Opinion: We must improve the global state of breastfeeding

When it comes to breastfeeding, timing is everything. Around the world, newborns who are put to their mother’s breast within the first hour of life are more likely to survive, while those left waiting face life-threatening consequences. So why does a new study from United Nations Children's Fund and the World Health Organization show the majority of the world’s newborns wait too long before being put to the breast, or never breastfeed at all?

Breastfeeding is a challenging skill to learn, especially in the first moments after birth. Too often, poor policies, weak programs, and unskilled professionals make that challenge even greater: Outdated practices that separate mothers and babies after birth, rising rates of over-medicalized institutional deliveries, unnecessary cesarean sections, misleading information by health professionals, and aggressive marketing by the infant formula industry.

The latter is of concern. Formula sales are skyrocketing; according to an article published in The Lancet, total global sales are expected to reach a staggering $71 billion next year, up from about $45 billion in 2014. Research continues to show that the industry’s aggressive marketing is associated with lower breastfeeding rates, as formula feeding becomes more common around the world.

The data tells us that mothers who receive free formula samples when they are discharged from hospital breastfeed less, and that the widespread promotion of formula and other breast-milk substitutes leads to misinformation about breastfeeding, influencing families’ feeding decisions in ways that impact children throughout their lives.

This is why many countries are adopting legislation that is aligned with the International Code of Marketing of Breast-milk Substitutes, which seeks to ban the inappropriate marketing of infant formula and other breastmilk substitutes, such as the promotion of these products in the health care systems or to the broader public, using advertising and social media to promote formula, using special offers or price reductions to entice new customers, publicizing health claims on labels, idealizing formula products in text or images, providing free supplies to health facilities, and sponsoring the education and professional meetings of health workers.

The latest data by WHO and UNICEF indicate that currently, 136 countries have enacted legal measures related to the code, but only 35 countries have enacted all of its provisions.

Breastfeeding is one of the smartest investments a country can make. Improving breastfeeding practices could save the lives of more than 800,000 children every year. Breastfeeding acts as a baby’s first vaccine, with antibodies that provide infants with a critical immunity boost. It also promotes mother-child bonding and supports babies’ socio-emotional and cognitive development, which contribute to higher educational achievement and potentially greater earnings in adulthood.

Breastfeeding also provides children with safe water and hydration, which is particularly important in low- and middle-income countries, where access to safe drinking water is constrained. Mothers also reap important health benefits, including lower risk of breast and ovarian cancers, as well as type 2 diabetes.

The population-level effects of breastfeeding are powerful, but so is each personal story. While working in Africa and Asia, I have met thousands of mothers for whom the support of a breastfeeding counselor in the maternity ward at the time of delivery has been a game changer in their breastfeeding journey. I vividly remember how the placement of trained breastfeeding counselors in each state-run district hospital in Madhya Pradesh, India contributed to a twofold increase in the proportion of mothers who started breastfeeding their newborns within one hour of birth over a mere two-year period.

Every woman who wants to should be supported to breastfeed. But millions of mothers around the world stop breastfeeding before they want to because they don’t get the support they need.

A scorecard from WHO and UNICEF presents a daunting reality: Only nine countries in the world meet at least five of the seven recommended standards for supporting breastfeeding. This includes access to trained counselors, adequate maternity benefits, workplace time and space to breastfeed or express milk, and the regulation of the formula and baby food industries.

We’ve just completed World Breastfeeding Week, during which women, advocates, and policy experts across the globe shared inspirational stories and new insights about the benefits and importance of breastfeeding. Our mission now is to take that inspiration and translate it into action on policies that will provide true support for women.

The Global Breastfeeding Collective — led by UNICEF and  WHO — calls on governments, health care institutions, and health care workers to take several measures to break down existing barriers and improve the global state of breastfeeding. These include adequately funding programs that support early initiation of breastfeeding; adopting and enforcing the International Code of Marketing of Breastmilk Substitutes; establishing national and health facility-level policies that promote immediate skin-to-skin contact after birth; providing more breastfeeding counseling to all mothers; encouraging community support for breastfeeding; and tracking the data to measure progress on breastfeeding programs.

We know that early initiation of breastfeeding is a life-saving intervention, with the power to protect newborns when they are most vulnerable. Every woman should have the opportunity to do what she feels is best for her child and herself in those immediate moments after birth, with the support of skilled health workers, her family, and her community. Working together, governments, policy makers, health providers, and the media can help pave the way for healthier populations by supporting early breastfeeding. By making mothers and newborns a priority, we can capture the moment and give every newborn the best start to life.