14 Breastfeeding Challenges African Nursing Mothers Need To Know

By: Chiamaka Wisdom-Asotah, MBBS, MPH. Freelance Health Writer and DLHA Volunteer. Reviewed by: Chika Jones, RN, RM, RPHN, BNSc. 

 

An African Mother holding her baby in a cradle-hold position  with an incandescent bulb glowing against a darkened background. Image credit: Freepik        

 

Breastfeeding: The Food Your Baby Needs

Breastfeeding is the most important source of nutrition for your newborn. When it is the only source of food and fluids for your baby for the first six months of life, it is referred to as exclusive breastfeeding. However, breastfeeding can continue till your baby reaches two years of age during which additional sources of feeding can also be provided. [1, 2]  Interestingly for many mothers, breastfeeding is not as easy as it seems, even though it’s a natural process.

Several breastfeeding challenges often hinder this new experience, and in fact, research shows that in Africa, the rate of exclusive breastfeeding is low. Despite these challenges, breastfeeding protects you from health conditions such as breast and ovarian cancers. Exclusively breastfed children are protected against infections and grow to have higher order brain function [3]. 

This article will explore the common breastfeeding challenges you may face as an African nursing mother and ways you can deal with them.

 

Breastfeeding Challenges

For ease of understanding, the common breastfeeding challenges will be discussed under those related to you the mother and those related to your baby (see fig. 1).

 

Fig. 1: Showing common breastfeeding challenges related to you, the mother or your baby. Click on the image to enlarge.

 

 A. Breastfeeding Challenges Related to You, the Mother 

 

1. Sore/Cracked Nipples

Cracked or sore nipples are very common, especially for new mothers [4]. They usually indicate that your baby is not attached correctly during feeds. You need to ensure your baby latches or attaches deeply and is well-positioned.

Common causes include: 

• Your baby chews on your nipples for relief during teething. Use a clean, wet washcloth from the refrigerator to soothe their gums. Putting a bit of expressed breast milk on your nipples (breast milk has healing properties) or applying nipple balm after each feed can relieve your soreness.

• Your baby keeps sucking as they come off the breast. To break the suction, insert a finger gently into the sides of the mouth as they leave the breast.

•  If your breast skin is always wet, it can cause sore nipples. To keep your breasts dry, wear breathable bras instead of synthetic ones and as often as you can, leave your breasts open for some air.

• Breast skin that’s too dry isn’t left out. It can cause your nipples to crack. Avoid soaps or solutions that remove natural skin oils and dry your skin. Use moisturizing oils as recommended by a healthcare professional.

Other causes of nipple soreness include:

• Pump trauma
• Hormones 
• Infection 
• Tongue-tie.

 

2. Let-Down Issues

Let-down, also known as the milk ejection reflex, refers to the milk flow into your breasts. Oxytocin is the hormone responsible for this action. Usually, within 1-2 minutes of your baby’s fast suckling or breast pumping, a let-down should occur [5].

Signs of a let-down include:

•  A tingling feeling in the breast before or during breastfeeding

•   Milk leaking from the breasts when you think about your baby or when they cry

• Milk dripping from the other breast while the baby suckling

• Milk flowing in streams if the baby stops sucking

• Baby making deep sucks and swallowing

• Cramps in your uterus or light bleeding

• Feeling thirsty while you nurse

If these are present, then you need not worry.

Milk let-down issues could be in two ways:

a. Slow milk let-down

b. Fast/strong milk let-down

If your baby is bottle-fed, this may delay let-down, as your baby’s suckling pattern may not effectively stimulate your breasts. Women with medical conditions such as hypothyroidism, breast reduction and bleeding after delivery may also experience let-down problems. You need to consult your health practitioner for support in this regard.

Regarding a strong let-down, a few seconds after your baby starts suckling, they could choke a little. They may stop nursing and start crying because of the quick milk flow into their mouth.

To manage strong let-down:

1.  Remove your baby from the breast when you notice your milk flow is fast and return them afterwards.
2.  Try different breastfeeding positions and see what works best for you. One recommended position is the laid-back position because it helps milk flow slowly into your baby’s mouth.

 

3. Reduced Milk Supply

Reduced milk supply is a common reason why most women wean their babies early, and research shows that it affects 10 to 15% of mothers. Human milk is easily digested, so your baby might feed frequently (8-12 times daily) [6]. 

Occasionally, mothers mistake this frequent feeding for insufficient milk volumes, but that’s not always the case.

