challenges or provide them with tips on establishing successful lactation, a trend we also observed in the rest of the region.
The remaining mothers either didn't want to commit to an answer, or believed that "some healthcare providers are well-informed, while others are not".
When we asked our respondents to share positive and negative experiences with breastfeeding-related healthcare, we received comments from mothers whose healthcare providers helped them with positioning, latch, and mastitis prevention. Most, however, shared negative stories. One comment that really stood out was: "I wanted to breastfeed, but because my baby was fed formula in the nursery, she was full every time she was brought to me and was not interested in the breast."
What Montenegrin Mothers Think Of Breastfeeding In Public
Despite the fact that 66 percent of our Montenegrin respondents stated that they believed mothers should have the legal right to breastfeed in public, only 50.7 percent felt comfortable doing this themselves. Comments from mothers opposed to breastfeeding in public were more strongly worded than those we previously received from participants in Serbia, Bosnia, and Croatia. "That's indecent and unpleasant for onlookers," one said, while another believed that "only women who want to draw attention to themselves would do that" — and these views offer a very fair representation of the remaining comments from women opposed to public breastfeeding we received.
Given that many mothers, most of whom have themselves breastfed or are still breastfeeding, feel this strongly about breastfeeding in public, it is almost a surprise that "only" 16.9 percent of those who did choose to nurse while out and about received negative comments, including that they were engaged in "morally questionable acts". Just over seven percent was met with positive reactions while nursing in public locations, with 26.76 receiving neutral reactions.
What Would Improve Breastfeeding Rates In Montenegro?
When presented with this question, the highest number of mothers who participated in our survey said that they believed the answer mainly lies in better healthcare provider education, with 20.38 percent answering this way. Better education of new mothers would be the best way to improve breastfeeding rates according to 17.83 percent of mothers.
Other proposed solutions were:
- Better social acceptance of breastfeeding (8.92 percent)
- More actively involved healthcare providers (11.46 percent)
- Strict enforcement of "Baby Friendly" protocols (8.92 percent)
Private pediatrician Dr Vjera Jankovic, meanwhile, told SteadyHealth that she believes that breastfeeding challenges such as mastitis and pain are, alongside worries about whether a mother has enough milk or not, the main reasons due to which the breastfeeding rate in Montenegro is not higher. She told us:
"What is needed is raised awareness of the benefits of breastfeeding, and that should primarily include pregnant mothers, who need to be fully informed of everything they can expect while breastfeeding. Likewise, we, healthcare workers, need to be engaged and motivated to help nursing mothers resolve all the challenges that they may encounter while breastfeeding."
What Can We Learn From Montenegro?
Of all the countries we surveyed, Montenegro was the one in which the highest number of mothers reported following the World Health Organization's guidelines in nursing exclusively during the first six months of their babies' lives. The finding that much lower numbers stopped breastfeeding because they believed they lacked milk was also especially notable. The Montenegrin survey shows that cultural attitudes towards breastfeeding might influence breastfeeding rates, but more than that, broader cultural attitudes play a role. It is no coincidence that Montenegro, the most traditionally patriarchal of the countries we surveyed, is home to mothers who breastfeed for longer — despite the fact that we found they were exposed to the same detrimental breastfeeding-related healthcare practices we observed in Serbia, Bosnia, and Croatia.
While more mothers might breastfeed for longer in Montenegro compared to its direct neighbors, we also have to ask what their breastfeeding experience is like. Given the strong opposition towards breastfeeding in public among mothers themselves, we can only conclude that, more than focusing on increasing breastfeeding rates, what Montenegrin mothers could benefit from is a cultural shift in attitudes towards women.
- Infographic by SteadyHealth.com
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