A surprising yet simple way to boost Cambodia’s economic growth? Breastfeeding.
Following the World Breastfeeding Week commemorations, Ms. Kirsty Milev, Programme Quality Director at World Vision International in Cambodia, remembers her experience of becoming a mother in Phnom Penh, and explains how breastfeeding can – as it did for her children – build a prosperous generation for Cambodia.
"I feel sad I only breastfed my first daughter for three months. I had no experience caring for a baby," says 32-year-old Channara, "I felt that it would be tough to continue to provide breastmilk; my workplace is about 60 km away from home, I have to ride a motorbike for 3 hours every day."
Millions of mothers across the world can relate to this testimonial of a Cambodian midwife from rural Siem Reap province. When I gave birth to my first child in Phnom Penh Capital ten years ago, I was equally terrified. My milk didn’t come in right away, and my baby struggled to latch. As he lost weight daily, I considered formula. Thankfully, a midwife explained the benefits of colostrum, coached me on latching techniques, and provided the support I needed. My milk came in within the week, and my baby began to thrive. With the support of trained Cambodian midwives and flexible working conditions, I was able to provide the best nutrition for my children AND save money - after all, nappies alone cost a fortune!
Cambodia has made significant strides in reducing new infant mortality rates in the past decades, from 116.1 deaths per 1,000 births in 1990 to 23.7 per 1,000 births in 2022. However, exclusive breastfeeding practice is declining. In 2010, 65.8% of mothers breastfed within one hour of birth, and 73.5% exclusively breastfed for the first five months. By 2021, these rates dropped to 54% and 50%, respectively, according to the Cambodia Demographic and Health Survey (CDHS).
With greater cooperation at all levels, here are three ways we can altogether address this decline and give Cambodian's next generation the best start in life:
1. Supporting mothers of newborn babies before, during and after the delivery on the how-to breastfeed in the health facilities.
Health Care Workers (HCWs) play a crucial role in supporting breastfeeding. Studies show that mothers’ perceptions of hospital staff attitudes predict breastfeeding success. The Baby-Friendly Hospital Initiative (BFHI), launched by WHO and UNICEF in 1991, promotes practices that support breastfeeding. In Cambodia, the Ministry of Health developed national guidelines for BFHI implementation. World Vision International in Cambodia (WVI-C) adapted this model for health centres, piloting it in Siem Reap province with local health authorities. The pilot saw significant improvements: midwives like Channara increased their capacity to support breastfeeding from 55.5% to 82.5%, and the rate of mothers initiating breastfeeding within one hour of birth rose from 81.7% to 98%.
WVI-C found that implementing this approach in health centres costs $3,615 per centre in the first year, decreasing to $1,206 by the third year. With 1,141 health centres, the cost would be $4.1 million in the first year, $2.7 million in the second, and $1.4 million annually thereafter. This investment is minimal compared to the $4 million annual cost of malnutrition in Cambodia. Research by Alive & Thrive, published in the Health Policy and Planning Journal, highlights that adequate breastfeeding practices could prevent 1,097 child deaths and 256 maternal deaths from cancers and type II diabetes, save over $1 million in health system costs, generate an additional $137 million for the economy over children’s productive years – increasing cognitive capacity and preventing mortality – and reduce families’ out-of-pocket expenses for treating diarrhoea and pneumonia.
2. A stricter monitoring of breastmilk substitutes’ marketing
The decline of breastfeeding rates in Cambodia is also partly attributed to aggressive marketing of breastmilk substitutes and limited maternity benefits. Although the government passed Sub Decree 133 in 2005 to prohibit the promotion of breastmilk substitutes and developed guidelines for enforcement, these measures face challenges in implementation.
Early initiation protects newborns from infections and reduces infant mortality. Exclusive breastfeeding for the first six months offers optimal nutrition and health benefits for both mother and child. One underestimated factor about breastfeeding, in comparison to using formula: it’s free.
In addition to the health and economic benefits, breastfeeding also has significant environmental advantages. It produces no waste, requires no packaging – aside from storing – and has a lower carbon footprint compared to the production and distribution of formula.
3. Extending maternity leaves to six months to help working mothers breastfeed new-born babies
Maternity leave is only three months at 50% pay, making it difficult for mothers to continue breastfeeding exclusively for the recommended six-month period. Efforts to extend maternity leave to six months at 100% pay have been unsuccessful. Despite ongoing advocacy to enforce existing measures supporting breastfeeding among working mothers, such as mandatory childcare facilities and lactation rooms, significant gaps remain.
However, even if adequate maternity leave is granted and prohibition of marketing of substitutes is enforced, without understanding and support from new mothers and trained health workers, breastfeeding rates will continue to decline.
Early and exclusive breastfeeding significantly impacts child health and nutrition outcomes. The Baby-Friendly Health Centre (BFHC) model - implemented by World Vision together with the Ministry of Health and Provincial authorities in Siem Reap and Preah Vihar - is a cost-effective approach to promoting sustained breastfeeding and improving these outcomes.
This initiative is particularly crucial in rural areas where Government-run public health centres are the only service providers for the most vulnerable communities. Combined national efforts to enforce the decree on breastmilk substitute promotion and progressive policies on maternity leaves would complement this initiative and fully create an enabling environment for the next Cambodian generation, building a prosperous future for the Kingdom of Wonder.
About the author:
Kirsty Milev is the Programme Quality Director of World Vision International in Cambodia. Mother of two, Kirsty has over 13 years of experience ensuring quality child protection and social work programmes in South-East Asia. She has been living and working in Cambodia for the past ten years and is currently leading the Programme Quality Department of World Vision-Cambodia; strengthening integration, quality programming and evidence-building in Child Protection and Participation, Education and Integrated Nutrition (including WASH and Livelihoods); as well as mainstreaming Advocacy, GEDSI, Disaster Management and Climate Action throughout World Vision-Cambodia.