Even if the percentage of new-born babies nursed at the exit of motherhood augmented these last years, France stays in the tail of europeens countries, both in percentage and in length of feeding. However, in spite of progress of maternis s milk, mother's milk does not lack arguments.

France is late on its European neighbours
Statistics 2000 shows that 50,1 % women nurse at the exit of motherhood against 42 % in 1995. These figures locate France in the platoon of tail of the European countries: the prevalency on the whole from Scandinavian countries and in Switzerland is superior to 90 %, it attains 85 % in Germany and more than 70 % in Italy, in the United Kingdom and in Luxembourg. Besides, the length of feeding in our country is relatively short, since the median is of ten weeks, less than 5 % in four months are 10 % of children nursed in month and. But especially, a third of the women with intention of nursing abandons before birth However, the maternal milk keeps important anti-contagious advantages

The contribution of the maternal milk in cellular elements, immunoglobulines and other immunomodulateurs elements, plays an essential role in the prevention of infections. This tendency persists after the stopping of feeding then becomes blurred in the course of the second year. This aspect is primordial in developing countries, particularly in precarious sanitary conditions. The risk of nconatale septicemia and of ent rocolite uic ro-n crosante is considerably diminished. Many jobs showed an important reduction of contagious gastroenteritises (virus, Shigella, Giardia) Belched. About fifty oligosaccharides and oligonucl ctides different and specific favour the establishment of bifidog ne flora and intestinal ripening, explaining inhibitive action in relation to Escherichia coli. He is also noticed a reduction of the respiratory infections and of otites by inhibition of the membership of the pneumocoque and d Hemophilus influenz in the read pith l m rhinopharyng . A recent North American study, concerning disadvantaged social circles, shows that the benefit of the breast-feeding can compensate, in terms of impact on neonative mortality, consequences of weak born weight!

He blares on the appearance of an allergic ground, on the growth of the facial massif and on the risk of obesity
Concerning the prevention of allergy, I influences some maternal milk was voquce from 1930. Generally, the breast-feeding diminishes the risk of allergy, but this preventive effect is not constant. A recent m ta-analysis shows that preventive action is especially net in case of atopique family ground. She practises in relation to eczema, to allergy in the proteins of the cow's milk and to a lesser degree to vis -live of respiratory allergy. For it, I' breast-feeding must be exclusive, followed during first four-six months of life, with introduction brought forward by some egg and by the fish after nine months.

The growth of the nursed new-born baby differs from that of the new-born baby accepting an industrial milk. The development of maxillo-facial massif and subsequent dental establishment is more harmonious. While staturo-weight growth is quicker first two months of life at the nursed child, weight benefit softens from three-six months, while the increase of size and of cranial perimetre remains comparable to the group fed artificially. In developing countries, the staturo-weight growth under breast-feeding is better until the age of two years, when health conditions are bad. Van Kries and al., in 1999, from six thousand five hundred Bavarian children, showed that risks it seeing happening a weight surcharge, or even an obesity, was significantly lesser at the nursed the place of new-born babies and what this tendency became more marked with the length of feeding. The relating reduction of the risk of obesity settles in 30 % during a study concerning three thousand two hundred Scottish, old babies from thirty-nine to forty-two months, after adjustment taking into account other variables. The breast-feeding contributes so to reduce risks of diabetes of type 2.

He could improve intellectual development
The advantageous impact of the maternal milk on psychomotor development and intelligence provoked controversies. Lucas and al., in Cambridge, showed a quotient of development in eighteen months and of intelligence in eight years significantly better to the premature and the urgent newborn babies benefiting from a human milk. This advantage is corr l with consummate milk quantity and persists after correction of other factors. A m ta-analysis notices that a majority of jobs disclose a favourable effect of feeding on the development of the child: visual ripening, capacity of synthesis and driving performances. These observations are corr l es with proportions plasmatiques and rythrocytaires derivatives of the docohexa no que acid and more generally in presence in the human milk of unsaturated fatty acids with very long chain. He is nevertheless difficult to make the part of the respective role of the components of the maternal milk and of factors socio- tucatifs, often more favoured in case of breast-feeding.

He protects finally the mom of risks of cancer and of complications of menopause
Except the pleasure of nursing, the woman who feeds withdraws some benefits for her health: reduction of the infections of the post - partum, quicker weight loss, risk diminished by ost oporose, by breast cancer and by ovary in premenopause.

