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Last update: Jan 2012

World Fit For Children Goal
To protect, promote and support exclusive breastfeeding for six months and continued breastfeeding with safe, appropriate and adequate feeding up to two 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 and age-appropriate feeding of solid, semi-solid and soft foods starting in the sixth month.

 

There is growing evidence (reported in Pediatrics and The Journal of Nutrition) of the significant impact of early initiation of breastfeeding, preferably within the first hour after birth, on reducing overall neonatal mortality. 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 indispensable nutrients, essentially acting as a first immunization for newborns, strengthening their immune system and reducing the chances of death in the neonatal period (Health and Population).

 

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, which means that no other liquid or food is required. In addition, breastmilk 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 foods, also helps ensure good nutritional status and protects against illnesses.

 

As reported in The Lancet, 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 annually. Yet early cessation of breastfeeding in favour of commercial breastmilk substitutes and the needless supplementation and poorly timed introduction of other 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 the proper 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 in areas 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 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.

 

It has been reported that complementary feeding is the only proven intervention that can significantly reduce stunting during the first two years of life. 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 the minimum required dietary quality is a challenge in many developing countries, and 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 poor. New programming options are now available to meet this challenge. A comprehensive approach includes both counselling for caregivers on the best 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 seek to continue support for exclusive breastfeeding during the first months of life if replacement feeding is not acceptable, feasible, affordable, sustainable and safe. 
 

References

'Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality' in Pediatrics, vol. 117, no, 3, 1 March 2006, pp. e380-e386

 

'Breastfeeding Pattern, Time to Initiation and Mortality Risk Among Newborns in Southern Nepal' in The Journal of Nutrition, vol. 138, March 2008, pp. 599-603.


‘The Effect of Colostrum on Infant Mortality: Urban rural differentials’ in Health and Population, vol. 15, no. 3-4, July-December 1992, pp. 94-100.


Butte N., M. Lopez-Alarcon and C. Garza, Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant During the First Six Months of Life, World Health Organization, 2002.

 

Hanson, L. A., Immunobiology of Human Milk: How breastfeeding protects babies, 2004.

Dòrea, Josè G. , 'Breastfeeding is an essential complement to vaccination', Acta Pædiatrica, 2009 98, pp. 1244-1250.

 

'Maternal and Child Undernutrition: Global and regional exposures and health consequences' in The Lancet, vol. 371, no. 9608, 19 January 2008, pp. 243-260.


'Effects of micronutrients on growth of children under 5 years of age: Meta-analyses of single and multiple nutrient interventions' in American Journal of Clinical Nutrition, vol. 89, January 2009, pp.191-203.