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Croatia has the most impressive breastfeeding rates in its region — why, and what could it do to perform even better?

In Serbia, an estimated 13.7% of babies are breastfed exclusively until they're six months old, while the same holds true for around 17.6% of babies born in Bosnia and Herzegovina. In neighboring, and fellow ex-Yugoslav, Croatia, meanwhile, data indicates that over half of all infants are exclusively nursed until they reach the half-year mark — something the World Health Organization strongly recommends for both mothers and babies to reap the full health benefits of breastfeeding. Compare the figures, and Croatia immediately pops out as a success story.

The fact that between 98% and 99% of new Croatian mothers initiate breastfeeding in the first place, however, begs the question: What causes the sharp drop in breastfeeding rates between birth and six months old?

SteadyHealth conducted a survey of 200 Croatian mothers based in its largest urban centers as well as the more rural areas immediately surrounding them, asking them to share their views of breastfeeding and their personal experiences with nursing. Their answers  from the survey, which was conducted in October 2016, offer surprising insights.

The vast majority of Croatian mothers who took part in our survey — 95.74% — reported that they started breastfeeding. Only 15.95% shared that they nursed at least one of their babies exclusively (meaning no solids, no water, and no tea, something mothers from this region are traditionally advised to offer their babies) for a full six months, in stark contrast with the 54.2% suggested by pre-existing national data.

Of those who didn't breastfeed at all or did so for a very short amount of time, the highest number gave "I had no breast milk" or "I had an insufficient amount of breast milk" as their reason; 36.36%. In addition:

  • 22.73% declared that they chose formula because they "knew nothing about breastfeeding"
  • 13.64% believed formula feeding would be more practical
  • 13.64% were urged to formula-feed by a healthcare provider

The concrete steps the Croatian healthcare system has taken to improve breastfeeding rates in the country have proven to be effective. For example, a 2012 study indicates that increased numbers of babies were able to room in with their mothers, be breastfed within their first half-hour of life, and nurse on demand after healthcare staff at a hospital in the major city of Split, one of the regions we surveyed, took a combined UNICEF/World Health Organization course.

The successes Croatia attained are best demonstrated by comparing our findings from Croatia to the data we collected from Serbia and Bosnia and Herzegovina during parallel surveys:

  • A quarter of Croatian mothers was able to breastfeed their babies within their first hour of life, something that held true for only 7.69% in Serbia and 15.48% in Bosnia and Herzegovina.
  • 7.74% of respondents in Croatia reported that their babies were fed formula without their consent, compared to 17.48% in Serbia and 17.32% in Bosnia and Herzegovina.
  • A very low 4.6% said they were unable to nurse their babies on demand because they were placed in the hospital nursery, while the same held true for 12.59% of Serbian respondents and 12.91% in Bosnia and Herzegovina.

We were impressed, and so were the mothers we surveyed. Croatia was the only one of the three countries we surveyed where a majority of respondents replied that they believed their healthcare providers were well-informed about breastfeeding: 52.94% felt this way.

Likewise, when we asked participants to tell us what they thought could be done to improve breastfeeding rates in their respective countries, "better healthcare provider education" emerged as the leading answer in both Serbia and Bosnia and Herzegovina.

In Croatia, however, nearly 12% let us know that they believed their healthcare system to be satisfactory and nothing needed to be changed — something not a single person from the other two countries believed!

Instead, the highest number of our Croatian respondents believed that breastfeeding rates would be improved by spreading awareness about the benefits of breastfeeding through social activism and the media.

Despite these very positive findings, however, we also have to note that fewer Croatian mothers reported having either received practical tips on getting started with breastfeeding or tips on how to overcome breastfeeding challenges they faced from their healthcare providers than did women in Serbia and Bosnia and Herzegovina. Higher numbers of mothers in Croatia replied that a healthcare provider pressured them to stop breastfeeding, as well.

An interesting picture emerged from our Croatian survey — the picture of a country that is trying its best to take concrete steps to follow World Health Organization guidelines and increase breastfeeding rates, but also the picture of a country that still has a way to go.

What messages did participating mothers take away from their social circles, then? While the vast majority of mothers was told that "breastfeeding is the most natural way to feed a baby", and a very significant number had also heard that "breast milk functions in accordance with the system of supply and demand", so that every baby gets the exact amount of milk they need, they also received some very different signals.

  • 30.34% was told that mothers themselves don't know whether they have enough milk
  • 30.34% heard that a mother's milk can suddenly disappear
  • 23.6% got the message that babies who cry a lot are hungry and need formula
  • 14.61% heard that "breastfeeding needs to be hidden away from society"

We can only conclude that our respondents were right — all the right steps have been taken to increase breastfeeding rates within the Croatian healthcare system. What is needed to bridge the gap between the extremely high breastfeeding initiation rates in Croatia and the lower rate of exclusive breastfeeding at six months is increased social activism.

Considering that only 34% of UK mothers are still breastfeeding when their babies are six months old, as well as that Croatia's breastfeeding rates stand Head and shoulders above those of the other countries we surveyed, we must however acknowledge that there is much to be learned from the Croatian healthcare system.

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