CAIRO — Wessam Said, 28, would have liked to breastfeed her child, but something was holding her back that had nothing to do with health or social norms: as the family's main breadwinner, she was simply working too much. "What could I do, our conditions are dire," she said.

It's medically advised around the world that newborns are breastfed until they are at least six months old. But in Egypt, only 40% of newborns are exclusively breastfed until the recommended age, according to the health ministry's Demographic and Health Survey (DHS) of Egypt in 2014 released last year.

Most of the women Mada Masr spoke to cited work as the main reason for not breastfeeding their babies. According to the Central Agency for Public Mobilization and Statistics, women between the ages of 15 and 64 made up 23% of the labor force in 2015. More than four of every five working women have full-time jobs. And that figure does not include women who work outside the formal sector such as in small businesses or as manual labor.

"Egyptian women are well aware of the advantages and necessity of breastfeeding," says Mona Mina, deputy chair of the Doctors Syndicate. "But, when they resort to artificial feeding, it is because of external reasons, the main one being that they have to return to work." She says only short maternity leave is offered in government jobs, and that period is even shorter in the private sector.

Ahmed Said Younis, the secretary-general of the Egyptian Association for Pediatrics and head of the association Friends of Breastfeeding, explains that the group is working to extend maternity leave to six months, which would bring it in line with UNICEF recommendations on breastfeeding.

"We managed to increase maternity leave from three to just four months, because the government in Egypt does not agree to provide mothers leave comparable to other countries. Those six months are the basic need for breastfeeding. How can we build a successful nation, if the government is not willing to allow the needed time to build a healthy individual?"

There's a "breastfeeding hour" mandated by law for working mothers which is often not enforced. Even at the workplaces that allow it, an hour is not sufficient for most women to return home, feed their baby and then to return to work.

Other women say they are ashamed of breastfeeding in public, especially in cities, when asked why they use baby formula.

"Once I forgot the bottle," recalls 28-year-old mother Rene Edward, "and I had to sit in a dark store to breastfeed my son instead of going back home and ruining the outing, although we were in a cafe and I had a cover." She did not want to breastfeed him in public because she says she would have been upset by people looking at them. "Honestly I no longer see women breastfeeding in public nowadays," she says.

The shame of breastfeeding in public can lead to social isolation for women. Hala Hassan, 35, says she could rarely leave her house during the months when she was breastfeeding. "I was exhausted because I didn't go out at all throughout that period, except to go to the doctor. I was deprived of outings and visits. I even left my work, unfortunately."

Delivery by Caesarean section is another important reason for low breastfeeding rates in Egypt. Amr Hassan, a lecturer in gynecology in the Qasr al-Aini faculty of medicine at Cairo University, explains that a high rate of cesarean sections is associated with low breastfeeding rates. "Because of pain following the operation, mothers are unable to breastfeed in the first few days after surgery, thus losing the important first few hours when putting the newborn to the breast stimulates the milk glands."

Egypt has one of the highest rates of delivery by C-section in the world, according to the World Health Organization. Figures provided by the 2014 DHS suggest C-sections are used in 52% of deliveries, a radical increase from the 2008 DHS, when it was 27%. The WHO recommends that the percentage of delivery by cesarean section should not exceed 15%.

Although breastfeeding has health benefits for the mother and child, many people in Egypt don't believe this. Instead, they think that breastfeeding causes flabbiness and obesity. In rural areas, many believe that breastfeeding leads to cancer.

A doctor working at a formula distribution room in a Motherhood and Childhood Care center in the Gharbiya Governorate says, "We are in an area that is more rural, and the belief that breastfeeding causes breast cancer comes up a lot with women who come to us seeking subsidized infant formula for fear of developing cancer. No matter how much we try to correct that misinformation, they do not respond easily."

A baby gets Egyptian flags drawn on her face in Cairo — Photo: Muhammad Ghafari

Many mothers say that they opted for infant formula because they were unable to produce enough milk. Younis says that this belief is also due to a misunderstanding. He says that many women lack the necessary information to understand what happens to their bodies after delivery with regard to the secretion of milk.

"Some women falsely think that their milk is scarce, so they seek artificial feeding straightaway," he says. "What we try to explain is that the milk is scarce during the first three days after delivery. It is called colostrum and consists mostly of water. That is why it appears diluted, but it is full of nutrients for the baby."

There also appears to be a widespread association of baby fat with health and wellbeing. Hassan says that mothers are often surprised when obese babies develop anemia. "They are happy with the size of a chubby baby as a result of artificial feeding, compared to babies who breastfeed and are of a smaller size. In fact, babies who feed on infant formula have an apparently fuller body but without better immunity or health. It is just empty chubbiness."

Infant formula is subsidized by the state. A child is entitled to 61 packages of subsidized formula in the first year of his or her life. There are only three conditions to access subsidized formula: The mother is suffering from an illness such as cancer, has delivered triplets, or is deceased. Mina calls these stipulations arbitrary.

In some cases, the nurse examines the breasts of the mother to ensure that she cannot breastfeed, which became the subject of debate in September.

A doctor at the Gharbiya Motherhood and Childhood Care center, speaking on condition of anonymity, indicates a recent trend that she and her colleagues have noted in rural areas, which has lead to increased demand for subsidized formula: "Some mothers, especially young ones, choose artificial feeding upon the advice of pediatricians who tell them to buy certain infant formula brands sold by those doctors or related pharmacies."

The mothers soon realize the infant formula is unaffordable and turn to the child centers for the subsidized product. "But when we examine them, we find they have milk in their glands, and they therefore do not qualify for the subsidized formula."

"We can only apply the law," the doctor says. She explains that there are many reasons that mothers turn to artificial feeding, including bad health, but the main one is the need to work.

"A mother who works in the public or private sector only gets a short leave, and the mother who works in other fields may not get any leave at all, especially if she is the primary wage earner at home," she says. "In this case her demand for subsidized formula is legitimate, but what can we do?"

*Translated by Aida Seif El Dawla

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