Understanding impact of smoking and alcohol use on breastfeeding and infant health

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By Ritah Nakijoba

August is World Breastfeeding Month, a time to celebrate the vital role of breastfeeding in promoting infant and maternal health. It also presents an opportunity to raise awareness about the factors that support or hinder successful breastfeeding.

Among these factors, maternal behaviours such as alcohol consumption and smoking during pregnancy and postpartum have emerged as critical issues. A recent review sheds light on how these behaviours are associated with breastfeeding practices and infant outcomes, with implications for public health, family support, and individual decision-making.

Understanding the Impact

Breastfeeding provides essential nutrients, antibodies, and emotional bonding between mother and child. However, various lifestyle factors can interfere with a mother’s ability to initiate or sustain breastfeeding. Two such factors are alcohol consumption and tobacco use.

Alcohol use during lactation has long raised concerns. While many mothers may be advised to completely abstain, the evidence from this review indicates that alcohol consumption is not significantly associated with breastfeeding duration.

Nevertheless, excessive intake may reduce milk production and alter milk composition, which may in turn affect infant development and feeding behaviours. Globally, the World Health Organisation (WHO) estimates that approximately 43% of people aged 15 years and older have consumed alcohol in the past year (WHO, 2018), with higher prevalence in high-income countries.

In Sub-Saharan Africa, although overall alcohol consumption varies across countries, studies report a prevalence of alcohol use among women of reproductive age ranging from 10% to 35% (Pengpid & Peltzer, 2019). In Uganda, the 2021 Uganda Demographic and Health Survey (UDHS) reported that 31% of women aged 15–49 had ever consumed alcohol, and 13% were current users (UBOS & ICF, 2022), raising concerns, particularly for breastfeeding mothers who require accurate information and support.

Smoking, on the other hand, was shown to have a clear negative impact. Maternal smoking during pregnancy is associated with shorter breastfeeding duration and increased risks of respiratory illnesses in infants. Longer-term outcomes for children of smoking mothers include a higher likelihood of childhood overweight and mental health challenges such as anxiety, depression, and neuroticism, some of which persist up to seven years of age.

Globally, approximately 22% of women of reproductive age (15–49 years) report having ever smoked, with current daily smoking rates around 6% (WHO, 2021). In Sub-Saharan Africa, smoking prevalence among women remains relatively low but is rising in some urban areas, with an estimated 2–8% of women using tobacco products, especially in countries undergoing rapid social change (Blecher & Ross, 2013; WHO, 2021).

In Uganda, the 2021 Uganda Demographic and Health Survey (UDHS) reported that about 1% of women aged 15–49 currently smoke cigarettes (UBOS & ICF, 2022). Despite the comparatively low prevalence, even small increases in smoking among women can have profound intergenerational health consequences, particularly during the sensitive breastfeeding period.

Social and Economic Factors at Play: Breastfeeding behaviours vary significantly across populations, influenced by maternal age, education, and socioeconomic status. Globally, women with higher education and income levels are more likely to initiate and continue breastfeeding, with exclusive breastfeeding rates around 50% for educated mothers versus 38% for those without formal education (UNICEF, 2020).

Older mothers (≥25 years) also tend to breastfeed longer than younger mothers (Rollins et al., 2016). In Sub-Saharan Africa, initiation rates exceed 90%, but early cessation is more common among urban and younger women (Benova et al., 2020).

In Uganda, 96% of mothers initiate breastfeeding, yet only 66% practice exclusive breastfeeding, with higher rates among older, educated, and rural women (UBOS & ICF, 2022). These findings stress the influence of social and economic factors on breastfeeding practices.

These places of interest pose a difficulty in decision-making around infant feeding. Many women face structural barriers such as poverty, lack of access to healthcare, or workplace policies that are unfriendly to breastfeeding, which can make sustained breastfeeding difficult. These barriers are often intertwined with smoking and alcohol use, which are sometimes coping mechanisms in the face of stress, social isolation, or mental health issues.

Moving Beyond Judgment: Respect, Support, and Equity: Rather than simply instructing women to stop smoking or drinking during breastfeeding, we must adopt a more supportive and equitable approach. This includes: Public health campaigns that address the root causes of substance use, including stress, poverty, and lack of education. Programs that support behaviour change in ways that are compassionate, non-stigmatising, and culturally sensitive.

Policies that support all mothers, including paid maternity leave, access to lactation consultants, and safe, private breastfeeding spaces at work. Respecting diverse experiences and choices. Not all individuals who give birth and parent conform to traditional roles and expectations. Respecting autonomy and providing individualised support are key.

What Can You Do This Breastfeeding Month? If you’re a healthcare provider, consider how your advice might be shaped by social assumptions. Offer support, not just information. If you’re a mother or parent, know that your decisions deserve respect and support. Seek help when needed.

You’re not alone. If you’re a policymaker or advocate, push for systemic change that enables healthier choices, including policies that reduce tobacco and alcohol use while supporting breastfeeding-friendly environments. If you're a community member, offer encouragement, not judgment. Creating a supportive atmosphere for breastfeeding starts with all of us.

Final Thoughts: Breastfeeding is a natural and valuable act, but it doesn't occur in a vacuum. It is influenced by behaviours, circumstances, and systems that shape everyday life. This new research reminds us that maternal smoking is a significant barrier to sustained breastfeeding and poses risks for long-term child health. Alcohol, while not directly linked to breastfeeding duration, still carries risks when consumed in excess.

As we mark World Breastfeeding Month this August, let’s remember that supporting mothers means addressing not only their knowledge and motivation but also the real-world challenges they face.

Every mother deserves the opportunity to give her baby the best start in life, and that starts with informed, compassionate, and equitable care.

The writer is with Infectious Diseases Institute, Mulago, Uganda,

PHD scholar, Makerere University, School of Public Health