Health: Making baby hit the bottle: Mother's milk is best, but many husbands and grannies are against breastfeeding, says Tessa Thomas (CORRECTED)

CORRECTION (PUBLISHED 5 JANUARY 1993) APPENDED TO THIS ARTICLE

SEX and babies don't mix. Although the first may determine the second, it is commonly diminished by them. Michel Odent, author of The Nature of Birth and Breastfeeding, says: 'A woman who is breastfeeding is not receptive to the demands of the male, and the male is not attracted to breastfeeding females. This produces a conflict of interest.'

Under the influence of their partners, and of midwives who increasingly ask what contraception they will be using when they get home, he says that women feel compelled to return to 'normal' sexual activity. The result is that many give up breastfeeding after a few weeks.

Whatever the reason, and despite the Department of Health's best intentions, breastfeeding is on the decline, according to its Infant Feeding Survey. But in an effort to halt this bolt for the bottle, the Government has announced two initiatives: next month the National Breastfeeding Working Group will begin to 'promote and facilitate' breastfeeding; and an extra pounds 70,000 is to be made available to the voluntary sector.

Britain now has one of the lowest rates of breastfeeding in Europe, and Mark Belsey, director of family health at the World Health Organisation (WHO), says that fathers' attitudes are a determining factor.

In Norway and Sweden, where men attend breastfeeding classes, 80 per cent of mothers are still feeding nature's way at six months. But one London GP reports that women regularly speak of their partner's displeasure at the practice. One gave up because her partner accused her of enjoying it; another's husband said

he wanted to be able to feed the baby, too, so they switched to a bottle.

Ninety per cent of women decide how they are going to feed their baby before the birth. But the breastfeeding lobby says that many midwives, instead of instructing women on how best to breastfeed, are doing little to reverse prejudices.

Dora Henshall, of the Joint Breastfeeding Initiative, set up by the Government to increase the number of mothers breastfeeding after six weeks, points to the shortage of midwives in most wards, and their inexperience (most receive only a day's training in breastfeeding).

The result, she says, is that by six weeks, 40 per cent of mothers have turned at least partially to the bottle. Most of those surveyed said they had done so because the baby was hungry, and for the same reason two-thirds of mothers are introducing solids by three months. (The WHO recommends nothing but breast milk for the first five to six months of life.)

And many women are not instructed how to breastfeed properly. Dr Chloe Fisher at the John Radcliffe Hospital, Oxford, has demonstrated that during breastfeeding the fat-rich milk comes at the end of the feed, so that each breast must be emptied if the baby is to receive adequate calories.

Ignorance among mothers and a shortage of midwives are compounded by the pronounced move in recent years towards short stays in hospital after the birth, Ms Henshall says. Three-quarters of the women surveyed stayed fewer than five days. 'That first week is the critical period, but without sufficient informed help, it is really not long enough to establish breastfeeding or confidence.'

If the first week is critical, the first hour is even more so. The WHO and Unicef have demonstrated that the sooner a baby is put to the breast, the more likely the mother is to prolong breastfeeding. Early skin-to-skin contact is now thought to encourage the sufficient production of milk. Dr Walter Barker, director of the nation-wide Child Development Programme, says: 'That first hour is absolutely vital. Taking the baby away from its mother and washing and drying it remove all the senses that bond them together.' The survey bears this out: only 12 per cent of mothers whose babies were allowed to suckle immediately gave up breastfeeding within the first fortnight, compared with twice as many who had delayed for up to an hour.

Once out of hospital, it seems, women are at the mercy of their own mothers, who had babies in the Sixties, when bottles became big business. Cynthia Rickett, pioneer of a radical breastfeeding promotion programme in Sunderland, says: ' 'New Men' wanting to share in the feeding of their babies are partly to blame for the bottle habit, but the granny influence is the biggest single factor.'

She and researchers at Newcastle Polytechnic are developing a way of predicting which women are most likely to give up breastfeeding early. 'We've discovered that the most important question is, 'How often do you see your mother?' The more they do, the less likely they are to breastfeed.'

Grannies aside, much of the blame can be laid on the infant formula manufacturers, which supply their products free to maternity wards. Farley's, for example, recently offered hospitals pounds 18 for every baby fed on Ostermilk, and a lump sum of pounds 24,000 if all were fed on it and mothers were persuaded to continue when they left.

The Government is examining ways of legislating to end such practices, but their impact is clear: the number of babies being fed on formula milk at four months has almost doubled since 1985, despite mounting research demonstrating its inadequacy.

Try as they may, manufacturers are unable to reproduce the nutritional composition of breast milk. In the meantime, the medical case for breast milk continues to gather strength.

A study at the Royal Hospital for Sick Children in Glasgow has found that formula milk contains an imbalance in the fatty acids that are thought to contribute to brain development and function.

In Dundee, a study has shown that bottle-fed babies are six times as likely to suffer from gastro- enteritis and four times as likely to suffer respiratory infections in the first year (a fact that may be linked to the higher incidence of sudden infant death syndrome among bottle-fed babies). And new evidence shows that breastfeeding for more than six months increases immunity to Haemophilus influenzae type b disease, a form of meningitis.

People with radical views, such as Michel Odent, believe proper, prolonged breastfeeding may override the need for many of the new childhood vaccinations. He is conducting a world-wide study to clarify the extent of the link between breast milk and immunity.

Reports in the Journal of Clinical Epidemiology suggest that these benefits extend to the mother's health as well, and that women who breastfeed show a lower incidence of breast or ovarian cancer. Other research points to a higher resistance to urinary tract infection and, in the shorter term, breastfeeding at night has been found to release endorphins that ensure better sleep.

This is all grist to the mill of the breastfeeding lobby, but the Health Education Authority, which has just published a breast- feeding guide for new mothers, emphasises that popular prejudice remains a major deterrent. 'Young mothers increasingly opt for the bottle on social grounds,' explains a spokeswoman for the authority.

Cynthia Rickitt concurs. 'We need to convince people long before they have babies that the benefits of breastfeeding far outweigh any social obstacles.' But that, she believes, will take another two decades.

'The Nature of Birth and Breastfeeding' is published by Bergin & Garvie, pounds 13.50.

CORRECTION

Infant feed: Following the publication of 'Making baby hit the bottle' (Health, 29 December), Farley's - the makers of infant formula - wish to point out that they do not supply baby milk free to hospitals, 'except for the purpose of controlled assessment trials'.