Breastfeeding

Exclusive Breastfeeding

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. A recent review of evidence has shown that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO and UNICEF recommend:

Initiation of breastfeeding within the first hour of life

Exclusive breastfeeding – that is the infant only receives breastmilk without any additional food or drink, not even water

Breastfeeding on demand – that is as often as the child wants, day and night

No use of bottles, teats or pacifiers

Breastmilk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life.

Breastmilk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. These effects can be measured in resource-poor and affluent societies (Kramer M et al Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. Journal of the American Medical Association, 2001, 285 (4): 413-420)

Breastfeeding contributes to the health and well-being of mothers, it helps to space children, reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a secure way of feeding and is safe for the environment.

While breastfeeding is a natural act, it is also a learned behaviour. An extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices. WHO and UNICEF launched the Baby-friendly Hospital Initiative in 1992, to strengthen maternity practices to support breastfeeding. The foundation for the BFHI are the Ten Steps to Successful Breastfeeding described in Protecting, Promoting and Supporting Breastfeeding: a Joint WHO/UNICEF Statement. The evidence for the effectiveness of the Ten Steps has been summarized in a scientific review document.

The BFHI has been implemented in about 16.000 hospitals in 171 countries and it has contributed to improving the establishment of exclusive breastfeeding world-wide. While improved maternity services help to increase the initiation of exclusive breastfeeding, support throughout the health system is required to help mothers sustain exclusive breastfeeding.

WHO and UNICEF developed the 40-hour Breastfeeding Counselling: A training course to train a cadre of health workers that can provide skilled support to breastfeeding mothers and help them overcome problems. Basic breastfeeding support skills are also part of the 11-day Integrated Management of Childhood Illness training course for first-level health workers, which combines skills for adequate case management with preventive care. Evaluation of breastfeeding counselling delivered by trained health professionals as well as community workers has shown that this is an effective intervention to improve exclusive breastfeeding rates (link to graph)