Breastfeeding is the natural and normal way to feed infants and young children

Breastfeeding is the natural and normal way to feed infants and young children. Breast milk alone provides all the nutrients an infant requires to grow well until about six months. After six months, breastfeeding, with appropriate complementary foods, continues to contribute to the optimal growth of infants and young children. Perhaps more important than its nutritional function, along with its positive effect on bonding and attachment, is breastfeeding’s protective role. The composition of breast milk changes in response to the needs of the baby, during a feed, during the day, and over time. Breast milk, unlike artificial substitutes, adjusts to each infant's needs for growth and development. Formula feeding, therefore, should be used only in medically recommended situations. Lack of breastfeeding is associated with an increased risk of harm for the baby and the mother.

Comparisons between EU countries are problematic

In the EU not all the countries gather regular data on breastfeeding. Even less produce data on trends. Comparisons among countries are not easy; the definitions and methods of data collection are different. From available evidence it appears that initiation, exclusivity and duration of breastfeeding are higher in Scandinavian countries, lower in Belgium, France, Greece, Ireland and UK, and in between in the remaining countries. The reported rates in any case fall short of what is recommended, though most countries appear to be showing an upward trend since the mid 1990s. Breastfeeding initiation, exclusivity and duration are lower in lower social class families and in children of less educated mothers.

Increased risk for illnesses and disorders due to lack of breastfeeding

A lack of breastfeeding is associated with an increased risk of illness in childhood, in particular of diarrhoea and respiratory infections, and through adult life. In low income countries lack of breastfeeding is associated with an increased risk of mortality in childhood. The longer the lack of breastfeeding and the shorter its exclusivity, the greater the risk of harm created. Lack of breastfeeding is also associated with increased risks for the mother and increased costs for families, health care systems and society in general.

Breastfeeding rates and exclusivity fall short of the recommendations

In some EU countries only about 50% of mothers initiate breastfeeding. Even where initiation rates are higher, many mothers experience breastfeeding problems during the first few weeks due to lack of knowledge and little self confidence, and inadequate support for good positioning and latching. Low initiation rates and high incidence of initial problems are typical of bottle feeding cultures. Good initiation alone, however, is insufficient. Support for the continuation of exclusive breastfeeding up to six months is also necessary.

Breastfeeding rates tend to fall between 4 and 6 months due to mothers receiving inaccurate advice from different sources and/or the need to return to an active work life. Better social protection for working mothers has been shown to be beneficial to overall child health, in addition to breastfeeding. Mothers of preterm and sick infants, who may benefit even more than healthy term infants from exclusive breastfeeding, need special support at both hospital and community level. In addition, the early and inappropriate use of aggressively marketed formula or other breast milk substitutes contributes to non-exclusive or shorter-than-desirable breastfeeding.

The presence of environmental contaminants in breast milk is not associated with health risks; on the contrary, breastfeeding appears to reduce or revert the damage caused to the newborn by the exposure to the same contaminants during pregnancy. Alcohol and smoking should, however, be avoided or reduced to a minimum in pregnancy and during breastfeeding.

Promoting exclusive and long term breastfeeding

It is important to represent breastfeeding to the general public as the natural way to feed infants, and create an environment where breastfeeding becomes the normal, easy and preferred choice for the vast majority of parents. Health education classes and multiple individual contacts with competent health professionals and/or peer counsellors during pregnancy are an effective way to promote the initiation and extend the duration of breastfeeding.

The application of the 10 Steps for Successful Breastfeeding of the Baby Friendly Hospital Initiative around childbirth is also effective, but it is essential to provide individual competent support in the weeks following birth as well, to establish adequate lactation and exclusive breastfeeding. Mothers of ill or preterm infants need special support to maintain lactation while their babies are unable or too ill to breastfeed.

Social networks offering both expert and peer support to breastfeeding families are to be encouraged, as well as measures to protect the right of women to breastfeed their babies whenever and wherever they need. All these initiatives should address specifically the needs of women less likely to breastfeed, such as women having their first child, immigrants, adolescents, single mothers and less educated women. Last but not least, sound national and local policies and plans, dealing also with pre- and in-service training of health professionals, should be developed and implemented to protect, promote and support breastfeeding.