Breastfeeding: achieving the new normal

February 01, 2016
Cindy Galloway

Breastfeeding: achieving the new normal

Breastmilk makes the world healthier, smarter, and more equal: these are the conclusions of a new Lancet Series on breastfeeding. The deaths of 823 000 children and 20 000 mothers each year could be averted through universal breastfeeding, along with economic savings of US$300 billion. The Series confirms the benefits of breastfeeding in fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers. The Series represents the most in-depth analysis done so far into the health and economic benefits that breastfeeding can produce.

However, although the Series is comprehensive, the message is not new. In 2013, a Lancet Series on maternal and child nutrition established that 800 000 child deaths could be prevented through breastfeeding, and called for further support. Despite consolidation of evidence for breastfeeding’s benefits in recent years, in particular the economic gains to be reaped, global action has stalled. Why has so little progress been made?

Rates of breastfeeding vary wildly; it is one of the few health-positive behaviours more common in poor countries than rich ones. In low-income countries, most infants are still breastfed at 1 year, compared with less than 20% in many high-income countries and less than 1% in the UK. The reasons why women avoid or stop breastfeeding range from the medical, cultural, and psychological, to physical discomfort and inconvenience. These matters are not trivial, and many mothers without support turn to a bottle of formula. Multiplied across populations and involving multinational commercial interests, this situation has catastrophic consequences on breastfeeding rates and the health of subsequent generations.

There are glimmers of hope. Despite—or perhaps, because of—the execrable provision for paid maternity leave in the USA, the Affordable Care Act provides protected nursing breaks and insurance cover for breast pumps. Such allowances, the Series predicts, could increase breastfeeding by 25%. But, more importantly, genuine and urgent commitment is needed from governments and health authorities to establish a new normal: where every support she needs to do so.

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.

Why invest, and what it will take to improve breastfeeding practices?http://www.thelancet.com/series/breastfeeding

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women’s work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry’s large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.

Breastfeeding: a smart investment in people and in economies

If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics. For while “breast is best” for lifelong health, it is also excellent economics. Breastfeeding is a child’s first inoculation against death, disease, and poverty, but also their most enduring investment in physical, cognitive, and social capacity.

Spotlight on infant formula: coordinated global action needed

Breastfeeding has often been described as cost free.1 It is not free. Breastfeeding requires investment to overcome the sociopolitical barriers that exist in many countries2,3 through the effective approaches and practices described in the second paper of the Lancet Breastfeeding Series.4 As shown in the first Series paper, infants, children, and mothers who do not breastfeed experience an increased risk of mortality and morbidity.5 Breastfeeding is nutritionally, immunologically, neurologically, endocrinologically, economically and ecologically superior to breastmilk substitutes (BMS), and does not require quality control of manufacture, transport, storage, and feeding mechanisms.

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