Breastfeeding is the ideal method of feeding and nurturing infants for their optimal nutrition, growth, and health. WHO, UNICEF, USAID and other international partners recommend that infants should be exclusively breastfed for the first six months and, from six months up to two years and beyond, infants should continue being breastfed and receive adequate and safe complementary foods to meet their nutritional requirements (WHO et al., 2007). Support for government policies and programs to promote breastfeeding and timely initiation of healthy complementary feeds are directly in keeping with Millennium Development Goals # 1. reduce poverty and hunger and # 4. reduce infant mortality, and indirectly related to #5. improve maternal health.  Achieving the goal of improved breastfeeding practices, however, presents major challenges, given recent data showing only 39% of children globally are breastfed for four months and the rates are even lower for the recommended six months (WHO 2008).

Epidemiologic research has clearly demonstrated that breastfeeding provides health and development advantages to infants while significantly decreasing the risk for a large number of acute and chronic diseases. Exclusively breastfed infants are at a much lower risk of diarrhea and acute respiratory infections, two leading causes of infant death, than are infants who receive other liquids and foods in addition to breast milk during their first months of life (UNICEF, 2009). Breast milk stimulates infants’ immune systems and response to vaccinations, and it contains hundreds of health-enhancing antibodies and enzymes. An additional benefit of exclusive breastfeeding is that it protects the mother from pregnancy during the early postpartum period and can be used intentionally for family planning if she meets the three lactational amenorrhea method (LAM) criteria: (1) the mother’s period has not returned; (2) the infant is fully or nearly fully breastfed and is fed often, day and night; and (3) the infant is less than six months old (USAID, 2008).

Early initiation of breastfeeding shortly after birth improves the likelihood that mothers will be able to successfully initiate lactation, will encounter fewer problems breastfeeding, and will be able to maintain optimal breastfeeding behaviors. Breastfeeding should begin no later than one hour after the delivery of the infant. Skin-to-skin contact between mother and infant is important for bonding, maintaining infant body warmth, and may stimulate mother and infant, thereby facilitating suckling (Sheau-Huey and Anderson, 2009). Early use of water and substitute feeds postpartum can interfere with the initiation and success of breastfeeding.

In contrast to the benefits of breastfeeding, breast milk substitutes and feeding bottles have high risks for contamination that can lead to life threatening infections. Infant formula is not sterile, can be mixed with contaminated water, and/or improperly diluted. In 1981, the World Health Assembly (WHA) adopted the International Code of Marketing of Breast-milk Substitutes as the minimum international standard for the proper use of breast milk substitutes (WHO, 1981). The WHA has adopted subsequent resolutions and in 2002, WHO Member States endorsed the Global Strategy for Infant and Young Child Feeding that includes the Code and further resolutions, the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, as well as the, Baby-Friendly Hospital Initiative (WHO, 2008; WHO, 2009).

In 2007, WHO held a global consensus meeting on assessing infant and child feeding which identified a set of eight core and seven optional indicators that are population-based and can be derived from household surveys, such as DHS. The goal of the common set of indicators is to standardize the assessment and evaluation of breastfeeding and infant feeding behaviors across programs implemented and funded by different organizations. For further information on the consensus recommendations for breastfeeding, complementary feeding and food diversity indicators, see Indicators for assessing infant and young child feeding practices, (WHO et al., 2007). Three of the five core indicators selected for this database are from the WHO consensus indicators and are being used for macro-level surveillance of regional and national breastfeeding practices and trends (WHO, 2010). One indicator reflects country-level policies on adopting the WHO and WHA recommendations for use of breastmilk substitutes and a second indicator measures use of LAM for family planning. Evaluators can use the indicators as outcome variables in measuring behavior change due to program interventions in the context of an experimental or quasi-experimental design and for the purpose of tracking breastfeeding behavior among clients.  

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References:

Sheau-Huey Chiu, Anderson G C, 2009, Effect of Early Skin-to-Skin Contact on Mother-Preterm Infant Interaction Through 18 Months: Randomized Controlled Trial, International Journal Nursing Studies; 46(9):1168.

USAID, 2008, The Lactational Amenorrhea Method (LAM): A Postpartum Contraceptive Choice for Women Who Breastfeed, Washington, DC:USAID. https://www.globalhealthlearning.org/sites/default/files/page-files/The%20LAM_A%20postpartum%20contracep%20choice.pdf

WHO, UNICEF, UC Davis, USAID, IFPRI, 2007, Indicators for assessing infant and young child feeding practices. Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241596664_eng.pdf

WHO, 1981, The International Code of Marketing Breast-Milk Substitutes, Geneva. http://whqlibdoc.who.int/publications/9241541601.pdf 

WHO, 2008, The International Code of Marketing Breast-Milk Substitutes: Frequently Asked Questions, Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241594295_eng.pdf

WHO, 2009, Baby Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care. Geneva: WHO http://www.unicef.org/nutrition/files/BFHI_section_2_2009_eng.pdf

WHO, 2010, Integrated WHO Nutrition Global Database: Nutrition Landscape Information System (NLIS). http://www.who.int/nutrition/nlis/en/