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1. Introduction
2. Breastfeeding practices in Australia
3. Age, educational attainment and alcohol consumption among mothers

1. INTRODUCTION

This paper presents data from the 1995 and 2001 National Health Surveys (NHS). The first section of the paper focuses on breastfeeding practices among Australian women including how many women begin breastfeeding their babies, when they introduce other sources of nutrition, and when and why they stop breastfeeding their children. The second part of the paper presents statistics on the age and education level of mothers. Statistics on alcohol consumption by breastfeeding status are also presented and a set of brief explanatory notes provide more detail on the methods and concepts used.

1.1 Why is breastfeeding important?

Internationally and in Australia, breastfeeding has received increased attention as a focus for improving public health. Breastfeeding has increasingly been recognised as the optimal form of infant feeding (WHO 2001). Research has provided evidence that breastfeeding increases a baby's resistance to infection and disease and is particularly suited to the growth and requirements of the infant (Marks et al. 2001).

Positive implications for women's health have also been recognised. Breastfeeding helps a mother's body recover to its pre-pregnant state more quickly, and lactation (the production of breastmilk) protects against premenopausal breast cancer and osteoporosis (ABA 2003). Psychological benefits between a mother and an infant when breastfeeding, encouraging close bonds, have also been recognised.

Current Australian and World Health Organization (WHO) guidelines outline optimal breastfeeding practices, in terms of initiation (when breastfeeding begins), intensity (the extent breastfeeding is a dominant source of nutrition), and, total duration (the length of time a mother breastfeeds her infant).

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2. BREASTFEEDING PRACTICES IN AUSTRALIA

Results from National Health Surveys show that in 2001, 87% of infants aged 0-3 years had, at some stage, obtained nutrition from breast milk, a similar figure to 1995 (86%). This includes those who had been obtaining all nutrition from breastmilk, those obtaining nutrition from both breastmilk, other milk and milk substitutes (e.g. infant formula, cows milk, soya milk), and those who obtain their nutrition from breastmilk, other milk, milk substitutes and solids.

2.1 Initiation of breastfeeding

There has been a general increase in the proportion of women initiating breastfeeding after discharge from hospital. In the 1970s it was estimated that from 40-45% of women breastfed their infants after being discharged from hospital (Nursing Mothers Association of Australia 1995). National Health Survey results indicated that in 1995, 82% of all Australian 0-3 year olds were breastfed when first taken home from hospital, and the result in 2001 was similar (83% of all 0-3 year olds). Only a small proportion of children 0-3 years of age, who were initiated to breastfeeding, were not breastfed when first discharged from hospital (4% of all 0-3 year olds in 1995 and 2001).

2.2 Duration of breastfeeding

There has been considerable discussion surrounding the optimal duration a mother should breastfeed her infant. The World Health Organization (WHO) recommends exclusive breastfeeding (the consumption of breastmilk only) for 6 months with the introduction of complementary foods (milk substitutes and solids), and continued breastfeeding up to 2 years of age. In Australia, the National Health and Medical Research Council (NHRMC) recommends exclusive breastfeeding to around 6 months (NHRMC 2003), and breastfeeding with appropriate complementary foods is encouraged up to at least 12 months of age (Marks et al. 2001).

Results from the 1995 and 2001 National Health Surveys indicate that the proportion of children receiving any breastmilk declines steadily with age (graph 1). In 2001, by age six months around half (48%) of all children were being breastfed. This had declined to 23% of children who were being breastfed by age one and 1% of children being breastfed by age two.

Graph 1 Proportion of children breastfed by age in months 1995(b) and 2001



a) The percentage of children breastfed is based on a lifetable method (see explanatory notes).
b) Data by age in months is only available from the 1995 NHS for children under the age of one. Estimates for 1, 2 and 3 year olds can be provided on request.
Source: National Health Survey 1995 and 2001.

2.2 Breastfeeding Intensity

The Dietary Guidelines for Children and Adolescents in Australia incorporating the Infant Feeding Guidelines for Health Workers (NHMRC 2003) recommends "exclusive" breastfeeding (the consumption of breastmilk only) for around six months. In the early nineties a report prepared for the Commonwealth Department of Health, Housing and Community Services (now the Department of Health and Ageing) set a target of 60% of infants up to three months old being fully breastfed and a target of 50% of babies being fully breastfed for infants up to the age of six months (Nutbeam et al. 1993). The 2003 NHMRC dietary guidelines also recommend an initiation rate of 90%, and 80% of infants being breastfed at the age of six months, as important objectives for Australia.

The 2001 NHS indicates that 54% of infants 3 months or less in age were fully breastfed in 2001, and that 32% of infants six months or less in age were fully breastfed. The proportion of infants from newborn to six months being fully breastfed is shown in graph 2. No infants at age six months were being fully breastfed in either 1995 or 2001. Results from the NHS also show that higher proportions of infants 3 months or less in age were regularly being given solids and formula, when compared to infants from this age group in 1995 (graph 3).

