Breastfeeding and Smoking in South Africa – The Hard Truth
Breastfeeding and Smoking in South Africa – The Hard Truth
Carene "5% of South African woman were using tobacco during their pregnancy...double the global average..."
Breastfeeding is one of the most effective ways to ensure child health and survival, especially in a country like South Africa, where infant nutrition and early childhood development are public health priorities. However, smoking—both during and after pregnancy—poses significant risks to both mother and child. Understanding the intersection between breastfeeding and smoking is critical for informed choices and public health interventions. Here are the hard facts.
The Benefits of Breastfeeding
"breastfeeding—despite these risks—still offers irreplaceable benefits that outweigh the risks of nicotine exposure."
We have over 5 decades of scientific research that documented the numerous benefits of breastfeeding. If you haven’t seen it yet, I have a blog article on The Benefits of Breastfeeding for the Baby and for the Mother. Go and have a read, you might just learn a few more benefits that have been added to the list. Here are some of the well-known and unmatched health benefits of breastfeeding:
- Supreme nutritional value: Breast milk contains the perfect combination of nutrients like vitamins, minerals, protein, carbohydrates, fat and water—everything a baby needs exclusively in the first six months and in combination with safe foods beyond 2 years.
- Immune building: Breast milk is a live liquid. It contains an extensive cocktail of immune modulating components which is transferred to the baby to build up and mature their own immune system. Their strengthened immune response helps to protect against common childhood illnesses like diarrhea and pneumonia. These are two of the leading causes of child mortality in South Africa.
- Unparalleled bonding: It fosters physical closeness and emotional bonding between mother and child, through this intimate and regular activity. New research is finding that breastfeeding mothers are generally more in tune with their baby’s needs.
- Long-term benefits: Breastfed children are less likely to become overweight or develop chronic diseases like diabetes and cardiovascular disease. Ongoing research is being conducted on the reduced risk of cancers due to the transfer of tumor fighting cells in breast milk. There is also evidence to support that breastfed individuals are more likely to perform better in intelligence tests.
Some shocking truths about Smoking in South Africa…
According to the South African Demographic and Health Survey (SADHS) and other national statistics:
- About 20–25% of South African women of childbearing age smoke or are exposed to second-hand smoke.
- One local study found that 5% of South African woman were using tobacco during their pregnancy. This is double the global average for low to middle income countries (International Journal of Preventive Medicine, 2019).
- Approximately 3.7% of mothers who were found to use tobacco during pregnancy also used alcohol (International Journal of Preventive Medicine, 2019).
- Tobacco use seemed to coincide with one or more chronic health condition in approximately ¼ of the study population (International Journal of Preventive Medicine, 2019).
- Tobacco use is higher in socioeconomically disadvantaged communities, where breastfeeding rates also tend to be lower.
- E-cigarettes typically deliver less nicotine, however it can also contain other potentially harmful chemicals. Little is known about the effects of e-cigarettes on mothers and infants, and new evidence is required to improve guidelines (CDC, 2025).
- Smoking remains prevalent despite widespread anti-tobacco campaigns and laws aimed at reducing cigarette consumption.
"Studies have shown that families tend to reduce smoking habits if they have received education on the risks during pregnancy and breastfeeding."
Facts about Smoking While Breastfeeding
Maternal smoking during pregnancy already poses health risks to the infant, with a high incidence of low birth weight and premature birth. These are also conditions that are known to increase breastfeeding difficulty, while breastfeeding is a life-saving intervention for those vulnerable infants. There are reports of mothers that manage to stop smoking during pregnancy but restart as soon as the baby is born. A meta-analysis done in 2016 found that a total of 43% of woman relapse after the birth (International Breastfeeding Journal, 2021). Some of these mothers might think that the risks are lower, when in fact there are numerous negative impacts during breastfeeding.
- Nicotine Passes Into Breast Milk
- There is strong evidence to show that nicotine and other harmful chemicals from tobacco smoke are transferred into breast milk (National Institutes of Health, 2008).
- The amounts of nicotine transferred to the baby in the breast milk have been found to be directly related to the number of cigarettes the mother smokes (National Institutes of Health, 2008).
- These substances can affect a baby’s developing brain and body, leading to irritability, sleep disturbances, and feeding issues.
- Reduced Milk Production (International Breastfeeding Journal, 2021)
- Smoking is associated with decreased levels of prolactin—a hormone essential for milk production.
- This can lead to reduced milk supply and subsequent early cessation of breastfeeding and inadequate nutrition for the infant.
