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| To protect, promote and support exclusive breastfeeding for 6 months and continued breastfeeding with safe, appropriate and adequate feeding up to 2 years of age and beyond |
The challenge
Optimal infant and young child feeding means that mothers are empowered to initiate breastfeeding within one hour of birth, breastfeed exclusively for the first six months and continue to breastfeed for two years or more, together with nutritionally adequate, safe, age-appropriate, responsive feeding of solid, semi-solid and soft foods starting in the sixth month.
There is growing evidence of the significant impact of early initiation of breastfeeding, preferably within the first hour after birth, on reducing overall neonatal mortality1. It ensures that skin-to-skin contact is made early on, an important factor in preventing hypothermia and establishing the bond between mother and child. Early initiation of breastfeeding also reduces a mother’s risk of post-partum haemorrhage, one of the leading causes of maternal mortality. Colostrum, the mother’s milk during the first post-partum days, provides protective antibodies and essential nutrients, essentially acting as a first immunization for newborns, strengthening their immune system and reducing the chances of death in the neonatal period2.
Breastmilk alone is the ideal nourishment for infants for the first six months of life, providing all of the nutrients, including vitamins and minerals, an infant needs, meaning that no other liquid or food is needed. In addition, breast milk carries antibodies from the mother that help combat disease, protecting babies from diarrhoea and acute respiratory infections. Breastfeeding stimulates an infant’s immune system and response to vaccination and, according to some studies, confers cognitive benefits as well. Continued breastfeeding beyond six months, accompanied by sufficient quantities of nutritionally adequate, safe and appropriate solid, semi-solid and soft foods, also helps ensure good nutritional status and protects against illnesses.
It has been estimated that optimal breastfeeding of children under two years of age has the potential to prevent 1.4 million deaths in children under five in the developing world annually3. Yet early cessation of breastfeeding in favour of commercial breast milk substitutes, needless supplementation and poorly timed introduction of solid, semi-solid and soft foods, often of poor quality, are far too common.
Strategies to protect, promote, and support exclusive breastfeeding are needed at the national, health centre and community levels. At the national level, creation of appropriate structures that ensure the adoption and implementation of appropriate policies and legislation is vital. This includes the development and carrying out of national infant and young child feeding policies and strategy frameworks as well as the development and enforcement of legislation that relates to the International Code of Marketing of Breast-milk Substitutes and maternity protection. At the health systems level, this includes implementation of the 'Baby-Friendly Hospital Initiative' (BFHI) as well as capacity-building of health workers on topics such as breastfeeding counselling. At the community level, mother support activities involving community health workers, lay counsellors and mother-to-mother support groups are crucial. Implementation of an evidence-based comprehensive communication strategy using multiple channels, which ties efforts at the three levels together, is also vital for the successful protection, promotion and support of breastfeeding. Governments are in fact obliged, under article 24 of the Convention on the Rights of the Child, to ensure that all sectors of society know about the benefits of breastfeeding.
Complementary feeding is the only proven intervention that can significantly reduce stunting during the first two years of life4. An important issue is that the quality of the food received is often inadequate, thus not providing sufficient protein, fat or micronutrients for optimal growth and development. Meeting the needs for minimum required dietary quality is a challenge in many developing-country settings, and it has often not been given enough emphasis. Children may not receive complementary foods at the right age (often either too early or too late), are not fed frequently enough during the day, or the quality of the food may be inadequate. New programming options are now available to meet this challenge. A comprehensive approach includes both counselling for caregivers on the optimal use of locally available foods and feeding and care practices, and the provision of micronutrient and food supplements when needed.
For HIV/AIDS-positive women, the benefits of breastfeeding must be weighed against the risk of mother-to-child transmission of the virus. Current policies aim to continue support for exclusive breastfeeding during the first months of life if replacement feeding is not acceptable, feasible, affordable, sustainable and safe.
References
Part of this section is adapted from Tracking progress on child and maternal nutrition – a survival and development priority, UNICEF, November 2009.
1. Edmond, Karen, et al., ‘Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality’, Pediatrics, vol. 117, no. 3, 1 March 2006, pp. e380–e386,
2. Singh, Kiran, and Purnima Srivastava, ‘The Effect of Colostrum on Infant Mortality: Urban rural differentials’, Health and Population, vol. 15, no. 3–4, July–December 1992, pp. 94–100.
3. Black, R. E. et al., ‘Maternal and Child Undernutrition: Global and regional exposures and health consequences’, The Lancet, vol. 371, no. 9608, 2008, pp. 243-260.
4. Usha Ramakrishnan, Phuong Nguyen, and Reynaldo Martorell. “Effects of micronutrients on growth of children under 5 years of age: meta-analyses of single and multiple nutrient interventions”, Am J Clin Nutr 2009;89:191–203.