Breastfeeding: a simple, costless and effective action

Globally, breastfeeding has the potential to prevent about 800 000 deaths among children under five each year. While early initiation of breastfeeding could prevent about one fifth of neonatal deaths worldwide, less than half of infants are put to the breast within one hour of birth.

Credit: WHO /Petterik Wiggers.

Breastfeeding has a lifelong impact on health and survival of newborns, infants and young children. Breast milk is the ideal food for newborns and infants: it gives all the nutrients they need and contains antibodies that help protect them from common childhood illnesses, such as diarrhoea and pneumonia, two leading causes of mortality in children under 5 years old in the African Region.

Proper infant and young child feeding is key to improving child survival and promoting healthy growth and development, thus contributing to the attainment of Millennium Development Goal 4 of reducing by two thirds, between 1990 and 2015, the under-five mortality rate.

WHO recommends that all infants should be exclusively breastfed starting within one hour of birth and for the first 6 months of life. Exclusive breastfeeding, according to the Innocenti Declaration, means that no other drink or food is given to the infant. Worldwide, the actual practice is low at 38%.

After 6 months, nutritious complementary foods should be added while continuing to breastfeed for up to 2 years or beyond. Globally, only about half of children aged between 20 and 23 months are still breastfed.

Evidence-based recommendations

Over 30 studies from around the world, in developing as well as developed countries, have shown that breastfeeding dramatically reduces the risk of dying. A WHO pooled analysis indicates that breastfeeding could prevent more than three quarters of deaths in early infancy, and 37% of deaths during the second year of life.

A study in Ghana revealed that infants who were exclusively breastfed during the first hour of life were 9 times less likely to die than those who were initiated into mixed formula and breast milk within 72 hours of birth.

Data from the African Health Observatory shows that in the great majority of countries of the African Region the rate of children exclusively breastfed in the first six months is quite low, with an average of 35% for the 2007-2012 period. WHO global target is to increase exclusive breastfeeding in the first 6 months to at least 50% by 2025.

Early initiation of breastfeeding in the Region shows a similar trend (48%) between 2006 and 2011. The percentage of children 6–8 months introduced to solid, semi-solid or soft foods is high, with a regional average of 71% in 2011.

Training professionals to support mothers

Breastfeeding has to be learned, and many women encounter difficulties at the beginning. To enable a mother to breastfeed, a team involving family, community, health care professionals (with specific tools), policy makers and champions is needed. Mothers and families also need to be supported for their children to be optimally breastfed. 

Healthcare professionals, especially midwives, will help determine the success or failure of breastfeeding. Postnatal care must also be provided. Home-based support by community health workers specifically trained in breastfeeding support has proved to be effective during pregnancy, in the first weeks after childbirth and beyond.

Demystifying current misconceptions about breastfeeding and the adoption and promotion of conducive policies are all necessary.

WHO and UNICEF have developed courses for health workers, such as Breastfeeding counselling: a training course and Infant and young child feeding counselling – An integrated course.

On the occasion of the World Breastfeeding Week 2014, WHO has made available several infographics and other multimedia resources, which highlight the role of the health professionals, as well as that of the community and relatives, and can be used by countries as part of their national breastfeeding promotion strategy.

WHO also provides guidance to countries for promoting and supporting improved infant feeding by HIV-infected mothers.

Useful documents

Global strategy for infant and young child feeding
Maternal, infant and young child nutrition: implementation plan
Every newborn: an action plan to end preventable deaths
Child survival: A strategy for the African Region
Progress report on “Child survival: A strategy for the African Region”
Progress in implementing the child survival strategy in the African Region, The African Health Monitor, issue 11
International Code of Marketing of Breast-milk Substitutes
Country implementation of the International Code of Marketing of Breast-milk Substitutes – status report 2011
Infant and young child feeding factsheet (updated February 2014)
Global targets 2025 – nutrition

Technical resources
Breastfeeding Counselling (BFC) and HIV counselling training: Follow-up assessment tool
Integrated management of childhood illness computerized training tool
Guidelines on HIV and infant feeding 2010
Evidence for the ten steps to successful breastfeeding
Infant and young child feeding list of publications
Documents on infant feeding/breastfeeding

Other resources
Early initiation of breastfeeding brochure
10 facts about breastfeeding
Child survival in the WHO African Region – flyer
Baby-friendly Hospital Initiative
World Breastfeeding Week 2014 – WHO message

Data and statistics
Atlas of African Health Statistics 2014
The WHO Global Data Bank on Infant and Young Child Feeding
The Global Database on the Implementation of Nutrition Action (GINA)