Breastfeeding is a demand-and-supply process, meaning the more your baby feeds, the more milk you produce. However, no matter how much milk you produce, the quality remains the same and greatly benefits your baby [5].

Causes of reduced milk supply include: [7]

• Insufficient feedings or milk expression (fewer than 8 times a day)
• Long periods without breast stimulation (no nighttime feeds)
• Baby's suction is too weak
• Pump not suitable or not used effectively
• Baby frequently takes a bottle
• Inconsistent breastfeeding
• Worry, stress and anxiety
• Previous breast surgery
• No bonding between you and your baby
• Delay in initiating breastfeeding
• Pregnancy while breastfeeding
• Use of oral contraceptives or decongestants containing pseudoephedrine

Here’s what you can do

•  Start skin-to-skin contact immediately after delivery and begin breastfeeding without delay.
•  Seek professional breastfeeding assistance after delivery to ensure proper latch while you nurse.
•   Keep your baby in the same room with you for 24 hours daily (rooming-in).
•  Exclusively breastfeed unless your healthcare provider recommends supplementation due to medical reasons.

Signs your baby is getting enough milk:

a)    Steady weight gain

b)    6–8 wet diapers occur on average per day.

c)    Stool colour changes from green to yellow by day five

If you’re not sure you’re producing enough, a healthcare professional should observe your breastfeeding process, give expert advice, and support you in feeding or expressing milk more frequently (8-12 times daily) to increase your supply [8].

Medications like galactagogues (i.e., breast milk producing drugs; e.g., domperidone) may be helpful for mothers who want to breastfeed their adopted babies but should not be used first before trying other solutions [6].

 

4. Engorged Breasts

Within the first three to five days after delivery, most women experience breast engorgement. An engorged breast feels hard, swollen and lumpy. The pain can be uncomfortable for you, and your baby may have difficulties latching to take a suck.

Breast engorgement isn’t just caused by your breasts filling up. It happens when your breasts are not well emptied. As your baby learns to latch correctly, they suck enough to empty your breasts and prevent an engorgement. Engorgement can happen when your baby sleeps longer than usual, misses a feed or is being weaned off breastfeeding.

To manage engorgement, consider doing the following:

• Before feeding, gently apply counter pressure to the areola near the nipple with your fingertips.
• Express some milk to relax the breast.
• Breastfeed your newborn on demand.
• Apply ice/cold compresses after each feed/pumping session.
• Wear a supportive and well-fitting bra.
• Use gentle breast massage.
• Take ibuprofen or paracetamol for pain relief.
• Be careful not to pump/hand express too much when you have an engorgement as this could worsen the situation by an oversupply! [6]

                  

5. Breast Milk Oversupply

Some mothers wish for an oversupply with the intent of having their babies well-fed, but this doesn’t come without its challenges.

Possible issues with an oversupply are:

• Strong letdowns that can make your baby choke, spit up, hiccup or become gassy
• Fussiness and crying in your baby during feeds
• Refusal of feeds
• Nipple injury as your baby clamps down on your nipple to reduce milk flow
• Increased risk of mastitis or clogged ducts

 To treat an oversupply, try:

• Nursing in a laid-back, reclining, or side-lying position (see fig. 2] These positions help regulate the flow of milk to your baby during breastfeeding.
• Feeding your baby from just one breast per feed instead of both (block feeding).

 

Fig. 2: Cartoon illustration of common breastfeeding positions. Click on the image to enlarge.

 

6.    Plugged Milk Ducts

Plugged milk ducts (channels that transport milk from the breast to your baby’s mouth) are a common breastfeeding challenge. It means your milk channels are blocked. They can happen if feeds are skipped, your baby doesn’t feed well, or if you wear tight bras.

Symptoms of a plugged milk duct include:

• Pain in your breasts
• Hotness and redness in an area of your breast
• Lump felt close to your breast skin

To treat a plugged milk duct, try the following:

• Massage your breast towards the nipple.
• Apply ice or cold packs for relief.
• Breastfeed on demand and use different positions.
• Make sure to empty the affected breast first during feeds.
• Wear a supportive bra that is not tight and has no underwire.

 

7. Mastitis

Mastitis refers to pain, redness and swelling of the breast. It can be caused by an infection or breast engorgement. You may also have a fever if you have mastitis.

Mastitis occurs when there’s a blocked milk duct or build-up of milk. If mastitis is not treated promptly, it could cause a breast abscess (a painful build-up of pus in the breast). Breastfeeding is safe even if you have mastitis, and it helps to prevent engorgement that can worsen the condition [6].

