EU comparisons are restricted by limited available data

Not all EU member states gather regular data on breastfeeding. Even less produce data on trends. The ECHI shortlist recommends using the rates of breastfeeding at 48 hours and at 3 and 6 months as indicators. The WHO-HFA database offers data for breastfeeding at 3 and at 6 months of age (see Percentage of infants breastfed at 3 months of age in the EU-27; Percentage of infants breastfed at 6 months of age in the EU-27).

Accurate comparisons are difficult because of methodological issues, especially in the case of breastfeeding at 48 hours. For example, the precise definitions of breastfeeding may differ: the data reported in the table may include different degrees of exclusive breastfeeding. Also, the methods through which data were gathered may be different: from surveys using the last 24 hours as recall period to interviews administered to mothers of older children asking them to recall the breastfeeding status at 3 or 6 months after much longer time (Cattaneo et al., 2000; Aarts et al., 2000; Cattaneo et al., 2005).

Very roughly, considering data currently available in the WHO-HFA database and other data reported by countries participating in EU-funded projects (Cattaneo et al., 2005), it would appear that initiation, exclusivity and duration are relatively high in Scandinavian countries, lower in Belgium, France, Greece, Ireland and UK, and in between in all other countries. More accurate comparisons of breastfeeding rates are currently impossible.

Breastfeeding rates in the EU are below WHO guidelines but on the rise

Though accurate comparisons are impossible, it is clear that the rates of initiation, exclusivity and duration of breastfeeding in EU countries fall short of WHO recommendations. This is also true for the rest of the world, including low income countries (Lauer et al., 2004). The scanty data available from EU countries, however, often at sub-national level, seem to indicate an upward trend since the mid 1990s (see Trends in percentage of infants breastfed at 3 months of age; Trends in percentage of infants breastfed at 6 months of age). A limited number of studies have also shown that the rates of breastfeeding initiation, exclusivity and duration in the EU are lower in lower social class families and particularly in children of less educated mothers (Yngve & Sjostrom, 2001).

There is a need for appropriate and comparable data collection systems

WHO recommends using standard definitions for breastfeeding and standard methods for collecting data worldwide, see Definitions of breastfeeding recommended by WHO. These have been used in surveys worldwide over the past 15 years, but not in EU countries. More recently, WHO has proposed a standard set of eight “core” and seven “optional” indicators on infant and young child feeding based on the above definitions, see Set of infant and young child feeding indicators proposed by WHO. Data collection systems in European countries should adopt WHO definitions, methods and indicators to ensure that future data collected can be used in international comparisons. Data collection should also be carried out using an equity lens. This requires the collection of data on the socio-economic determinants of infant feeding (e.g. data on the numbers of low income mothers breastfeeding) (Yngve & Sjostrom, 2001).