The Lancet Breastfeeding series

Despite many of the benefits of breastfeeding having been clearly established for years, rates of breastfeeding have not substantially increased in the last two decades. In January 2016, the prestigious medical journal The Lancet published the most comprehensive analysis of breastfeeding yet undertaken. It found that, globally, only 35.7% of children are exclusively breastfed for the first six months.

Breastfeeding is among the few positive health- related behaviours that are not correlated with national wealth: in high-income countries, fewer than 20% of children are breastfed for 12 months. Even in low- and middle-income countries, there is plenty of room for improvement: a third of children aged between 6 months and 2 years receive no breast milk. From systematic reviews and meta- analyses of more than 1300 studies from around the world, The Lancet found that shortfalls in breastfeeding are responsible for:

• economic losses of USD 300 billion each year related to the lower cognitive abilities developed by children who are not breastfed – breastfeeding is associated with a three-point increase in IQ scores
• about 820,000 deaths of children each year
• about 20,000 deaths of mothers from breast cancer, the risk of which is reduced by breastfeeding
• nearly half of all cases of diarrhoea in low- and middle-income countries
• one-third of all respiratory infections in low- and middle-income countries
• billions of dollars spent on treatment costs of common childhood illnesses that breastfeeding helps to prevent – for example, a 90% breastfeeding rate in the USA would save USD 2.45 billion in healthcare spending.

Why do more women not breastfeed? The Lancet identifies several factors including:

• inadequate maternity leave in many countries – for example, mothers with more than six weeks of maternity leave are four times as likely to persevere with breastfeeding as those given less than six weeks of leave
• healthcare providers not having enough knowledge or capacity to disseminate accurate information on the value of breastfeeding, or to provide support to breastfeeding mothers
• lack of support from family or community, linked to negative cultural traditions and social attitudes towards breastfeeding – a factor which can be addressed through public information campaigns
• aggressive marketing of breast milk substitutes such as infant formula, involving sums that far exceed those spent on campaigns to promote breastfeeding; many countries have implemented the World Health Organization’s International Code of Marketing of Breast-milk Substitutes only partially or not at all.

‘Supporting breastfeeding makes economic sense for rich and poor countries and this latest breastfeeding study proves it,’ said the co-lead of The Lancet Breastfeeding Series, Dr Cesar G. Victora, Emeritus Professor of Epidemiology at the Federal University of Pelotas in Brazil. ‘Breastfeeding is a powerful and unique intervention that benefits mothers and children, yet breastfeeding rates are not improving as we would like them to – and, in some countries, are declining. We hope the scientific evidence amassed in this Series will help revert these negative trends and create a healthier society for everyone – mother, child, poor and rich.’