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

Elsevier, The Lancet, Volume 401, Issue 10375, 11–17 February 2023, Pages 472-485
Prof Rafael Pérez-Escamilla PhD, Cecília Tomori PhD, Sonia Hernández-Cordero PhD, Phillip Baker PhD, Aluisio J D Barros PhD MD, France Bégin PhD, Donna J Chapman PhD, Laurence M Grummer-Strawn PhD, Prof David McCoy PhD, Purnima Menon PhD, Paulo Augusto Ribeiro Neves PhD, Ellen Piwoz PhD, Prof Nigel Rollins MD, Prof Cesar G Victora PhD MD, Prof Linda Richter PhD, 2023 Lancet Breastfeeding Series Group

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.