The infection with HIV (AIDS) is main situation where the breast-feeding can be discussed
When the mother is infected or at risk of pollution by the HIV, recommendations of the WHO are not similarly applied in the developed countries or not. The pollution of the child is favoured by the recentness of the infection, the absorption of the colostum rich in cellular elements, the presence of crack, the prematurity (by reduction of gastric acidity and immaturity of the digestive barrier) and existence of a candidiasis, of a gingivostomatite, of a pharyngitis or else of a gastroenteritis. On the other hand, the maternal milk seems to decelerate the incubation of the AIDS by inhibition of the link of the virus in the receiver Iymphocytaire CD4. According to studies, the risk of pollution of the child after delivery would augment from 3 to 30 % in case of feeding. The importance of morbidity and of mortality of contagious origin in the countries of development leads nevertheless to recommend the feeding, whatever is maternal status. Situation must be analysed in fact in every country according to the policies of health and of the availability of artificial forms.

Medicaments, I' alcohol and tobacco blare on feeding
Some toxins and medicaments are going to pass in the maternal milk and meet in higher concentration than in industrial milk. Contraindications
medicinal are less numerous (amiodarone, some, beta-swots, estroprogestatifs in strong dose, the psychotropic, the bromocriptine, antimitotiques, some antidepressants, the ergotamine, antivitamins K, some antiepileptics). The prescribed medicament must be necessary, in dosage divided up and minimal and taken just after the suckling. The local treatments (antiseptic iodized especially) are to avoid. The consumption of drugs (cocaine and cannabis) has consequences to behaviour and development of the preschooler. The catch of alcohol diminishes the reflex of ejection and the milk volume. On the whole, these behaviours pose more the problem of maternal aptitude. The tobacco addiction, except higher risks of sudden death and of asthma, diminishes the milk volume and joins a risk of more precocious weaning. On the other hand, contagious risk remains lower at the nursed new-born baby.

Obstacles to a successful breast-feeding are of personal, sociocultural, commercial, political and medical order
Most inquiries raise a strong link between confidence, self-esteem and success of feeding. The slightest frequency of feeding in the less favoured classes originates here. The passage of a rural society to an urban society and the absence of transmission mothers-daughters, reached with a sometimes excessive m dicalisation of delivery, are also negative factors. A vision distorted by feeding is added to it, received as a servitude and a touchy envabissement, besides, to be detrimental in the aesthetics of the female body The commercial pressure of the food of substitution in the specialised magazines, in the course of meetings and congresses, on walls even of motherhood, the distribution of samples or of discount vouchers, contributed to the progressive decline of the breast-feeding. The international Code of the substitutes of the maternal milk (1981) remains badly applied or badly known, just as ten recommendations of the WHO at the origin of the quality-label Hospital, friend of the babies (1991). It does not exist currently in France of federal national committee desactions in favour of feeding. The resumption of job represents another factor mattering from stopping of feeding, unless the weekly length of job is less at twenty o'clock. A majority of the mothers face difficulties of technical order, in the course of the first weeks, (crack, catch of the breast, blocking or milk insufficiency), having badly taken care in the middle of medical. Too often recommended solution consists in stopping feeding. The training of the professionals of health is often deficient and the degree of weak competence.

Measures of information, of education and of support are necessary
The respect for the decision of the future mom does not exclude an information maintaining that to nurse it is better for the child and his mother and represents a source of pleasure and of satisfaction. The question of feeding must be deepened during preparation in delivery. The father must be invited there to participate to decision. The mother who nurses must be able to benefit from a benevolent support of the personnel of motherhood and from a support after the exit, thanks to the competition of associations regrouping volunteers and professionals and services of PMI. Ideal would be to lean in motherhood, services of n onatologie and of PMI on two referents assuring a consistent and consensual speech (from leaflet and textbooks) as wish it steps of accreditation. Many examples show the effectiveness of networks gathering different structures. A coordination could also come into the world, allowing to promote and to support the breast-feeding by the organisation of campaigns of information (secondary schools, Iyc es, pregnant women) and by interlocutor's positioning to medical and political authorities. The promotion of the breast-feeding is part of nine specific objectives of the programme nutritionsant (January, 2001). It would be necessary to make sure that 100 % women who wish after information to nurse could reach it for the duration of 100 % choice!

Pr Dominique Turck, Private hospital of Paediatrics Jeanne de Flandre hospital, CHRU of Lille