1 March 2005

Findings of the National Breastfeeding Survey 2001

The National Breastfeeding Survey 2001 was the first comprehensive study on breastfeeding conducted at a national level to establish the prevalence of breastfeeding in Singapore and the factors influencing breastfeeding.  A total of 2,098 Singaporean mothers who delivered their babies in 8 restructured and private hospitals were interviewed 2 months after their delivery and again 6 months after.

Key findings of the Survey

The survey found that about 95% of the mothers surveyed attempted breastfeeding as compared to 65% in 1980. The most important reason for initiating breastfeeding, cited by 84% of these mothers, was that breast milk was healthier for their babies.  Of the minority who made no attempts to breastfeed their babies, the most important reason cited by them was that they did not see the need to breastfeed.

The mean duration of breastfeeding was 13 weeks.  The prevalence of breastfeeding was about 72% at 1 month with 50% continuing to do so at 2 months.  But the prevalence rate dropped to 21% by the time the babies were 6 months old.  The working status of mothers did not have a significant impact on the initiation of breastfeeding although it did have a significant impact on the breastfeeding duration.  About 26% of non-working mothers breastfed for up to 6 months as compared to 18% of working mothers. 

The factors that contributed to working mothers stopping breastfeeding between 2 and 6 months were due to work-related factors (such as the need to return to work, facilities at the workplace not being conducive for breastfeeding and the demands of work interfering with breastfeeding), insufficient breast milk  and baby preferring formula milk. 

The factors cited by non-working mothers stopping breastfeeding between 2 and 6 months were insufficient breast milk , baby preferring formula milk and lack of help with the care of baby, other children or household chores. 

The Survey also showed that exclusive breastfeeding is not a common practice in Singapore. For most mothers, breastfeeding was combined with supplementary feeds of powdered milk. Only 14% of the 2 months old babies were breastfed exclusively. By 6 months, less than 1% of the babies were breastfed exclusively.  According to a publication by WHO in 1996, the exclusive breastfeeding rate under 4 months of age is 49%; in the South East Asia region, and 34% in the Americas.

The survey found that the most commonly cited sources of information that the surveyed mothers cited were healthcare professionals (such as instructors at antenatal classes, doctors, nurses and other health professionals), family members, resource materials on breastfeeding and friends.  Studies have also indicated that it is important for women to receive credible information and advice as soon as possible as infant feeding decisions are made prior to delivery and such a decision would influence the initiation and duration of breastfeeding. 

Benefits of breastfeeding

Breastfeeding has been proven in many studies to confer numerous benefits on both baby and mother.  It has clear benefits for the general health of infants while reducing their risk for a large number of diseases such as gastrointestinal and respiratory infections, diabetes mellitus and lymphoma.  Breastfeeding has also been related to the enhancement of cognitive development and educational ability in toddlers and children of preschool ages. 

For the mothers, breastfeeding has been associated with reduced risk of ovarian cancer and breast cancer in pre-menopausal women.  The short-term benefits to the mother include rapid return to normal weight and a delayed resumption of ovulation leading to increased child spacing. 

HPB’s recommendations on breastfeeding

The World Health Organisation recommends that babies should be breastfed exclusively for 6 months to confer the maximum benefit of breastfeeding on both mother and child.  In line with this recommendation, HPB recommends that infants should be breastfed exclusively for 6 months for optimum infant and maternal health. 

Strategies to promote breastfeeding in Singapore

The Health Promotion Board encourages breastfeeding in Singapore and works closely with the healthcare professionals, breastfeeding promotion groups and support groups to promote and encourage breastfeeding in Singapore.  HPB also spearheads a committee, the Sale of Infant Foods Ethics Committee, Singapore which promotes breastfeeding by providing guidelines on the appropriate marketing and distribution of breast milk substitutes among infant milk industries and health professionals.

To promote and raise the awareness of breastfeeding in Singapore, the Association for Breastfeeding Advocacy (Singapore) (ABAS) was registered as a society in 2003.  The Association is chaired by Dr Lim Sok Bee, Head of Neonatology, KK Women’s and Children’s Hospital, and comprises an alliance of healthcare institutions, healthcare professionals’ associations, mother-support groups and individual healthcare professionals in private practice.

ABAS provides a systematic approach to promote and encourage breastfeeding in Singapore.  Recognising that breastfeeding requires support both on an organisational and individual level, the Association networks between the healthcare professionals and support groups to look into working with organisations to promote support structures that will promote and encourage working mothers to breastfeed. 

The main strategy of ABAS, for 2005 is in line with the findings of the National Breastfeeding Survey.  It is to help interested workplaces develop breastfeeding-friendly initiatives.  ABAS will work together with the management of organisations to provide consultations to put in place policies and facilities that will assist their staff who are breastfeeding.  It will also help to conduct talks at lunchtime to educate staff on the benefits and management of breastfeeding after returning to work.

“We believe that breastfeeding ensures the best possible health, development and psychological outcome for the baby.  We are committed to encouraging all mothers to breastfeed and to enabling all professional caregivers to make breastfeeding a viable option for mothers.  Working mothers with healthy infants also make for a more productive and committed workforce.  We want to encourage the workplace to work together with their employees who are breastfeeding to work out breastfeeding-friendly initiatives and work policies which will make breastfeeding an easier option for working mothers.  This would benefit both their employees and the organisation,” said  Dr. Lim Sok Bee, President, Association for Breastfeeding Advocacy (Singapore) and Head of Neonatology, KK Women’s and Children’s Hospital.

“Studies have also shown that problems like poor milk supply or baby not sucking well are usually caused by supplementary feeds from the bottle, that is, mixing breastfeeding with bottle-feeding.  Such difficulties can be overcome by educating and encouraging mothers to breastfeed frequently and consistently. This will increase milk production and prevent the baby from being confused as breastfeeding and bottle-feeding require different sucking actions,” Ms Cynthia Pang, Member of Executive Committee, ABAS and Lactation Consultant, KKH Women’s and Children’s Hospital.