Breastfeeding rates declined during the pandemic. Some countries show how we might be able to reverse the trend

Recent research on breastfeeding rates provide cause for concern – early studies in Italy and the United States found that exclusive breastfeeding rates decreased by as much as 15 percent during the pandemic. In South Africa, increased rates of hunger during lockdowns may have reduced breastfeeding rates, while in other countries hospitals adopted protocols calling for the separation of mothers and newborns to prevent the spread of COVID-19, which may have unintentionally undermined breastfeeding.

This year’s World Breastfeeding Week from August 1-7, seeks to bolster support for reversing the sudden decline in breastfeeding.

Decades of research around the world has found that optimal breastfeeding is linked to improved health outcomes for both mothers and children. The Lancet series in 2016 on breastfeeding found that “breastmilk makes the world healthier, smarter, and more equal.” The World Health Organization and UNICEF recommend early initiation of breastfeeding within one hour of birth; exclusive breastfeeding for the first six months of life; and continued breastfeeding for up to two years, or longer, with the introduction of nutritious and safe solid foods when the infant turns six months old.

The WHO aims to increase the rate of exclusive breastfeeding in the first 6 months to at least 50 percent. Nutrition International’s tool to measure the costs of low breastfeeding rates estimates that each year 595,379 children between the ages of 6 months to 59 months die from diarrhea and pneumonia as a result of no or sub-optimal breastfeeding. Currently, only 40 percent of children in low- and middle-income countries (LMICs) are breastfed within the first hour of life. Globally, only 38 percent of infants 6 months and under are exclusively breastfed.

There are four evidence-based strategies that can help accelerate progress toward this goal. These include: ensuring hospitals and health facilities support exclusive breastfeeding through adopting the Baby-Friendly Hospital Initiative; significantly limiting aggressive marketing of breast-milk substitutes through monitoring, enforcement, and legislation; empowering women by enacting six months of mandatory paid maternity leave, as well as policies that encourage women to breastfeed in the workplace and in public; and by strengthening community-based support, including through communication campaigns.

This last strategy reflects a wealth of research documenting how closely breastfeeding rates reflect support for mothers. This includes new research showing that children who are born during or just before a weekend are less likely to be breastfed, “owing to poorer breastfeeding support services in hospitals at weekends.” Further, research shows that breastfeeding rates can improve quickly when governments and health systems adopt the right set of policies.

Several countries demonstrate the potential of these four strategies and provide a potential pathway for progress for other countries looking to increase breastfeeding rates.

The Kyrgyz Republic, for example, first increased community support for mothers by passing Order N. 19 in 1996, which tasked community health workers with disseminating information about the importance of breastfeeding and optimal breastfeeding. Later, in 2000, the country adopted the WHO and UNICEF’s Baby Friendly Hospital Initiative which promoted the principles of successful breastfeeding in maternity hospitals. Finally, in 2008, the country restricted the marketing of breastmilk substitutes.

The combined impact was noteworthy. Between 1997 and 2012 the number of infants breastfed within one hour of birth increased from 44 percent to 84 percent and the number of infants breastfed within one day of birth increased from 67 percent to 95 percent. Similarly, the median duration of exclusive breastfeeding increased from less that one month to almost three months. This shift helped the country reduce stunting rates from 36 percent in 1997 to 12 percent in 2018.

In Nepal, the government also increased community support for women through investment in Female Community Health Volunteers, who were tasked with promoting optimal breastfeeding practices. Support and guidance from the volunteers, who are typically village women with basic health training, helped increase the rate of breastfeeding within one hour after birth from 18 percent to 55 percent between 1996 and 2016. Similarly, prelacteal feeding, a dangerous local custom whereby newborns are fed something other than breastmilk soon after delivery, decreased from 41 percent in 2001 to 29 percent in 2016.

Earlier this year, a team of researchers from Universidad Iberoamericana, Yale University, Alive & Thrive Southeast Asia/FHI 360, and Université de Montréal, published their findings on how Burkina Faso, the Philippines, Mexico, and the United States significantly increased breastfeeding rates. While each of these countries achieved progress through different means, the authors identified a few key similarities: “in all four countries, evidence-based advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment.”

Among their findings: in Burkina Faso, the awareness campaign “Stronger with breastmilk only” combined with support groups for mothers helped improve breastfeeding rates. As did the 2004 law that made women eligible for fully paid maternity leave of 14 weeks.

In Mexico, researchers found that the conditional cash transfer program Prospera helped empower women to breastfeed and a National Breastfeeding Strategy launched in 2014 called on healthcare providers to promote, protect, and support breastfeeding.

In the Philippines, the government began restricting the marketing of breastmilk substitutes in 1986. In 2008, it adopted a new national protocol that required hospitals to be more supportive of breastfeeding by not separating mothers and their babies, to encourage the early initiation of breastfeeding. Finally, in 2019, the country extended paid maternity leave to 105 days.

The authors identified aggressive marketing of breast-milk substitutes as a continued and significant threat to the progress made in each country.

This year’s World Breastfeeding Week will focus on what advocates call the “warm chain” – support for breastfeeding. This includes communities, healthcare providers, families, and workplaces who can help create breastfeeding-friendly environments for mothers. Advocates are also focused on the role breastfeeding can play in reaching the Sustainable Development Goals. Breastfeeding plays a huge role in nutrition, food security, and the reduction of inequalities. Indeed, gains in breastfeeding in both the Kyrgyz Republic and Nepal helped reduce childhood stunting rates in those countries.