Breast. No Bottle.

To nurse, or not to nurse: that is not a question!

Norway. Success in protecting and sustaining breastfeeding

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I often hear Norway being mentioned as success in breastfeeding promotion. Usually there is a mention of very low breastfeeding rates in the 1960’s. Recently somebody used Norway as an example of breastfeeding promotion in context of using donor milk in hospitals as successful strategy. This is a very simplistic and incorrect way to evaluate what worked in that particular context. Donor breastmilk was used in hospitals because Norway had already been a breastfeeding culture. Let’s take a closer look at Norwegian model of success.

Breastfeeding success Norway

1. Midwifery model of care. Most births are attended by midwives. Normal births that allow for breastfeeding to happen.

Take away points – traditional female birth support.

2 .Breastfeeding culture. Norway has always been a breastfeeding culture. Breastfeeding has never been a choice. It is default state of things when a baby is born. Similar patterns have been observed in Scandinavian and the USSR. Initiation rates always approach 100%. This is why donor milk was used to begin with – breastfeeding was the norm. If nursing at the breast was not possible for whatever reason, donor milk was used.

3. High breastfeeding failure rate. Norway had catastrophically high breastfeeding failure rates attributed to entry into healthcare system. Contact with any medical professional inevitably lead to failure in breastfeeding. Thus the problem at hand was not breastfeeding promotion but breastfeeding continuation past three months, the most frequently observed shedding point for breastfeeding.

4. Paid maternity leave. Norway instituted paid maternity leave as early as 1958, at the time of the rapid decline in breastfeeding. You can read more on maternity leave history here. 

Take away points – paid and long leave that essentially prevents separation of mothers and children, therefore making breastfeeding possible; social protection of childbearing women.

5. Grassroots breastfeeding support. A mother, Elizabet Helsing, inspired by La Leche League’s book “The Womanly Art of Breastfeeding”, co-authored her own brochure with another mother on practical how-to’s of breastfeeding. She went to the Norwegian Ministry of Health and asked for the brochure to be published by the government and distributed throughout the country.

Take away points – women driven initiative, not top-down from the government or medicine.

6. Government support of women’s grass-roots breastfeeding movement. By chance Elizabet Helsing encountered what I call a weak link in patriarchal structures that devalue women, women’s knowledge and experience. She met another woman, Gro Harlem Brundtland, who was pregnant with her forth child at the time. Coincidentally, Ms.Brundtland had just returned from Harvard, USA, where she completed her master’s degree with a focus on decline in breastfeeding. “Her male colleagues had laughed at the idea of a brochure. She described the event as “awakening.”  40 million brochures have been published and distributed by the government.

Take away points  – education of women, ability of women to enter professional workforce, ability of women to move up the ranks of decision makers, governmental support of women’s grassroots initiatives, respect towards female knowledge and experience.

7.  Mother-to-mother support groups. In 1968 Elizabet Helsing went on to start Ammehjelpen (meaning breast-feeding help). The founding principles of this mother-to-mother support group were firmly rooted in feminism and autonomy in decision-making for women.

Take away points – women’s empowerment, women’s self-help, grassroots dissemination of knowledge, lack of censorship from patriarchal structures (government, medicine).

8. Government sponsored education of healthcare providers. Education of healthcare providers was mandated by government as the expression of the will of the women. In 1990’s Baby-Friendly Hospital Initiative was implemented in the country, lagging some 20 years behind women’s movement. Most hospitals in the country are Baby-Friendly. 70% of healthy term babies in Baby-Friendly facilities get supplemented with formula.

Take away points – mandated education about basic breastfeeding support comes from the government, patriarchal medical structures remain resistant to breastfeeding support in breastfeeding cultures despite governmental and policy driven interventions.

9. WHO Code. Norway is a very tiny market that is not particularly lucrative for formula manufactures. In 1983, shortly after the WHO Code was adopted, infant food industry entered into a voluntary agreement on the marketing of breastmilk substitutes with the Norwegian health authorities. Read more details on the implementation of WHO Code in Norway.

Take away points – regulation of formula and infant food industry as an important step in protecting and sustaining breastfeeding.

10. Women’s access to money, education, healthcare, and participation in government. Norway rates very high in the indices of gender gap, meaning that women in Norway have above average access to jobs, money, resources, healthcare, education, and can participate in political decision making.

Take away points – empowerment of women, education for women, governmental and political participation women, social protection of childbearing women.

As we can see from the complex picture of Norwegian case study, there are many factors that all play together to result in high rates of breastfeeding. Norwegian data is very consistent with research suggesting that breastfeeding correlates with empowerment of women and social justice across life spectrum of women. Women driven initiatives and grassroots movements have high level of success. Traditional patriarchal structure of medicine continues to impede breastfeeding even in breastfeeding cultures with high rates of breastfeeding.


Written by Medical Nemesis

September 7, 2014 at 15:42

One Response

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  1. Excellent article, thank you. I just finished reading your article on Russia and look forward to your examination of other countries. I would like to note that I am an admin of the Facebook group “Friends of the WHO Code.” The discussion you reference is from a closed group and so your readers cannot see the thread, which is based on this news article: “Breast Milk Banks In Brazil Slash Infant Mortality By Two-Thirds, Become Model For The World” Fox News Latino, September 4, 2014:

    I posted the article and also mentioned Norway’s milk banking model to highlight that donor milk goes beyond breastfeeding promotion to support women to breastfeed their babies. This is in the larger context of the backlash against breastfeeding promotion when it is not accompanied by effective support for women to breastfeed, or for protection from cultural and institutional practices that undermine breastfeeding. It was not my intent to suggest that Norway’s breastfeeding rates are due to the use of donor milk system is a promotion strategy and I am glad you have provided background in this post. I’ve shared your post with the group. I would like to add that I do believe that the use of donor milk in hospital when infants need to be supplemented an important contribution to the promotion of breastfeeding. It is done first, however, to improve health outcomes for babies who are not able to be fully breastfed by their mothers.

    Jodine Chase

    September 8, 2014 at 11:17

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To nurse, or not to nurse: that is not a question!

Breast. No Bottle.

To nurse, or not to nurse: that is not a question!

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