Improving infant feeding practices in South Africa

From the IAEA Division of Human Health, Nutritional and Health-Related Environmental Studies Section

What is the benefit of using stable isotope techniques to assess infant feeding practices?

Collecting saliva from a baby in South Africa. (Photo: H. Mulol, University of KwaZulu-Natal, South Africa)

  • The World Health Organization recommends exclusive breast-feeding (consuming only human milk) from birth to 6 months of age, followed by the introduction of appropriate complementary foods and continued breastfeeding for up to two years;
  • Breastfeeding has long-term consequences for both the mother and the child;
  • For every 12 months of breastfeeding (either with one child, or in total for several children), the risk of breast cancer decreases by 4.3% compared to women who did not breastfeed;
  • Exclusively breastfed infants suffer from fewer infections, have better motor development, and do better at school;
  • Global rates of exclusive breastfeeding are very low, so most countries have breastfeeding promotion campaigns;
  • The deuterium oxide dose-to-mother technique is the only way to objectively measure human milk intake and whether the baby is exclusively breastfed or not. Therefore, it can be used to assess accuracy of information reported by the mothers, and the impact of breastfeeding promotion campaigns.

How does it work?


  • The mother consumes an accurately weighed dose of D2O;
  • The D2O mixes with the mother’s body water;
  • The baby consumes deuterium through its mother’s milk;
  • Saliva is sampled from the mother and from the baby for 2 weeks;
  • The amount of deuterium in the saliva is analysed.


  • The mother consumes an accurately weighed dose of D2O;
  • The D2O mixes with the mother’s body water;

Nuclear techniques confirm the improvement in exclusive breastfeeding in South Africa

  • Healthcare professionals have been promoting exclusive breastfeeding in order to prevent malnutrition, disease and eventually death in infants;
  • Exclusive breastfeeding is when the baby receives only its mother’s milk and essential medications. Exclusively breastfed infants are more resistant to disease and infection;
  • Infant mortality is very high in South Africa. Around 1.1 million babies were born in 2013, but 33 babies out of every 1000 live births died within a year. Therefore, improving breastfeeding practices has become an urgent priority;
  • With funding and support from the IAEA, researchers started in 2010, using the deuterium oxide dose-to-mother technique, to assess how many babies were being exclusively breastfed, and if complementary foods were being introduced into babies’ diets. The results showed that the mothers’ reports of exclusive breastfeeding were a large over-estimation compared to the more accurate information obtained by using the deuterium dilution technique;
  • In 2012, a long term mentoring programme with new mothers was introduced. Mothers were also trained as breastfeeding counsellors. The mentoring and counselling programme had a big impact on improving exclusive breastfeeding rates, and has been so effective that mothers are resisting strong external pressure to introduce complementary foods too early.

Picture of the first group of mothers to graduate from the counselling programme. (Photo: H. Mulol, University of KwaZulu-Natal, South Africa)

Mothers participating in a counselling session on infant and young child nutrition in South Africa. (Photo: H. Mulol, University of KwaZulu-Natal, South Africa)

"My friends came to my house, and asked me what porridge I am giving to my baby, as she is so fat and looks so good. I replied that I am not giving porridge, only breast milk." - A mother participating in the mentoring and counselling programme.