To treat mastitis, you can try thes following:

•  Breastfeed/pump frequently. Make sure not to overdo it to prevent an oversupply.
•  Your baby should latch deeply during nursing.
• Apply ice to the affected breast.
•  Massage your breast toward the nipple.
•  Take ibuprofen or paracetamol as directed.

 

8. Breastfeeding Exhaustion

Every new parent experiences exhaustion, especially in the first few weeks [5]. This is completely normal. Adjusting to your baby’s schedule will help you cope with this new phase. You might have to sleep when your baby is sleeping, even when you don’t feel like it, to enable you to rest enough.

To manage this, try:

• Breastfeeding while lying down can help you catch some sleep at night; however, you should do this safely. 
• Ask for help from your family.
•  Pump some milk so someone else can feed the baby while you rest.

 

9. Leaking Breasts

As your breastfeeding gets established, you may start to notice your breasts leak at different times. You may experience leakage when your baby is nursing, when you think about them, hear them cry or go for long without nursing them. This is normal and shouldn’t get you worried. If you want to avoid this, then get your baby to feed as soon as you feel your breasts get full. Consider wearing nursing pads to help prevent milk stains, especially when you’re out and about.

 

 B. Breastfeeding Challenges Related to Your Baby 

1.    Tongue Tie and Lip Tie

Tongue and lip tie conditions (see fig. 3) are common concerns for breastfeeding parents. Tongue-tie (also known medically as ankyloglossia), is a condition that occurs when the tongue is held down to the floor of the mouth in the midline by a tissue called frenulum. This may occur because the frenulum is too short, or tight thereby restricting tongue movements.

 

Fig 3: Cartoon illustration of tongue and lip ties in a baby. Click on imge to enlarge.

 

Lip tie on the other hand is less frequently seen compared to tongue tie. It is a condition that occurs when the frenulum connecting the upper or lower lips to the gums in the midline is too short, tight or thick thereby restricting lips movement. 

This breastfeeding challenge can make nursing difficult because it limits your baby from moving their tongues and or lips easily.

Both conditions (tongue and lip ties) can affect breast and bottle feeding as well as speech development, 

Signs your baby has a tongue or lip tie:

• Baby produces smacking sounds while sucking
• Baby appears sleepy or slow while nursing
• Baby drools more than usual
• Baby is not gaining weight as expected
• Baby chews on the nipple while nursing
• Mother feels pain during breastfeeding
• Mother’s breasts stay engorged after feeding
• Mother frequently experiences milk bleb (small whitish dot on the nipple that is a sign of inflammation of the milk duct), mastitis, or clogged ducts

If you suspect your baby has a tongue or lip-tie, seek help from your baby’s healthcare provider.

While you wait for the help, try any of these:

• Change nursing positions to see what works.
• Use of specialized nipple shields.
• Therapy to enhance mobility.

 

2.    Oral Thrush

Thrush is an infection caused by Candida albicans, a spore producing germ that feeds on moulds, yeast and mushrooms. The condition thrives in warm and moist areas and can affect the skin, nails, mouth and other parts of the body. 

Oral thrush occurs when Candida albicans infection affects the mouth  to form a flurry whitish coating on the tongue, gums and back of the throat (see fig 4).

 

Fig. 4: A balck child with oral thrush. Clickon image to enlarge. Image credit: Skin Deep 

 

Having a cracked nipple makes you prone to having this infection and you can pass it on to your baby. If you or your baby has had antibiotics recently, then thrush could also happen.

Symptoms of oral thrush include:

• Mother: Itchy and brownish red nipples that are painful or uncomfortable during and right after nursing.
• Baby: White patches in the mouth and/or a diaper rash. This can make them fussy.

To treat this, your provider will prescribe antifungal medications for use by you and your baby.

 

3.    Spitting Up

Babies spit up a lot and this is normal. In the first few days to weeks, they could take in more milk than they need and then spit out the excess [5].

If you’re concerned about this, try to address the following possible causes:

• Manage oversupply properly
• Ensure good positioning during breastfeeding
• Burp your baby to ease ingested air.

Consult your healthcare provider for further guidance if your baby spits up for hours or you feel concerned.

 

4.    Breast Preference

Some babies prefer one breast to the other. You may have noticed this with your little one. Though common, it often doesn’t last for long.

The reasons could be:

• Your nipples feel different
• Your baby has some discomfort on one side of their body (neck or head pain), making them prefer feeding on a particular side of your breast.
• Your milk supply or flow is different on both sides.

