22 November 2016

Ethiopia: Exclusive Breastfeeding Prevents Child Deaths

Kokeb Negussie breastfeeding her son Moges.

Solutions are often not very simple, but when it comes to breastfeeding the evidence is overwhelming. A new series of articles published in the British medical journal The Lancet add more proof to the fact that exclusive breastfeeding for the first six months of a child's life is a substantial health benefit for both mothers and children. In short, it saves lives.

What makes the topic unique is the fact that it is a global issue. Some of the world's poorest countries have great breastfeeding rates while some of the wealthiest are near the bottom. Rwanda's exclusive breastfeeding rate of 85 percent is best in the world, while Finland, the UK, and Greece share the bottom position at 1 percent.

"This is not some sub-rate intervention we try to flog onto poor countries," Shawn Baker, director of the nutrition team at the Gates Foundation, said in an interview with Humanosphere. "It is excellent in any setting."

The new research, with financial back from the Gates Foundation, analysed more than 1,300 studies from around the world on breastfeeding. Raising the global exclusive breastfeeding rate to near-universal levels can save more than 800,000 lives per year, estimate the researchers. That would cut out 13 per cent of all preventable child deaths.

In addition to having healthier children, mothers benefit as well. The risk of ovarian cancer is reduced thanks to breastfeeding. And women who breastfeed for more than two years in their lifetime see the risk of invasive breast cancer cut by 6 per cent. Increasing breastfeeding rates would mean that the nearly 20,000 cases of breast cancer avoided each year globally would double.

What makes the research important is that it is a cross-cutting issue around the world and the preponderance of evidence on the benefits of breastfeeding is overwhelming. A second paper in the series examines the things that impact breastfeeding rates, such as limited to non-existent maternity leave, lack of support for mothers, and knowledge gaps among healthcare providers. One major concern is the marketing and sales of breast milk substitutes.

"When infant formula is promoted through the health system and is seen as the default option, it could lead to lower breastfeeding rates," said Baker. "This is not a blame-the-mother approach. This is first and foremost creating an environment where this is a viable option."

Baker and the report authors are careful to point out that not all use of substitutes is bad. There are mothers who for varying reasons are unable to exclusively breastfeed or breastfeed at all. However, that should be the exception rather than a rule. A commentary with the series by The Lancet Global Health editor Zoë Mullan says that breastfeeding should not be a public debate.

"Women should not feel bullied or emotionally blackmailed into breastfeeding by one over-zealous section of society any more than they should be made to feel ashamed for breastfeeding in public by another," writes Mullan. "Breast milk provided exclusively for at least 6 months is unequivocally the best nutrition a baby can receive; women and their families need respectful advice to make the choice wherever that is possible."

The World Health Assembly set the target of a 50 per cent global exclusive breastfeeding rate by 2025. Currently, the rate is only 35.7 per cent. There is a long way to go. The studies show that programmes supporting families can improve breastfeeding rates. For example, counselling services in Bangladesh include the mother-in-law and father of the child, both have significant influence on whether a mother breastfeeds her baby.

"Sometimes the big new shiny object is more attractive than something that has been around since we've existed as a species," said Baker. "The analyses show that exclusive breastfeeding is such a powerful intervention for the health of the kids and the mum. It is a rational investment."

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