The thousand forms of breastfeeding: a journey through cultures, traditions and science

A newborn is born with the same biological needs in Milan, Tokyo, Nairobi or Mexico City. Yet, the way they are nourished during the first year of life can be profoundly different.
Breast milk is a biological product regulated by sophisticated neuroendocrine mechanisms; breastfeeding, on the other hand, is also a behavior influenced by the social and cultural context. Around the breast and nutrition, rituals, beliefs, taboos, dietary prescriptions and care methods have developed that change in relation to geography, al</r21><r21>alla struttura familiare, alle condizioni socioeconomiche e all’organizzazione dei sistemi sanitari.

Science makes it possible to define nutritional needs and the conditions that favor the child’s health and growth. The way these needs are interpreted and met, however, also depends on culture, family, economic conditions, parents’ work lavoro dei genitoriand access to health services. It is precisely the interaction between these factors that makes the feeding of the first year a particularly interesting field of transcultural medicine.

The first milk: the same biological function, different meanings

Colostrum is the first mammary secretion produced after childbirth. It is initially produced in relatively small amounts and is rich in immunoglobulins, lactoferrin, immune cells, and numerous other bioactive components.

From an anthropological perspective, however, colostrum has been attributed widely differing meanings.

Ethnographic studies, some of which were conducted several decades ago, have documented populations in which the initiation of breastfeeding was delayed and the newborn was given pre-lacteal foods or liquids. The reasons could include beliefs concerning the quality of colostrum, birth rituals, or the idea that the first milk was not yet suitable for the baby. These data must be interpreted in their historical and geographical context: they do not necessarily describe the current practices of the populations studied. However, they remain a particularly interesting example of how the same biological function can receive very different cultural interpretations.

Sub-Saharan Africa: a plurality of practices

To speak of ‘African breastfeeding’ would be improper. Sub-Saharan Africa includes thousands of communities with profoundly different traditions, religions, family structures and socioeconomic conditions.

In some studied populations, newborn care traditionally involves  a  wider family network in which grandmothers, sisters, other female family members and community members can participate in the transmission of knowledge and influence decisions regarding infant feeding.

In specific contexts, practices of pre-lacteal feeding have also been documented, with the administration of water, infusions, honey, or other foods before or along with the initiation of breastfeeding. The frequency and meaning of these practices vary considerably between communities and may be associated with rituals, the perception that the newborn is thirsty, or beliefs regarding colostrum and milk quality.

Even duration and exclusivity of breastfeeding vary considerably between countries and populations. It is therefore important to distinguish between the continuation of breastfeeding and exclusivity: according to the World Health Organization definition, a child receiving water or other foods and beverages is no longer considered exclusively breastfed.

South Asia: family, traditions and shared decisions

India, Bangladesh, Nepal and Pakistan include very diverse populations, religions and traditions; therefore, there is no single South Asian model of breastfeeding.

However, anthropological and qualitative studies conducted in specific communities have documented situations in which decisions regarding the mother and newborn involve various family members.

In some families, maternal or paternal grandmothers can play an important role in the transmission of postpartum practices, advice on maternal nutrition and decisions regarding breastfeeding and the introduction of complementary foods.

Furthermore, in different South Asian traditions, cultural classifications of foods have been described according to concepts traceable, with different meanings from community to community, to the categories of ‘hot’ and ‘cold’. These classifications do not correspond to the categories of modern nutritional science, but can concretely influence dietary choices.

For the healthcare professional, it therefore becomes important to understand not only what a mother eats, but also what meaning she attributes to those choices.

China: nutrition and postpartum traditions

In various Chinese communities, the postpartum period is traditionally associated with zuo  yuezi, a set of postpartum practices that may include rest, protection from the cold and specific dietary indications. The ways in which these prescriptions are interpreted and applied vary however between regions, families and generations and have transformed over time.

Broths, soups, eggs, meat and other foods may be recommended with the aim of promoting maternal recovery or supporting milk production. Some foods are traditionally considered galactagogues.

On a physiological level, however, milk production is regulated by endocrine mechanisms and above all, after the onset of lactation, by the frequency and effectiveness of milk removal from the breast. Adequate nutrition remains important for the woman’s health and nutritional status, but it is not correct to automatically attribute a specific galactagogue effect to a single food in the absence of adequate evidence.

The difference between therapeutic tradition and evidence-based pharmacology becomes particularly interesting.

Japan: when lactation becomes a family heritage

In Japan too, practices related to motherhood and infant feeding have changed considerably over time and can vary between families and generations.

The family involvement in meal preparation and support for the mother can influence the experience of the postpartum period.

A particularly recognizable cultural dimension concerns complementary feeding, indicated by the term rinyūshoku. Food progression is generally adapted to the child’s abilities, with gradual modifications in consistency and variety.

Rice, vegetables, fish, tofu and other foods belonging to family cooking can progressively enter the child’s diet in ways compatible with age, development and food safety.

Complementary feeding thus represents not only a nutritional transition, but also one of the child’s first encounters with the food culture of their family.

Middle East and Islamic world: religion, culture and nutrition

In Muslim communities, breastfeeding can also assume a religious dimension. The Quran in fact refers to a two-year period for complete breastfeeding, helping to give prolonged lactation a meaning that is not exclusively nutritional.

Concrete practice naturally varies between countries and families, but religion and culture can influence the duration of breastfeeding, the organization of care and maternal nutrition.

At the same time, traditional practices regarding colostrum, pre-lacteal feeding and the maternal diet have been described in specific populations.

Complementary feeding subsequently fits into the different local gastronomic traditions. Cereals, legumes, yogurt and other dairy products, fruit, vegetables, eggs and meat can progressively enter the child’s diet.

Nutritional science does not in fact require a universal cuisine: it requires nutritionally adequate foods, safe, sufficiently varied and appropriate to the child’s development.

Latin America: tradition and transformation

Studies conducted in various communities have shown how in many areas of Latin America, knowledge regarding pregnancy, the puerperium and infant feeding can be transmitted across generations. In some families, mothers, grandmothers and other figures in the family network can influence choices regarding breastfeeding and complementary feeding.

At the same time, urbanization, migrations, changes in female employment, transformations of the family structure and greater availability of industrial foods have modified many eating behaviors.

Tradition and modernity do not necessarily replace each other. Instead, they can produce hybrid models in which breast milk, expressed milk, formula when used, industrial infant foods and family kitchen preparations coexist during the first year of life.

Oceania and indigenous populations: nutrition, identity and colonization

In several indigenous populations of Australia, New Zealand and the Pacific Islands, pregnancy, birth, nutrition and childcare have historically been embedded in family and community networks and can take on meanings that go beyond nutrition alone.

Colonization and subsequent social transformations have interfered, in different ways across different populations, with the intergenerational transmission of knowledge and practices related to motherhood and infant feeding. For this reason, in such contexts, the promotion of breastfeeding may require not only nutritional information, but culturally safe services and the involvement of the communities concerned.

Europe: less tradition, more health system?

The comparison with Europe is particularly interesting.  At first glance, European countries might seem much more uniform compared to other areas of the world. In reality, this is not the case.

Available data show considerable differences between countries in the prevalence of breastfeeding, its duration, exclusive breastfeeding and support policies.
A survey conducted in  11 European countries found important differences in the percentage of children still being nursed and in exclusive breastfeeding at six months.

Differences do not depend solely on individual preferences.  In Nordic countries, parental leave and institutional support have historically created favorable conditions for the continuation of breastfeeding.  In other countries, return to work, healthcare  assistance modalities, professional support and social norms may influence its duration more.

The culture of breastfeeding, therefore, does not necessarily manifest itself through traditional rituals. It can also express itself through social expectations regarding intervals between feeds, weight control, the use of breast pumps and the perception of maternal performance.

And Italy?

Italy occupies a particularly interesting position because it retains a strong family food culture, but has simultaneously incorporated a growing medicalization of early childhood. Breastfeeding is supported by health recommendations, but its duration varies in relation to socioeconomic, territorial, educational and occupational factors.

When it comes to complementary feeding, even more recognizable characteristics emerge. Italian cuisine offers an extremely wide heritage of cereals, legumes, vegetables, fruit, extra virgin olive oil, fish, eggs and other protein sources. However, in contemporary practice, the introduction of the first foods is often accompanied by specific infant products, homogenized foods, flours and industrial preparations.

An Italian study conducted on 2,023 families found that complementary feeding is generally started between the fifth and sixth month; 77% of families predominantly used homemade liquid or semi-liquid preparations or industrial infant foods.

Rather than speaking of a single ‘Italian weaning’, it is therefore appropriate to describe a plurality of pathways: traditional preparations, specific infant foods, progressively modified textures and family table foods can be used in different ways.