An age-old cure for what ails the world

By Shawn Baker, Cesar Victora 01 February 2016

Kokeb Negussie breast-feeds her son Moges in Ethiopia. Globally, breast-feeding could save about 820,000 lives a year. Photo by: UNICEF Ethiopia / CC BY-NC-ND

Ever since the Millennium Development Goals were adopted in 2000, many wondered how the world would look 15 years later. Looking back, we can see tremendous progress: more children survive, more girls are in school, and more women have access to family planning and economic opportunity. Now, moving forward towards the 2030 Sustainable Development Goals, there is unprecedented energy to further this success — and that challenges us to aim higher.

As we look for the next great drivers of change, innovation is critical. But we must not forget long existing, low-cost, proven approaches. One of these could add billions of dollars to the global economy and save hundreds of thousands of lives each year, increase educational achievement and productivity, and decrease the incidence of cancer.

It sounds almost too good to be true, right? It’s not. It’s breast-feeding.

As a perfectly adapted nutritional supply, breast milk is the ultimate personalized medicine. It has evolved over millions of years into an exquisite substance that, while low-tech, is in fact incredibly sophisticated. This isn’t just for poorer countries; breast-feeding has many benefits for women and children, regardless of where they live. And there is new research to back this up.

A new two-part series published in The Lancet is the most comprehensive review of breast-feeding research ever conducted. The results confirm that breast-feeding is still one of the best investments we can make in maternal and child health. The numbers speak for themselves.

Globally, breast-feeding could save about 820,000 lives a year, 87 percent of them infants under six months of age. Nearly half of all diarrhea episodes and one-third of all respiratory infections could be prevented with increased breast-feeding in low- and middle-income countries.

Longer breast-feeding in infancy and early childhood is associated with higher performance on intelligence tests among children and adolescents — which in turn can translate into improved academic performance and increased long-term earnings. And for each year a mother breast-feeds, her risk of developing invasive breast cancer decreases by 6 percent and her risk of ovarian cancer may fall as well.

Yet The Lancet series shows that millions of babies around the world are missing out on this opportunity. On average, the data show that mothers in wealthy countries breast-feed for a shorter amount of time than mothers in low and middle-income countries. However, even in low-and middle-income countries, only 37 percent of infants are breast-fed exclusively in their first six months.

Though children will bear the greatest burden, we are all already paying the price. Given the link between breast-feeding, intelligence and economic productivity, The Lancet series shows that high-income countries lose more than $230 billion annually due to low rates of breast-feeding, while low- and middle-income countries lose more than $70 billion annually.

The Lancet series offers a comprehensive road map for all countries — wealthy and poor alike — to support mothers and their families so that children can benefit from breast-feeding. With the right combination of policies and programs that support, promote, and protect breast-feeding, the series authors estimate exclusive breast-feeding rates may be increased by 2.5 times.

Several countries are leading the way. Countries as diverse as Bangladesh, Burkina Faso, Malawi, Peru, and Zambia have implemented various strategies to increase breast-feeding rates over the last several years.

Brazil is another country that has made tremendous progress in a rapid amount of time. In the early 1980s, the average duration of breast-feeding for Brazilian children was about three months — now it’s more than one year, on average.

How did they do it? Increasing paid maternity leave played a role, as did banning the advertisement of infant formula in hospitals, which is aligned with the International Code of Marketing of Breastmilk Substitutes. Brazil has the world’s largest network of human milk banks. And the government also expanded the availability of one-on-one counseling for new mothers after birth.

More importantly, like other countries where huge increases have been achieved, what really fueled change was political commitment at the highest levels of the Brazilian government. Once breast-feeding shifted from being a women’s issue and a mother’s issue to a national priority — change was dramatic.

This August, Brazil will host world leaders in Rio de Janeiro to mark the second Nutrition for Growth summit alongside the 2016 summer Olympics. In the spirit of Brazil’s leadership, all countries should come with a commitment on how they plan to make breast-feeding a national priority.

Women should not be made to feel guilty for not breast-feeding. Yet countries and societies must bear greater responsibility for providing the right policies, incentives, and supports that are essential for women to successfully breast-feed.

New, actionable commitments to support, protect and promote breast-feeding — in line with the series recommendations — could transform the lives of mothers and families around the world. Our evidence base for action is clear, and it’s only going to continue growing. The time to fully embrace this simple, yet sophisticated, solution to health and economic growth is now.

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.

About the authors

Shawn baker
Shawn Baker

Shawn Baker is the director of the nutrition team at the Bill & Melinda Gates Foundation. He leads the foundation’s efforts to ensure that women and children receive the nutrition they need for healthy growth and development.


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Cesar Victora

Cesar Victora is emeritus professor of epidemiology at the Federal University of Pelotas in Brazil and has honorary appointments at Harvard, Oxford and Johns Hopkins University, and the London School of Hygiene and Tropical Medicine. He has conducted extensive research in maternal and child health and nutrition, birth cohort studies, inequalities in health, and on the evaluation of the impact of major global health programs.


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