South Africa has the lowest rate of exclusive breastfeeding in the world (8%). Lack of understanding of the critical importance of breastfeeding, compounded by fears of HIV transmission, among other factors, has hindered progress to promote and support breastfeeding in this country.

The Tshwane Declaration of Support for Breastfeeding in South Africa committed them and called on all stake-holders to support and strengthen efforts to promote breastfeeding in August 2011. They resolved that (among other things) comprehensive services to be provided to ensure that all mothers are supported to exclusively breastfeed their infants for six months and thereafter to give appropriate complimentary foods and continue breastfeeding up to two years of age and beyond.

South Africa adopted the Baby Friendly Hospital Initiative (BFHI) in 1993. Baby-Friendly practices are based on the premise that individual attitudes toward breastfeeding are largely influenced by breastfeeding education during the early prenatal period, positive birth and initial breastfeeding experiences, and continued provider support. The BFHI addresses a major factor which has contributed to the erosion of breastfeeding – that is, health care practices which interfere with breastfeeding. Until practices improve, attempts to promote breastfeeding outside the health service will be impeded. Although inappropriate maternity care cannot be held solely responsible for low exclusive breastfeeding rates, appropriate care may be a prerequisite for raising them.

The Innocenti Declaration on The Protection, Promotion and Support of Breastfeeding produced and adopted by the WHO/UNICEF in 1990 was signed by South Africa. It states that “…all women should be enabled to practice exclusive breastfeeding and all infants should be fed exclusively on breast-milk from birth to 6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond. This child-feeding ideal is to be achieved by creating an appropriate environment of awareness and support so that women can breastfeed in this manner.

The WHO and UNICEF developed The Global Strategy for Infant and Young Child Feeding in 2002 to revitalize world attention to the impact that feeding practices have on the nutritional status, growth, development, health, and survival of infants and young children. This strategy is based on the conclusions and recommendations of expert consultations, which resulted in the global public health recommendation to protect, promote and support exclusive breastfeeding for six months, and to provide safe and appropriate complementary foods with continued breastfeeding for up to two years of age or beyond. Optimal nutrition during infancy and childhood is critical to child health and development. The Global Strategy was built on previous initiatives such as the International Code of Marketing of Breast-milk Substitutes in 1981, the Innocenti Declaration in 1990 and the Baby-friendly Hospital Initiative in 1991. South Africa’s Infant and young child feeding policy says Health care personnel should promote, protect and support exclusive breastfeeding for six months and continued breastfeeding up to two years of age or beyond.

The National Department of Health (NDOH) has prioritized infant and young child feeding as one of its key areas of focus. Given the significant milestone of the Tshwane Declaration in August 2011, the Department has legislated national regulations in support of the International Code of Marketing of Breastmilk Substitutes. Furthermore, the National Maternal, Neonatal, Child and Women’s Health and Nutrition Strategy 2012-2016, has committed to have all facilities with maternity services accredited as Mother-Baby Friendly.