Breast‐feeding and fertility: Sociocultural factors

This paper reviews the physiological consequences of variations in breast feeding practices and their impact on nutrition fertility and mortality under different sociocultural milieu in different communities. Ample data suggest that the duration of lactation is a critical determinant of lactational amenorrhea. Conception rates during lactational amenorrhea regardless of its duration are no more than 2-10%. Even after the return of menses continued lactation has some inhibitory effect on the return of normal menstruation and normal fertility. The greater number of suckling episodes among women from developing countries a determinant of plasma prolactin levels could be 1 of the factors responsible for their greater durations of lactational amenorrhea. The duration of unsupplemented lactation may also be a major factor in determining the duration of lactational amenorrhea. The introduction of supplements results in a reduction in both the number of suckling episodes and in the total duration of suckling. Ample data exist to show that undernourished women in developing countries lactate successfully and that maternal undernutrition is not associated with an alteration in the quality or quantity of milk produced in terms of proximate principles. Most studies of dietary supplements to lactating women fail to show any changes in quantity or quality of breast milk. There has been some speculation that the return of menses is delayed in undernourished women and a few studies support this hypothesis. In many developing countries there is a tradition against feeding colostrum and suckling is allowed only when 24-72 hours have elapsed since delivery. In spite of this delay there is no problem in initiating breast feeding. In contrast the hospital practice of separating the mother and her infant in the 1st 1-2 days after delivery and a delay in initiating suckling are thought to be the major factors in the decline of lactation in the developed countries. In developing countries bottle feeding and processed supplements have been accepted as a symbol of sophistication. The expense of supplements may lead to their being overdiluted and insanitary conditions may lead to increased infections. Although lactation is a critical determinant of the duration of lactational amenorrhea undue delay in introducing supplements does not postpone indefinitely the return of menstruation and fertility.