Graph 2 Proportion of infants from newborn (<1 month) to 6 months fully breastfed(a), 1995 and 2001



(a) Were receiving only breastmilk on a regular basis (see explanatory notes).
Source: National Health Survey 2001.


Graph 3 Proportion of infants aged 3 months or less currently breastfeeding and receiving formula and solids-1995 and 2001



Source: National Health Survey 1995 and 2001.

In 2001, 70% of all 0-3 year olds were regularly being given cows milk. Over half (53%) of all 0-3 year old children were consuming cows milk regularly by the age of one and by age two, 68% of all 0-3 year olds were consuming cows milk regularly (graph 4).

In 2001, 9% of 0-3 three year olds were regularly being given milk substitutes, the most common of which was soy milk (80% of 0-3 year olds being given milk substitutes). By the age of one, 6% of all children 0-3 years of age were regularly receiving milk substitutes and by age two, 9% were regularly consuming these products (graph 5). Patterns in the age at which children first begin regularly receiving cows milk and milk substitutes suggest that the first year of life is a key milestone for the introduction of these products (graph 4 and graph 5).


Graph 4 Proportion of all children 0-3 years old regularly receiving cows milk by age(a)-2001




(a) Data is only shown for children up to the age of 24 months, however, the denominator is all children 0-3 years in age.
Source: National Health Survey 2001.

Graph 5 Proportion of all children 0-3 years regularly receiving milk substitutes by age(a)-2001



(a) Data is only shown for children up to the age of 24 months, however, the denominator is all children 0-3 years in age.
Source: National Health Survey 2001.


2.3 Reasons for discontinuing breastfeeding

The most common reason reported for discontinuing breastfeeding of children aged 0-3 years old was problems in producing adequate milk (30%) (table 6). Factors which can influence milk production and supply include not enough, or too short feeds, poor positioning or sucking, changing sides too soon, or introduction of solids too early (ABA 2003). An estimated 40% of women who ceased feeding these younger children indicated problems with milk production (table 6). Proportionally fewer women who ceased breastfeeding children under the age of one year indicated they felt it was time to stop, when compared to women with older children.

Table 6 Main reasons for discontinuing breastfeeding




	Age group of child when mother ceased to breastfeed
	0	1	2	3	0-3
	%	%	%	%	%
Not producing any milk or inadequate amount of milk	40	30	28	26	30
Felt it was time to stop	11	21	24	29	23
Other problems with breastfeeding (e.g. cracked nipples)	17	9	9	9	10
Resumed work	6	8	7	9	8
Child bored	4	6	5	7	6
Teething	4	4	4	4	4
Pregnant	1	2	5	2	3
Other	16	20	18	14	17
Total	100	100	100	100	100
Source: National Health Survey 2001.



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3. AGE, EDUCATIONAL ATTAINMENT and ALCOHOL CONSUMPTION AMONG MOTHERS

There are many benefits to mother and child from sustained breastfeeding. This part of the paper briefly compares breastfeeding practices among mothers of different ages and education level. Statistics on alcohol consumption among breastfeeding mothers are also presented.

3.1 Age of mother

Results from the 2001 National Health Surveys indicate that the proportion of children receiving breastmilk was higher among older mothers (graph 7). By age six months 38% of children were being breastfed by mothers aged 18-29 years, compared to 54% of children with mothers aged 30 years and over, and by the age of one year 14% of children were being breastfed by mothers aged 18-29, compared to 28% of children with mothers aged 30 years and over.

Graph 7 Proportion of children breastfed by age in months by age of mother(b)-2001




(a) The percentage of children breastfed is based on a lifetable method (see explanatory notes).
(b) Mothers represented 83% of child proxies and as such some child records are excluded from this analysis (see explanatory notes).
Source: National Health Survey 2001.

3.2 Education level of mother

The proportion of children receiving breastmilk was higher among mothers who had attained an associate diploma or higher since leaving school, when compared to mothers with no post-school qualifications (graph 8). This result accords with research, which noted that educated women were more likely to breastfeed and tended to breastfeed their children for longer periods (Trussel et al. 1992).

Graph 8 Proportion of children breastfed by age in months by educational attainment of mother(b)-2001



(a) The percentage of children breastfed is based on a lifetable method (see explanatory notes).
(b) Mothers represented 83% of child proxies and as such some child records are excluded from this analysis (see explanatory notes).
Source: National Health Survey 2001.

3.3 Alcohol consumption and breastfeeding mothers

The Australian Alcohol Guidelines recommend that breastfeeding women follow the same guidelines as recommended for pregnant women (i.e. they should consider not drinking at all, should not become intoxicated, and if they choose to drink should have less than 7 standard drinks over a week) (DOHA 2003). This advice is based on concern that alcohol in the blood stream passes into the breastmilk and may have adverse affects on the infant (DOHA 2003). Larger amounts of alcohol in the breastmilk also inhibits the let-down reflex (DOHA 2003).

Results from the 2001 NHS show that an estimated 3.5% of women aged 18-44 years, who were currently breastfeeding, reported alcohol consumption that placed them at risk of long term harm, compared to 8.7% of all women in this age group.