Breastfeeding: crucially important, but increasingly challenged in a market-driven world

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.

Automated summary

In this Series paper, the interactions between individual-level mother and baby attributes and determinants of breastfeeding at other levels are examined, as well as their impact on breastfeeding outcomes and the necessary policies and interventions to achieve optimal breastfeeding. Prelacteal feeds and perceived insufficient milk are identified as common barriers to breastfeeding. The commercial milk formula (CMF) industry exploits these concerns with unfounded claims and advertising. Multilevel and multicomponent interventions across the socioecological model and settings have been shown to rapidly improve breastfeeding practices at a population level. Breastfeeding requires collective societal approaches that address gender inequities.