- Altered breast milk composition (International Breastfeeding Journal, 2021)
- Breast milk samples from smoking mothers have been found to have lower levels of antioxidants, vitamin A, E and C.
- Reduced fat concentrations in the milk, which can alter the taste of the milk and cause the baby to refuse the milk.
- Lower levels of immune and bioactive compounds, which are well known to give breast milk it’s unique qualities.
4. Higher Risk of Respiratory conditions
- Infants exposed to second-hand smoke and nicotine through breast milk are at a higher risk of Sudden Infant Death Syndrome (SIDS) an other lower respiratory illnesses, such as bronchitis and pneumonia (CDC, 2025).
- Infants with mothers who smoke have been found to have shorter sleeping intervals (International Breastfeeding Journal, 2021).
5. Lower Duration of Breastfeeding
- Studies in South Africa show that mothers who smoke are less likely to initiate breastfeeding and more likely to stop earlier than non-smokers.
- Research shows that there is a dose effect relationship between the number of cigarettes a mother smokes and the duration of breastfeeding. The higher the number of cigarettes, the shorter the duration that the mother breastfeeds (National Institutes of Health, 2008).
- A large international study found that mothers using tobacco tended to stop breastfeeding by 2 weeks (International Breastfeeding Journal, 2021).
What Should Mothers Do?
The World Health Organization (WHO), American Academy of Pediatrics and South African Department of Health agree on one crucial point:
Breastfeeding should continue even if the mother smokes.
However, quitting or reducing smoking is highly recommended.
Breast milk continues to provide valuable nutrients to the baby to grow and fight infections. The protective factors in breast milk are thought to supersede the harmful effects of maternal smoking. Breastfeeding was found to counteract the effects of passive tobacco smoke on the baby’s developing lungs and respiratory system (International Breastfeeding Journal, 2021).
If quitting isn’t immediately possible, consider these harm-reduction strategies:
- Never smoke around your baby—reduce second-hand smoke exposure.
- Avoid co-sleeping with the baby if one or both parents are smokers.
- Smoke immediately after breastfeeding, not before, to give your body time to reduce nicotine levels before the next feed.
- Breastfeed exclusively for the first six months, even if you smoke—infants still benefit more from breast milk than from formula.
- Regularly visit your supporting healthcare provider to monitor your baby’s growth and development.
Support and Resources in South Africa
Studies have shown that families tend to reduce smoking habits if they have received education on the risks during pregnancy and breastfeeding (International Breastfeeding Journal, 2021). I hope this may be your queue to seek help if you have trouble quitting or sharing with someone you know.
- The National Council Against Smoking Quit Line: 011 720 3145 or Whatsapp – 072 766 4812 – Offers support for South Africans trying to quit smoking.
- CANSA’s eKick Butt programme – Offers a unique online smoking cessation programme.
- Mothers2Mothers (m2m): Provides education and support on maternal and child health, including breastfeeding practices.
- Department of Health Clinics: Offer antenatal classes that include breastfeeding support and smoking cessation advice.
The hard truth is clear...
Smoking is harmful to both mothers and babies, even while in combination with breastfeeding. But breastfeeding—despite these risks—still offers irreplaceable benefits that outweigh the risks of nicotine exposure. The ideal scenario is a smoke-free, breastfeeding-friendly environment. Until then, education, harm reduction, and accessible health support is key to protecting our next generation.
Resources:
CDC. (2025). cdc.gov. Retrieved from CDC: https://www.cdc.gov/breastfeeding-special-circumstances/hcp/vaccine-medication-drugs/tobacco.html#:~:text=Safety%20of%20breastfeeding,recommended%20food%20for%20an%20infant.
Esra Can Özalp, S. S. (2021). Is maternal cigarette or water pipe use associated with stopping breastfeeding? Evidence from the Jordan population and family health surveys 2012 and 2017–18. International Breastfeeding Journal. Retrieved from https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-021-00387-z
Kate Goldade, M. N. (2008). Breastfeeding and Smoking among Low-Income Women: Results of a Longitudinal Qualitative Study. National Institues of Health, Birth. 2008 September ; 35(3): 230–240. doi:10.1111/j.1523-536X.2008.00244.x. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC2830716/pdf/nihms164424.pdf
Nancy Phaswana‑Mafuya, K. P. (2019). Maternal Tobacco use during Pregnancy in South Africa: Results from a National Population‑based Survey. International Journal of Preventive Medicine. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC6592098/pdf/IJPVM-10-99.pdf
National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF. (2016). South Africa Demographic and Health Survey. PRETORIA : National Department of Health. Retrieved from https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf
