Cross‐border promotion of formula milk in Lao People's Democratic Republic and opportunities for breastfeeding promotion

Phoutthakeo et al. are to be applauded for studying breastfeeding influences in Lao People's Democratic Republic (PDR) and drawing attention to factors affecting the decision to persist with breastfeeding in a country that has high infant mortality rates.1 Although they have focused upon the negative influences of cross-border media advertising from Thailand, over which health practitioners have little influence, they have also confirmed that initiation of breastfeeding in the first hour after delivery, a factor known from other studies to be important for breastfeeding initiation and for child survival, is one of the significant influences upon exclusive breastfeeding in this population.2, 3 They also identified the negative effect upon breastfeeding of operative delivery.1 Encroachment of electronic media upon societies in transition is probably inevitable. As important as these external influences are, the real challenge for health professionals in Lao PDR and elsewhere in South East Asia is dealing with the interaction of traditional practices and beliefs and social change, which undermine breastfeeding promotion. Relevant cultural beliefs and attitudes of Lao people include the view that colostrum is harmful, that mothers should avoid some potentially beneficial foods in the post-partum period, and exposure to hot-ember beds can enervate and dehydrate mothers.4, 5 Education of pregnant women and mothers regarding the importance of breastfeeding needs to be initiated before they become pregnant and reinforced during antenatal care and in the immediate post-partum period, with recent qualitative research providing some encouragement that these beliefs are amenable to change.5 Programmes that minimise the effect of operative delivery upon initiation of breastfeeding can also be implemented.6 The battle against electronic media is never likely to be won, making the challenge of improving breastfeeding initiation and maintenance all the more important.