The longer mothers exclusively breast-feed their babies, the less likely their children are to develop behavioural problems, known as conduct disorders, at primary school age, according to a study published in the open-access medical journal, PLOS Medicine in June.
The researchers found that children of mothers who exclusively breast-fed their babies for the first six months of their lives were about half (56%) as likely to experience conduct disorders as those who had not been exclusively breast-fed for that period.
The study assessed more than 1 500 children at the Africa Centre for Population Health, in South Africa between 2012 and 2014.
Conduct disorders usually start in childhood and can persist into the teen years, says lead researcher Tamsen Rochat of the Human Science Research Council. "Later in life they are associated with an increase in antisocial, and potentially violent and criminal behaviours, poor long-term mental health and low academic achievement."
While formal analyses on the economic costs of conduct disorders in low-middle income countries have not been carried out, research in the United Kingdom has shown that the cost of crime attributable to people with conduct disorder in childhood was, in 2007, an estimated £60-billion a year.
Rochat says when conduct disorders persist into the teen years "we see substance abuse, school dropout and risk of arrest. In adulthood, these children face higher risks for marital and work problems, homelessness and criminal behaviours. In a society like South Africa, prevention is crucial because interventions for conduct disorder are very expensive, and breast-feeding is a free and possible choice for all mothers."
Exclusive breast-feeding is when a mother gives a baby breast milk only — no other liquids, for instance water, or solids, such as porridge, are introduced during this period.
The World Health Organisation recommends that babies are exclusively breast-fed for the first six months of their lives, as research shows that they are less susceptible to childhood diseases such as diarrhoea and pneumonia, and also HIV infection, if their mothers are infected.
Breast-feeding in South AfricaSouth Africa introduced an exclusive breast-feeding policy in 2011 yet, in 2013, the country still had one of the lowest exclusive breast-feeding rates in the world with only 28% of children being exclusively breast-fed at six weeks of age, according to health department data.
A 2015 study published in the South African Journal of Clinical Nutrition, found the exclusive breast-feeding rate at six months to be only 12%. More than a third of the mothers had stopped breast-feeding their babies by the time they were a month old. The introduction of complementary food took place in about one in five (17%) infants in the first month.
According to the study's team leader, Ruth Bland from the Africa Centre for Population Health in Mtubatuba in South Africa's Kwazulu-Natal province, "a lot of women in South Africa start to exclusively breast-feed, but few continue. Pressures from family members and friends to introduce liquids and solids before six months, the belief that breast milk alone is not enough for the baby, and the fact that women have to return to work, and few employers offer facilities where nursing mothers can express breast milk, all play a role in our low rates of breast-feeding."
South African legislation allows for only four months of maternity leave. The South African Journal of Clinical Nutrition study found that close to a third (29%) of mothers said they had to stop breast-feeding because they had to return to work, 25% stopped because of their health status and 13% because of "perceptions of insufficient milk supply".
The PLOS Medicine study, which was funded through Grand Challenges Canada's Saving Brains programme, also found that children who attended crèche for at least one year prior to formal schooling were 74% more likely to have higher executive function than those who didn't. Executive function enables a person to successfully plan, concentrate, follow rules and juggle multiple tasks.
Children stimulated at home, through play for example, were about a third (36%) more likely to have higher executive function scores.
"It's not so much about the time, as in the number of hours in a day, a parent or family member spends with the child, it is more about the quality of interaction around children during that time," says Rochat. "People often assume this is about resources and learning tools, but it is about more than that.
For example, in very resource poor settings we see that parents and families are able to offer a very stimulating and responsive environment with very little means, just using household items, their voices, affection, play. But as children grow older and reach schooling age, providing more formal stimulation and learning materials becomes increasingly important, hence the additional effect when children have access to preschool."
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