"While we've never talked more about breastfeeding and the benefits it brings, as well as about the differences between formula and breast milk, it simultaneously appears — to me — that fewer and fewer women decide to nurse," pediatrician Gordana Mucibabic from Banja Luka said about her home country of Bosnia and Herzegovina.
SteadyHealth, looking into the social attitudes Bosnian mothers and the society that surrounds them have about breastfeeding, conducted an in-depth survey of 400 internet-using mothers within this country, which has gone through an immense amount of change over the last two and a half decades, from the break-up of Yugoslavia to civil war and the rebuilding of a new society. Bosnia and Herzegovina was organized into two administrative entities, the Bosniak-Croat Federation and the majority Serbian Republika Srpska. Hoping to understand potential differences between the two entities, we surveyed them separately in October 2016.
In the Federation, the most popular reason for which mothers ended up formula-feeding their babies was a healthcare provider recommending this, while Srpska-based respondents most commonly answered that they had no breast milk, or not enough of it.
Existing research indicates that up to 5% of mothers anywhere in the world might not have (enough) breast milk to feed their babies, so why did nearly a third of respondents from Srpska report that this was the reason for which they turned to formula?
Gordana Mucibabic cited a broad range of factors surrounding newborns, mothers, and their social circles, adding that childbirth is always stress-inducing on some level, and that "effective and expert assistance is required to establish lactation within the first few days". Likewise, she reported, new mothers often encounter negative comments about breastfeeding within their own families, reducing their confidence and motivation.
READ Western Balkan Moms Eager To Breastfeed, But Thwarted By Corruption And Old Wives' Tales
Our survey confirms her view:
- 24.42% of mothers in the Federation, and 21.59% of mothers in Srpska, had heard the idea that breastfed babies who cry a lot must be hungry and need formula.
- 24.42% of Federation moms and a whopping 37.5% of Srpska-based respondents received the message that mothers themselves don't know whether or not they have enough milk.
- 44.19% of Federation respondents and 32.95% of those in Srpska had friends and relatives who believed that breast milk can suddenly disappear. Conversely, 31% and 27% of our participants in the Federation and Srpska respectively held this view themselves, as well.
Though most mothers from both entities of Bosnia and Herzegovina heard positive messages about breastfeeding, including "breastfeeding is the most natural way to feed a baby", "breastfeeding in public is completely acceptable", and "breastfeeding mothers deserve practical and emotional support", significant numbers also heard very different messages. Approximately 10% in both entities had heard that "breastfeeding should be hidden away from society", for instance.
How Mothers In Bosnia Experience Breastfeeding-Related Maternity Care
Nearly one in 10 Federation-based mothers were able to nurse at least one of their children exclusively for a full six months, as recommended by the World Health Organization, while almost 17% in Srpska did. Did they feel comfortable doing so in public? While 59% in the Federation and 61% in Srpska believed they should have the legal right to do exactly that, lower numbers, 57% and 50% respectively, decided to nurse in public locations.
Some mothers boldly reported that what other people thought of breastfeeding in public wasn't important to them. "I don’t care what others think: what matters is that my child isn’t hungry", one said, and another added: "If they don’t like it, let them turn their heads the other way." Many of those who didn't nurse in public locations said they stayed at home to avoid social judgment, however.
How Bosnian Mothers Perceive Their Healthcare Providers
What experiences did our respondents have in the maternity hospitals where they gave birth?
In the Federation:
- 18.9% was able to breastfeed their baby within their first hour of life
- 31.7% received practical tips on establishing lactation
- 23% encountered breastfeeding challenges but received the care they needed to overcome them
- 16.9% reported that their babies were fed formula in hospital without their consent
In Srpska, meanwhile:
- 12.06% received the opportunity nurse their babies within an hour after delivery
- 30.5% got practical tips on getting started with breastfeeding
- 21.99% received the help they needed to overcome initial challenges
- 17.73% shared that their babies were given formula without their permission
What did Bosnian mothers make of their healthcare providers, in light of their experiences? When we asked them to share examples of the kind of care they received, both positive and negative, our respondents overwhelming decided to share negative examples.
Only 20.70% and 24.36% in the Federation and Srpska respectively believed that their maternity care providers were well-informed about the benefits of breastfeeding, possible challenges that can arise, and how to help their patients overcome those obstacles. Meanwhile, 32.50% in the Federation and 44.87% in Srpska believed their healthcare providers to be well-informed, but with a caveat: "they are not interested in doing their jobs".
READ Western Balkan Moms Eager To Breastfeed, But Thwarted By Corruption And Old Wives' Tales
What could be done to encourage more Bosnian mothers to breastfeed, and breastfeed for longer, then? According to our respondents, a combination of better information for new mothers and improved healthcare provider education — including direct instruction on how to talk to mothers with empathy — was the way forward.
Tereza Kis Miljkovic, a lactivist active across the ex-Yugoslav region and best known for her group "My Breastfeeding Support", told SteadyHealth:
"I am aware that the Baby Friendly system established by UNICEF functions perfectly in Croatia. We can learn a lot from how the system over there works, from their approach to work to the manners in which their hospitals practice and scrutinize all of the 10 steps of the Baby Friendly program. Likewise, there is an excellent support system in place in Croatia, which does not only include healthcare workers, but also peer-to-peer educators. I believe they are a good 10 years ahead of Serbia. In Bosnia meanwhile, support for the Baby Friendly System is increasing, so I am hoping that it will be established here too, just as it worked well in the late 1990s."
SteadyHealth's conversation with the Federation's ministry of health confirms that a lot is being done in this direction. Their spokesperson Aida Filipovic Hadziomeragic told us:
"The Federation of Bosnia and Herzegovina's child nutrition policies are particularly focused on breastfeeding and especially exclusive breastfeeding until infant age six months. In connection with this, the Federal ministry of health's direction of policy includes prioritized activities and interventions that serve to realize adequate conditions for optimal infant nutrition."
These policies include, but are by no means limited to, continuous breastfeeding-related healthcare provider education, parent education, the adoption of the international code of marketing of breast-milk substitutes, and certifying and recertifying hospitals as "Baby Friendly", in conjunction with the Agency for Quality and Accreditation in Healthcare and UNICEF. These steps show great commitment to furthering breastfeeding rates in the sphere of policy, the results of which Bosnian babies will hopefully reap in practice.
Sources & Links
- Infographic by SteadyHealth.com