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.

Breast milk 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 annually¹. Yet few of the 136 million babies born each year receive optimal breastfeeding, and some are not breastfed at all. 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. Professional and commercial influences combine to discourage breastfeeding, as do continued gaps in maternity legislation.

 

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.

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, while ensuring a knowledgeable choice on infant feeding options, with further research into the exact mechanisms of transmission to inform guidelines on this issue.

During emergencies such as earthquakes, floods, cyclones, drought and conflict, disease and death rates among under-five children are generally higher than for any other age group. Mortality may be particularly high due to the combined impact of a greatly increased incidence of communicable diseases and diarrhoea and soaring rates of undernutrition. This is why protecting and supporting breastfeeding and ensuring sufficient quantities of nutritionally adequate, safe and age-appropriate solid, semi-solid and soft foods in emergencies is crucial to the health and survival of infants and young children.

 

1. 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.