What you can do:

Encourage your little one to breastfeed from both sides so they can get enough milk. If this doesn’t work, allow them to feed on their preferred breast. You can express milk from the less preferred breast to maintain your supply and ensure your baby is full.

 

5. Latching Difficulty

Your baby may have a challenge attaching to your breasts in the first few days of life. With time, they learn to do this effortlessly. If your baby doesn’t latch properly, breastfeeding can become challenging for both of you. You need to know how to achieve a good latch (see fig. 5) with your baby as they may refuse to nurse [5, 6], and if they do, you could end up with nipple injuries.

 

Fig. 5: Cartoon illustration of good and poor baby attachment (latching) during breastfeeding. Click on image to enarge.

 

Some reasons for latching problems are:

• Poor positioning
• Engorged breasts
• Flat/inverted nipples
• Baby being forced to nurse
• Baby experiencing pains/discomfort.
• Your baby is used to bottle-feeding [5]
• Low milk flow

You can contact the breastfeeding support team in your area to help you with this.

 

Frequently Asked Questions (FAQs)            

 

1. What should I do if my baby has difficulties latching correctly?

A: Bring your baby to your breasts and allow them to latch themselves. Also, make sure you’re using a position that suits you both [9]. If this doesn’t help, consult your breastfeeding specialist.

2. How can I tell if my baby is getting enough milk?

A: If your baby is gaining adequate weight, having 6-8 wet nappies daily and passing yellow stools, they’re probably getting enough milk.

3. What should I do if I have a low milk supply?

A: It is rare to have a low milk supply because your body produces just what your baby needs per time. However, breastfeeding on demand and having a routine pumping schedule can improve milk production.

4. Is it okay to introduce a bottle or pacifier early?

A: Unless indicated by your healthcare provider, trying to establish breastfeeding with your baby before introducing a bottle or pacifier is recommended. This can be around 3 – 4 weeks of age.

5. What should I do if my baby is not gaining enough weight?

A: If you notice your baby isn’t gaining adequate weight, consult your healthcare provider so your baby can be thoroughly assessed and managed.

 

Conclusion

Breastfeeding challenges are common, and as a new mother, you could struggle to manage them properly. However, with proper knowledge and support, you can scale through and enjoy your breastfeeding journey.

 

References:

1. World Health Organization. e-Library of evidence for nutrition action (eLENA). Exclusive breastfeeding for optimal growth, development and health of infants.[Internet] Last updated: 9 August 2023. [Cited March 30, 2025] Available from here.

2. US Centers for Disease Control and Prevention. Breastfeeding report card, [Internet]. February 24, 2025. [Cited March 30, 2025]. Available from here.

3. Kramer MS, Aboud F, Mironova E, et al. Breastfeeding and Child Cognitive Development: New Evidence From a Large Randomized Trial. Arch Gen Psychiatry. 2008;65(5):578–584. doi:10.1001/archpsyc.65.5.578. Available from here.

4. Babakazo P, Bosonkie M, Mafuta E, Mvuama N, Mapatano M-A (2022) Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa. PLoS ONE 2022;17(10). Doi: 10.1371/journal.pone.0275477. Available from here

5. Bell A. Overcoming Common Breastfeeding Challenges. ]Internet]. UCLA Medical School, 28 July 2023. [Cited March 20, 2025]. Available from here.

6. The American College of Obstetrics and Gynecology. Committee opinion # 827. Breastfeeding Challenges. [Internet, n.d.]. Cited March 30, 2025. Available from here.

7. Jin X, Perrella SL, Lai CT, Taylor NL, Geddes DT. Causes of Low Milk Supply: The Roles of Estrogens, Progesterone, and Related External Factors. Adv Nutr. 2024 Jan;15(1):100129. doi: 10.1016/j.advnut.2023.10.002. Available from here

8. Kent, Jacqueline C., et al. ‘Principles for Maintaining or Increasing Breast Milk Production’. Journal of Obstetric, Gynecologic & Neonatal Nursing, vol. 41, no. 1, Jan. 2012, pp. 114–21.Available from here.

9/ OASH. Office of Women Health. DHSS, Getting a Good Latch. [Internet] Last updated Feb. 25, 2025. [Cited March 30, 2025]. Available from here.

 

Related:

• 10 Common Myths and Misinformation about Breastfeeding in Africa
• 6 Breastfeeding Tips for New African Moms
• Breast Hygiene and Care During Breastfeeding: A Guide for African Women

 

 

Published: April 28, 2025

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