Choosing whether to breastfeed or formula feed their baby is one of the important decisions expectants and new parents will make. For many, the decision to breastfeed or formula feed is based on their social, economic and demographic factors (1). Health experts believe that breast milk is the best nutritional choice as it is associated with better outcomes for both mothers and infants. Breastfeeding is considered a life-saving practice in developing countries and has been reported to improve infant survival rates in poor countries (2)(3). Whereas, formula feeding showed an increase in infant's mortality 3–5 times (4). While breastfeeding has proven to be effective in strengthening the infant's immunity, formula feeding was associated with an increased risk of acquired immunodeficiency as well as a risk of developing respiratory and gastrointestinal diseases in childhood (5)(6)(7). However, breastfeeding showed to be healthier for infants, formula feeding may be used as a management for some medical situations (e.g. lactulose intolerance) (8)(9). Breastfed infants frequently need vitamins supplements. In comparison, formula feeding has shown that it is able to provide infants with adequate amounts of vitamins (such as vitamin D) (10). Breastfeeding reduces a mothers' risk of developing ovarian and breast cancer more than formula feeding does (11). Also, it has been shown that breastfeeding rather than formula feeding strengthens the mother-baby bonding (12). Breastfeeding have demonstrated to lower the risk of the maternal postpartum depression (13)(14). Overweight or obese women may benefit from extra antenatal, postnatal and on-going breastfeeding support (15). Breast feeding may have particular benefits for infants of overweight or obese mothers or infants of diabetic mothers, in modulating the intrauterine programmed tendency to childhood obesity and, in the long term, type 2 diabetes mellitus and the metabolic syndrome (16).
In some situations, breastfeeding may not be possible for all women as shown in a survey conducted in UK (17). Multiple factors may contribute including delayed lacto-genesis, difficulty with positioning, attachment and latching, and maternal lack of confidence or self-esteem (18). Also, maternal problems such as painful breasts, cracked nipples and mastitis can form a barrier against breastfeeding. Also, concerns about whether the infant is growing, content and receiving enough milk make some parents prefer formula feeding (17).
The World Health Organization )WHO( recommends that infants should receive only breast milk with no solids or other fluids for the first 6 months after birth, with supplemental breast feeding continuing for 2 years and beyond (19). A survey conducted in Khartoum Province, Sudan, in 1983 found that 98% of the mothers breast-fed their babies at birth, the mean duration of breast-feeding ranged between 14.2 and 16.7 months (20). A study of maternal breastfeeding practices was conducted in 1993 in 6 states of Sudan, but Khartoum wasn’t among them. This study showed that almost all mothers (99.9%) initiated breast-feeding, mostly (83.2%) on the first day between 1–5 hours following delivery. The breast-feeding rate was 92.0% at 7 months and 65.0% at one year. 4% still breast-fed at 2 years (21). In another study conducted in 1994, in the same six states that were in the study mentioned previously, showed that 77.9% believed that breast milk was the best for their children (22). According to the World Bank collection of development indicators, compiled from officially recognized sources, exclusive breastfeeding in Sudan was reported at 54.6% in 2014 (23)(24). Despite the well-known benefits of breastfeeding over formula feed, there is a well-documented decline in breastfeeding in many countries, especially developing ones. In contrast, a resurgence of breastfeeding in many industrialized countries has been noted (25).
As we had shown previously, there are wide differences between breastfeeding and formula feeding. Therefore, it’s essential that expectant and new parents to be aware of such variations, as its important determinants of infant feeding behavior. In this study, we aimed to construct a solid foundation on the awareness and perception regarding breastfeeding in comparison to packed formulas among the Sudanese people. Additionally, we wished to identify if there are misconceptions about their benefits in the same regard.