Global breastfeeding efforts: a long way to go

Breastfeeding promotion and support are important public health tasks. The World Health Organization (WHO) recommends that infants be exclusively breastfed until 6 months of age and continue to be breastfed and fed safe and adequate solid food up to 2 years of age or older. There have been significant global policy efforts to promote breastfeeding over the years, such as the WHO international code of marketing breast milk substitutes (1981), the WHO or United Nations Children's Fund joint statement on protecting, promoting, and supporting breastfeeding (1982), the innocenti declaration on the protection, promotion, and support of breastfeeding (1990) and the baby-friendly hospital initiative (1992).

However, despite such efforts and the numerous benefits of breastfeeding initiation and continuation for both mothers and babies, their rates remain low in many countries. In 2016–2022, 46% of newborns were breastfeeding within 1 hour of birth, which falls short of the target of 70%. During this period, 48% of infants younger than 6 months were exclusively breastfed. Efforts target achieving a rate of 70% of the global population by 2030 [1].

Many barriers hinder exclusive breastfeeding. According to one meta-analysis, the most commonly reported barriers were the perception of insufficient breast milk, caesarean section birth, lack of mothers’ knowledge, inappropriate communication with healthcare providers, negative influence from family members and society, the need to resume work or school, traditional community practices, and lack of privacy in private and public spaces [2]. Maternal age also affects breastfeeding. According to the WHO, girls aged 15–19 years give birth to 12 million babies annually in developing countries. Adolescent mothers often face poor socioeconomic conditions. Moreover, they have a higher rate of obstetric complications, which can further hinder breastfeeding.

Pediatricians have the mission of promoting and supporting breastfeeding for child health, and their activities impact both individual and policy levels. Pediatricians are usually the first medical personnel to care for babies after hospital discharge and help mothers and their babies overcome various barriers. Even before birth, pediatricians play an important role in encouraging breastfeeding. The International Pediatric Association endorses the 1990 Innocenti Declaration, which recommends the establishment of a national coordination committee for breastfeeding and implement the “10 steps to successful breastfeeding” [3]. Interventions before and after birth can improve breastfeeding initiation and continuation [4,5]. Interventions vary according to individual or systemic approaches, periods (e.g., prenatal/peripartum/postnatal) and the specific methods applied (Fig. 1). Moreover, research has shown that both face-to-face and digital devices are effective [5,6]. Since women of childbearing age, especially adolescents, are active social media users, social media platforms can be used to promote messages to encourage breastfeeding, and online interventions can be easily accessed. On the one hand, the rates of breastfeeding initiation, exclusive breastfeeding, and a total duration of 2 years in young mothers are lower than those of older mothers. Adolescent mothers have greater breastfeeding requirements. Comprehensive efforts are needed, including family (especially mothers), peers, health providers, schools, communities, and policymakers. These interventions are also effective at promoting breastfeeding among adolescents and young mothers [7-9].

Fig. 1.

Interventions to encourage breastfeeding.

In a recent issue of Clinical and Experimental Pediatrics, Triadmajani et al. [10] conducted a cross-sectional study investigating the association between proper postnatal care (PNC) and exclusive breastfeeding practice among Indonesian mothers aged 15–24 years. PNC was defined as starting breastfeeding within 1 hour of birth, the provision of lactation counseling, and breastfeeding observation within 2 days after delivery. In the analysis, adolescent mothers aged 15–19 years visited PNC less frequently than older mothers aged 20–24 years. Interestingly, adolescent mothers who received proper PNC showed an 8 times higher likelihood of exclusive breastfeeding than those who received improper PNC. This study highlights that PNC plays a significant role in the exclusive breastfeeding of infants delivered by adolescent mothers aged 15–19 years.

Any intervention must be sensitive to the target group with consideration of age, culture, and social environment. Breastfeeding promotion programs specific to adolescents are also needed. As mentioned earlier, interventions vary widely; therefore, ongoing long-term, large-scale studies are required to identify the most effective interventions within that group.

Key message

· Despite much effort, breastfeeding practices remain unsatisfactory worldwide.

· Effective breastfeeding-promoting interventions are needed that are appropriate for age, culture, and social environment.

· Interventions can promote breastfeeding, especially in younger populations such as adolescent mothers.