World Breastfeeding Week 2021: why aren’t more mothers breastfeeding?

The WHO recommends initiating breastfeeding within the first hour of an infant’s life and exclusively breastfeeding (meaning only breast milk, no other foods or liquids) for the first six months of life. From the age of six months, children can begin eating other safe foods while continuing to breastfeed for up to two years and beyond.

Despite the health benefits to both the child and mother, nearly two out of three infants are not exclusively breastfed for the recommended six months, a rate which has not improved in two decades. Scaling up breastfeeding can prevent 20,000 maternal deaths and $302 billion in economic losses annually – so what is preventing us from achieving better coverage?

Why are more infants not being exclusively breastfed?

Globally, rates of breastfeeding vary. The UK, for instance, has one of the worst rates of breastfeeding, where fewer than 1% of infants are still breastfed at one year. Many women, however, say that they want to breastfeed but face difficulties early on, and 8 out of 10 women stop before they want to. There are numerous complex reasons as to why women avoid or stop breastfeeding, with cultural, societal and psychological factors coming into play. Breastfeeding is a highly personal and emotive subject, with many families not breastfeeding at all or experiencing difficulties in trying to breastfeed. Women may lack access to public services and maternity support in the workplace, which, coupled with misleading marketing of breast milk substitutes, has meant that rates of breastfeeding remain low.

For breastfeeding rates to increase, women need face-to-face and continuous support during their pregnancy through the early weeks and months of their child’s life. There is strong evidence supporting the Baby Friendly Initiative as a key intervention to increase breastfeeding rates. Creating a supportive community for women is also fundamental. In Vietnam, the Alive and Thrive campaign (a collaboration between the Ministry of Health and UNICEF) developed advertisements, organised support groups and trained community workers in infant feeding. In 2009, fewer than 20% of babies were exclusively breastfed in Vietnam. By 2014, the Alive and Thrive campaign had reached more than 2.3 million mothers and exclusive breastfeeding increased to 62% in Alive and Thrive intense areas.

World Breastfeeding Week 2021: Sustainable Development Goals

A key target set by the World Health Assembly is to increase the global rate of exclusive breastfeeding for the first six months of life to at least 50% by 2025. Breastfeeding can also be linked to all 17 of the United Nations’ Sustainable Development Goals. It is one of the ‘smartest investments’ communities and countries can make, in that it can promote economic growth and reduce health inequalities.

We need to stop blaming low breastfeeding rates on women and acknowledge that this is a global public health imperative. The message is clear: by investing in women’s health and breastfeeding, the societal implications and benefits are far-reaching.

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.