• Breastfeeding is every person’s first start in life, yet millions of South African mothers stop within weeks.
• A simple change in position or early expert support can make the difference between quitting and success.
• Myths, short maternity leave, and lack of workplace facilities are costing babies their best food.
• Supporting breastfeeding isn’t just good for health – it’s good for the economy and the planet.

Every year, from 1 to 7 August, we celebrate World Breastfeeding Week, but in the hierarchy of public health interventions, few are as deceptively simple, and as politically fraught, as breastfeeding. It is free, renewable, and scientifically proven to protect infants from malnutrition, infection, and developmental delays. Yet in South Africa, as in much of the world, its practice is undermined not by lack of evidence but by an absence of sustained support.

“Many mothers stop breastfeeding in the first few days or even weeks due to a lack of support,” says Professor Welma Lubbe of North-West University’s (NWU) Quality in Nursing and Midwifery  (NuMIQ) Research Focus Area. “Healthcare providers can make a huge difference by offering immediate help in the first hour after birth, promoting skin-to-skin contact, and ensuring access to a trained lactation consultant before a mother leaves the hospital. Even small adjustments matter. Sometimes changing the baby’s position by five degrees can make all the difference.”

The World Health Organization’s “Ten Steps to Successful Breastfeeding,” embedded in South Africa’s Mother Baby Friendly Initiative, set out what hospitals should do. Yet continuity of care remains elusive. Referral networks linking struggling mothers with lactation experts or peer counsellors are patchy. Time-pressed maternity wards may aim to offer help, but rarely have the capacity to see breastfeeding established before discharge.

The obstacles multiply outside the hospital. South African mothers are encouraged to breastfeed exclusively for six months; most do not. The chief culprit, says Prof Lubbe, is short maternity leave: four months, in law, and often less in practice.

“Many mothers return to work within three months, often to workplaces without lactation rooms or refrigeration. While legislation entitles them to two 15-minute breaks and a half-hour at lunch to express milk, very few employers provide the facilities to make that possible.”

The problem is worse for women in the informal sector, who enjoy no maternity protection, job security, or childcare options near their workplace.

“Long commutes and unsafe transport make direct breastfeeding or milk transport impractical. Poverty adds another twist: malnourished mothers may fear their milk is ‘not strong enough’. In reality, breast milk remains nutritionally complete even when the mother is undernourished, at the mother’s expense.

Cultural beliefs further complicate matters. Myths include that a crying baby signals insufficient milk, that formula is “just as good”, that babies need water or porridge before six months, or that breastfeeding ruins a woman’s body.

“All are wrong,” Prof Lubbe insists. “Frequent feeds are normal, formula lacks the immunological adaptability of breast milk, early solids can cause allergies, obesity, and asthma, and breast changes are caused by pregnancy hormones, not breastfeeding.”

Overturning such misconceptions, she says, requires early and broad-based education “for girls and boys at school level, in clinics, on radio, social media, anywhere the conversation can happen.” Influencers and community leaders should be recruited, traditional birth attendants trained, and the WHO code restricting breastmilk substitute marketing enforced.

This year’s World Breastfeeding Week theme of Prioritise breastfeeding: create sustainable support systems is, according to Prof Lubbe, timely. “Breastfeeding is more than food… It’s every person’s start in life. It shapes the developing brain, strengthens the immune system, and supports environmental sustainability by reducing waste and the carbon footprint of infant formula. It is also a bulwark of local food security.”

Her policy recommendations are straightforward: extend paid maternity leave; make workplace policies real, with accessible lactation rooms, offer mobile lactation support in underserved areas and foster community-based peer groups. One NWU project saw grandmothers trained as breastfeeding mentors. This is a reminder that older women can be allies in changing norms. Employers, too, need convincing. “There’s research showing reduced absenteeism and healthier babies if mums are allowed to breastfeed,” Prof Lubbe notes.

The challenge is to turn such recommendations from aspirational statements into enforceable norms. As with so many public health goods, breastfeeding support depends on political will, budgetary priority, and cultural acceptance. The prize, which is a generation of healthier children, fewer healthcare costs, and a more resilient society, should be incentive enough. But as Prof Lubbe points out, success starts small: “The first milk you got was the first lesson, and breastfeeding gave us all our start in life.”