Breastfeeding should be promoted as the natural way of feeding among the general public

Parents usually make decisions on infant feeding shortly before or early in pregnancy. The choice, however, can be influenced by attitudes established long before a pregnancy is even contemplated. It is therefore 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. It is important that boys and men should also receive infant feeding information because, as potential future fathers, they will have an important supportive role to play in the decision to breastfeed and in the success of breastfeeding.

Health education classes and antenatal services offer effective promotion tools

Health education classes specifically dedicated to breastfeeding and regular contacts with competent health workers, lactation consultants and/or peer counsellors, are an effective way to promote the initiation and extend the duration of breastfeeding, especially when continued after childbirth (Renfrew et al., 2005). The use of printed material alone, such as information booklets given to mothers, has not been found to be effective.

The health care system should not only ensure easier access to services but also identify and remove barriers (e.g. geographical, economic, linguistic, and cultural) that may make women less likely to use existing antenatal care services. For example, women from ethnic minority groups, adolescent mothers, women from lower socio-economic groups, and women who left school early may not use antenatal care services even when access is freely available. This may require alternative service provision specifically adapted to meet the needs of these vulnerable expectant mothers.

Baby Friendly Hospital Initiative offers effective support for breastfeeding mothers

Optimal care for the effective initiation and establishment of exclusive breastfeeding is the same whether the birth takes place at home, at a birth centre, or in a maternity hospital setting. In all these places, the application of the Ten Steps for Successful Breastfeeding of the Baby Friendly Hospital Initiative has proven to be effective (Kramer et al., 2001; Cattaneo & Buzzetti, 2001). In particular, rooming-in which allows breastfeeding on demand, results in ample milk production and helps establish an adequate lactation thus overcoming the often perceived problem of lack or insufficiency of breast milk. Hospital stay after delivery, however, is short and tends to become shorter. It is therefore essential that Baby Friendly practices be implemented also in primary health care and community services (see the Seven Steps for the Protection, Promotion and Support of Breastfeeding in Community Health Care Settings for more detailed information).

Some mothers require special support to continue breastfeeding

Women with particular breastfeeding difficulties need timely access to expert help and support to continue breastfeeding; those who stop breastfeeding before they wanted or planned to should be encouraged and assisted to examine the reasons for this, to help reduce feelings of loss and failure, and to ensure this experience does not adversely affect future infant feeding experiences. Mothers of ill or preterm infants need special support to ensure their lactation is maintained while their babies are unable or too ill to breastfeed. They should also get information on the safe handling and storage of expressed breast milk. This support should include the free provision of breast pumps and assistance with travel and accommodation to ensure they can be near or with their babies as much as possible.

Social and community interventions should be implemented to support breastfeeding

Collaborative projects involving voluntary and statutory services offering both expert and peer support to breastfeeding families and their social networks are to be encouraged. Supporting and protecting the right of women to breastfeed their babies whenever and wherever the need arises is fundamental. National and local initiatives which promote social acceptability of breastfeeding outside the home should be encouraged. If needed, governments should be urged to put in place legislation which protects a mother’s right to breastfeed in public. All these initiatives should specifically address the needs of women less likely to breastfeed, such as women having their first child, immigrants, adolescents, single mothers and less educated women.

Well co-ordinated and funded policies and plans are needed at a national and local level

Given the importance of a 'warm chain for breastfeeding' for public health, sound national and local policies and plans should be developed and implemented to protect, promote and support it. As stated in the Innocenti Declaration, all governments should establish or strengthen national infant and young child feeding authorities and coordinating committees that will adequately manage and fund planned interventions.

Moreover, policies and plans should make sure that both pre- and in-service training on breastfeeding for all health worker groups, including pharmacists, require a level of competency to be attained that meets best practice standards. Health workers should be trained not only on the scientific foundations and practical details of infant and young child feeding, but also on counselling and communication. In addition to individual communication provided by health workers to mothers and their families, policies and plans should include activities for social communication geared to behavioural and social change. In particular, media portrayals of infant and young child feeding should be monitored and media organisations should be guided and encouraged to depict and promote breastfeeding as normal, achievable and desirable.