100% of Maasai women breastfeed for a year or more but they’re doing it wrong

Girls in ceremonial dress, Maasi Village, Ngorongoro Conservationa Area, Tanzania

A recent paper on the breastfeeding practices of African Maasai women is filled with startling statistics.

According to Maternal perceptions of breastfeeding and infant nutrition among a select group of Maasai women in BMC Pregnancy and Childbirth:

  • 100% of the women breastfed
  • Nearly 100% began breastfeeding within an hour of birth.
  • 100% breastfed for a year or more.
  • 100% received breastfeeding guidance and support from older female relative.

It’s just the type of indigenous practice that breastfeeding researchers like to invoke when encouraging women in the industrialized world … except for the most starting statistic of all:

Supplementing breastfed babies is a universal practice.

0% of the Maasai women breastfed exclusively; 100% of the women practice supplementary feeding!

How could the Maasai women get it so wrong?

It’s not for any of the reasons that lactation professionals invoke when disparaging women in industrialized countries: It’s not because of formula because they don’t use it. It’s not because of formula advertising. It’s not because of lack of support.

Why do 100% of Maasai women supplement their babies?

The majority of mothers reported they were not aware of the EBF recommendation. While a few stated the recommendation was a good idea, many felt this was not realistic in their circumstances and expressed the belief that mother’s milk alone was never adequate to provide for an infant’s needs… (my emphasis)

They offered a variety of liquids:

Mothers were asked if their baby was receiving anything other than mother’s milk. None of the twenty infants under six months of age were EBF since all were receiving a liquid (including semi-solids) in addition to breastmilk. Butter (semi-solid) and goat/cow’s milk were the most common supplements provided to the infants at the time of the interview. Honey, juice, and water were also given with most infants receiving more than one supplemental liquid.

They aren’t the only indigenous women who hold that belief. Supplementing breastfed babies, especially before the mother’s milk comes in, is practiced on nearly every continent.

Nonetheless, the researchers are sure that the Maasai women are doing it wrong. And they believe that Maasai infants are dying as a result.

The overall infant mortality rate in the Tanzania northern zone encompassing Arusha and NCA was 38 per 1000 for the ten years preceding the 2015–2016 national survey. Research assessing child health among the Maasai in the nearby Arusha and Manyara areas of Tanzania found Maasai children were substantially more vulnerable and reportedly experience diarrhea, pneumonia, and fever more frequently when compared to other co-located ethnic groups. Maasai children were also two to three times more likely to exhibit stunted growth and wasting compared to the other ethnicities, with 80% of Maasai households classified as severely food insecure. The Maasai children also had higher rates of stunting (57% versus 45%) and wasting (10% versus 5%) compared to the national average during the same time period. In 2008, the leading causes of death for children under-five at a rural hospital serving primarily Maasai people in the Ngorongoro District were pneumonia, malaria, diarrheal diseases, neonatal conditions, and malnourishment

The obvious cause of these problems is starvation and semi-starvation, yet the researchers believe — without evidence — that ending the practice of supplementing would save lives.

But women who are starving can’t produce enough milk. As the authors acknowledge:

Maternal nutritional status, in turn, affects the composition and volume of human milk. While some nutrient content, such as calcium, is independent of maternal diet, others such as vitamins A and B6 are highly dependent on maternal nutritional status. Research with lactating women in pastoral communities in Kenya found the volume of mother’s milk consumed by infants was related to the mothers’ body composition, and concluded “there is a possibility that lactating mothers practicing EBF living under harsh conditions may experience periods of low breastmilk volume”…

In other words, the Maasai women are supplementing their babies because the babies will die without additional fluids, calories and nutrients.

And that may be why so many indigenous women in a variety of cultures on every continent continue to supplement babies. Since most humans throughout history have lived a subsistence existence, insufficient breastmilk is likely quite common, not rare. And supplementing babies has become a near universal practice.

But wait. Aren’t women — like all other mammals — designed to breastfeed. Other mammals don’t provide supplements … and they have high rates of infant death as a result. The difference between humans and other mammals is probably NOT that we are unique in having a high rate of insufficient breastmilk; the difference is that we are smart enough to be able to understand the problem and try to fix it with supplements!

The authors of the paper seem to tie the high rate of supplementation to the high rate of death.

Increased EBF among the Maasai of NCA could have a positive impact since more intensive breastfeeding is associated with reduced incidence of respiratory and diarrheal infections, leading causes of infant mortality in this region. EBF could also reduce the risks of bacterial and viral infections acquired by infant consumption of raw goat/cow milk, reportedly a normal practice among this group of women.

You know what else could reduce the risk of infant death and reduce it more reliably and effectively?

Food for mothers to encourage the production of more breastmilk and formula to provide better nutrition to infants than the supplements traditionally used by the Maasai.

The authors conclude:

… While breastfeeding is universal, there are cultural and socioeconomic barriers adversely impacting the provision of optimal infant nutrition as recommended by the WHO.

And there may be biological barriers as well. Breastfeeding may not be as perfect as lactation professionals pretend.

I find it baffling that, to my knowledge, no one has investigated why the practice of supplementing has gained such wide global currency. Obviously we cannot know the original reasoning behind the practice, but odds are high that it reflects the fact that up to 15% of well nourished women have insufficient or delayed production of breastmilk. The rate is almost certainly higher among women living a subsistence existence, which is the majority of women who have ever lived.

Supplemental feeding is common worldwide, but lactation professionals cling to the fantasy that breastfeeding is always perfect for every baby. As a result, exclusive breastfeeding — the holy grail of lactation — is now the LEADING risk factor for newborn hospital readmission, affecting TENS OF THOUSANDS of newborns each year.

How ironic that lactivists invoke indigenous women as justification for banning supplementation while ignoring one of their central insights: many babies need and benefit from them.

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  • Knittingbiddy

    Imagine if all the money pumped into BF research and promotion went to something useful and proven, like rotavirus vaccination…

  • PeggySue

    Perhaps it is just me being silly; did anyone else notice that the authors never discussed the supplementation habits of co-located ethnic groups? I bet a quarter that mothers in such groups also supplement. I’d bet another quarter that the 80% figure for Maasai households that are severely food insecure is the most important piece of information in the story.

  • MaineJen

    This is like offering a band aid to a person bleeding out of an artery. Just as useless and just as insulting.

  • Cartman36

    They just need more “support”. /sarcasm

  • Emilie Bishop

    Oh, this pisses me off. Remind me again how these lactivists are soooo different than Nestlé killing babies by unrealistic expectations of formula, because from where I sit it’s exactly the same. The only difference is these idiots are killing Western babies too. Why is breastfeeding more important than babies or their moms?!?!?

  • Sarah

    If you don’t do it like white, well off Western women, it doesn’t count as breastfeeding.

  • andrea

    Soap, clean water, and handwashing stations would prevent a lot of diarrhea and pneumonia, too; and probably have a much more measureable, immediate, satisfying, and scale-able “zing” than focusing on EBF.

    • Cristina B

      It drives me nuts when they harp on how formula is harmful without clean water (true) but then double down on breastfeeding when clean water would benefit the rest of the family too.

      • Daleth

        Omg that’s such a good point. Can’t believe I never thought of it before!

      • seenthelight

        Shameless plug for a ministry that actually does really, really good work the world over: https://www.livingwatersfortheworld.org/