By: Alessandro (Alex) Iellamo

Why is breastfeeding important?

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) Global Strategy for Infant and Young Child Feeding (2002)[7] recommends optimal infant and young child feeding as:

  1. Initiation of breastfeeding within one hour of birth
  2. Exclusive breastfeeding[1] for the first six months of life
  3. Continued breastfeeding for two years and beyond
  4. Introduction of adequate and appropriate complementary foods[2] from 6 months onward

Of the 132 million babies born every year, only 45% of newborns initiate breastfeeding within the first hour of life, 43% exclusively breastfed during the first six months and 46% continue breastfeeding up to the age of 2 years.[3]

More than eight hundred thousand under five deaths are attributed to sub-optimal breastfeeding annually worldwide, the majority within the first six months of life and an estimated 20,000 deaths from breast cancer are prevented and an additional 20,000 could be saved if rates improved.[4]

Exclusive breastfeeding for the first six months and continued breastfeeding would prevent 13% of under-five deaths, primarily from infections resulting in diarrhoea, pneumonia and neonatal sepsis.[5] Initiation of breastfeeding in the first hour would prevent an additional 22% of newborn deaths.[6] At the same time, beyond the early childhood period, breastfeeding can improve children’s quality of life through preventing leukemia, asthma, ear infections, allergies, and diabetes, and it could support the achievement of optimal mental development (IQ).[7],[8]

Overwhelming evidence shows that virtually all mothers can breastfeed.[9],[10],[11] Lactation failure is virtually unknown in societies where breastfeeding is highly valued, regarded as a natural physiological function which is the only way to nourish an infant. In these circumstances, families and societies strongly encourage and support breastfeeding. Women in these societies are also less exposed to circumstances that undermine lactation. Studies show that when mothers are given proper information and support, they breastfeed.[12],[13]

What we do so that mothers are provided with the needed support to breastfeed?

Six (6) key actions are recommended to be able to set systems in place that provide the support needed by women to be able to breastfeed successfully and for their children to be able to be breastfed. Breastfeeding is a right, and as such we should all contribute to its fulfillment.

1. Advocate to governments for the:

  1. Endorsement of national and sub-national plans of action to provide the platform for financing, implementing and monitoring. The plans should have budgets allocated and should be based on an in-depth country analysis. These plans should be further incorporated into national health sector plans and strategies.
  2. Passage of national enforceable legislation that would implement the International Code of Marketing of Breast Milk Substitutes and subsequent related World Health Assembly Resolutions (The Code). The International Code of Marketing of Breast Milk Substitutes was endorsed in the 1981 World Health Assembly Resolution WHA34.22. It marked a historical step in the efforts to protect breastfeeding and establish and support appropriate infant and young child feeding practices. To date only xxx governments have passed legislation that fully implement the Code.
  3. Passage of laws and regulations that would grant maternity and paternity protection in line with the ILO maternity protection conventions ( ILO 2000,183).

2. Initiate concrete steps so that the whole health care system (public and private) supports and practices the recommendations and the standards of the Baby Friendly Hospital Initiative (BFHI), launched in 1991, which aims to give every baby the best start in life by creating health care environments where breastfeeding is the norm. It provides the standards that all facilities where births take place should meet. The BFHI standards uphold the International Code as a key component of BFHI, and additionally include support for non-breastfeeding mothers and suggest additional modules on 1) HIV and infant feeding and 2) Mother-friendly care.

3. Ensure that all health workers, nutritionists and community based workers and volunteers should be able to provide the correct information and skilled support for exclusive and continued breastfeeding. These can be achieved by quality in-service education, but it is highly recommended to strengthen pre-service education, so that all new graduates are capable and sensitive to breastfeeding protection, promotion and support.

4. All key health and emergency policies, preparedness and response plans contemplate actions and resources for breastfeeding in difficult circumstances:

  • Infant Feeding (IYCF) in the context of HIV

WHO guidelines on HIV and infant feeding (2016) guide governments and partners to develop effective policy and programmes to support infant feeding in the context of HIV.  A major shift has been to move from “prevention of transmission” to “an HIV-free survival policy,” focusing then on “having children of mothers known to be HIV-infected [to] survive, while remaining HIV uninfected as the top priority.”

  • Infant feeding (IYCF) in emergency

The Emergency Nutrition Network (ENN), issued an operational guidance on infant and young child feeding in emergencies.40 It reaffirms the importance of a) supporting breastfeeding in difficult situations, b) ensuring no donations of breast-milk substitutes, and, c) that the minimum amount of infant formula that may be necessary be procured through the emergency coordinating mechanism.

5. Community support system:

Countries should be encouraged to establish counseling and community support systems wherein breastfeeding (stand-alone or integrated) will be a key component and focus of such support. In particular, peer-to-peer counseling, support groups and care groups have been recognized as an effective measure to support breastfeeding women within their own communities and neighborhood.

6. Behavioral Change Interventions:

Social marketing and communications need to be an overarching effort of governments and its partners to improve protection, promotion and support of optimal breastfeeding practices. The UNICEF infant and young child feeding programming guide suggests that communication should encompass advocacy, social mobilization, social marketing, behaviour and social communication.


Six (6) actions, would help prevent almost 1 million children deaths and thousands more deaths of women. It’s time we all act to advocate and support governments all over the world to ensure that investments and resources are put in place to protect, promote and support our mothers to enjoy their right to breastfeed, and their children’s right to be breastfed.

“If a new vaccine became available that could prevent 1 million or more child deaths a year, and that was moreover cheap, safe, administered orally, and required no cold chain, it would become an immediate public health imperative. Breastfeeding could do all this and more, 1,2 but it requires its own “warm chain” of support – that is, skilled care for mothers to build their confidence and show them what to do, and protection from harmful practices. If this warm chain has been lost from the culture, or is faulty, then it must be made good by health services”. (Breastfeeding a warm chain of support, The Lancet, Volume 344, Number 8932,1994)

[1] Exclusive breastfeeding: Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines.

[2] Complementary foods: means giving other foods in addition to breast milk. These other foods are called complementary foods. During the period of complementary feeding, a baby gradually becomes accustomed to eating family foods.

[3] UNICEF global databases, 2016, based on MICS, DHS and other nationally representative sources. Note: Data included in these global averages are the most recent for each country between 2010-2016. *Aggregates for these indicators use China, 2008; **Aggregates for these indicators do not include China due to lack of data and while >50% of the global population coverage was met, almost all of the data for these indicators are from low and lower middle income countries.

[4] Lancet series

[5] Jones at al, How many child deaths can we prevent this year. The Lancet, Lancet 2003; 362: 65–71

[6] WHO Global Observatory, early initiation and exclusive breastfeeding., viewed last July 18, 2013.

[7] Quantity and Quality of Breast milk. Report on the WHO collaborative study on Breastfeeding, Geneva, 1985.

[8] Ip et al. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009 Oct;4 Suppl 1:S17-30.

[9] Contemporary patterns of breast-feeding, Geneva, World Health Organization, 1981.

[10] Mata LJ. The children of Santa Maria Cauque. Cambridge, MA, MIT Press 1978: page 2.

[11] WHO Bulletin 1989; 67 (supplement):41-54.12.

[12] Dulon M, Kersting M, Bender 4. Breastfeeding promotion in non-UNICEF certified hospitals and long-term breastfeeding success in Germany. Acta Paediatr 2004; 92:653-8.

[13] Stremler J, Lovera D. Insight from a breastfeeding peer support pilot program for husbands and fathers of Texas WIC participants. J Hum Lact. 2004 Nov;20(4):417-22.



Leave a Reply

Your email address will not be published. Required fields are marked *