Breastfeeding: from Biology to Policy (UNSSCN, 1998, 28 p.): Global patterns

Breastfeeding: from Biology to Policy (UNSSCN, 1998, 28 p.)

		(introduction...)
		United Nations Administrative Committee on Coordination - Sub-Committee on Nutrition
		Foreword
		Introduction
		The biology of breastfeeding
		Global patterns
		Barriers to optimal breastfeeding
		Breaking the barriers with the baby-friendly community initiative - the Gambia
		Policy issues
		A challenge to SCN member agencies
		References
		Closing Remark made after Ms Semega-Janneh's Lecture
		Comment form the Reviewer

Global patterns

Despite documented evidence of its benefits, global estimates indicate that 85% of mothers do not conform to optimal breastfeeding practices (see Obermeyer and Castle, 1997). Exclusive breastfeeding is still rare in a number of countries (Labbok et al., 1997). Estimates from the WHO Global Data Bank (1996) indicate that only 35% of infants have been exclusively breastfed for some duration during the first four months of life (see table). These alarmingly low figures on exclusive breastfeeding are, however, usually hidden under high initiation rates and long duration of breastfeeding as in the example from the African region where the median breastfeeding duration is 21 months.

Exclusive breastfeeding and median duration of breastfeeding: a global and regional overview, 1996

*WHO Region*	Total number of infants (millions)	*Total number of countries*	Number of countries in the Region included (%)^a	*Percentage of Infants in the Region included^b*	Exclusive breastfeeding rate <4 months of age(%)^c	Median duration of breastfeeding (months)
Africa	23.3	46	25 (54)	71	19	21
The Americas	16.0	35	14 (40)	38	34	10
South-East Asia	42.2	10	5 (50)	93	49	25
Europe	11.5	50	4 (8)	19	16	11
Eastern	15.5	22	11 (50)	84	36	19
Mediterranean
Western Pacific	28.7	27	2 (7)	7	33	14
World total	137.2	190	61 (32)	58	35	18

^aCountries for which nationally representative data are available.
^bPercentage of children less than one year of age by region for which nationally representative data are available.
^c Percentage of infants under four months of age whose sole source of nourishment is breastmilk the day before the interview.

Source: WHO Global Data Bank on Breastfeeding

Breastfeeding: benefits for the mother

à Breastfeeding helps the uterus to return more quickly to its original size and thus minimises postpartum bleeding (Chua et al., 1994). This reduces the risk of anaemia for the breastfeeding mother and may contribute to a reduction in maternal mortality.

à Breastfeeding reduces the risk of premenopausal breast cancer (Newcomb et al., 1994) and ovarian cancer (Rosenblatt and Thomas, 1993).

à Breastfeeding is associated with improved bone remineralisation (Melton et al., 1993).

à Breastfeeding causes mothers to return more quickly to their pre-pregnancy weight (Dewey et al., 1993).

à Breastfeeding has child spacing benefits and prevents more births in Africa and many parts of Asia than contraception (Thapa et al., 1988). The Bellagio Consensus Conference in Italy in 1988 agreed that the Lactational Ammenorrhea Method (LAM) gives about 98% protection from pregnancy during the first 6 months after delivery if the mother is fully or nearly fully breastfeeding, and remains ammenorrheic during that period (Consensus Statement, Lancet, 1988). The efficacy of LAM was demonstrated in a clinical case control intervention study (Perez et al., 1992). The contribution to child spacing of the traditional practice of sexual abstinence during the breastfeeding period (see Obermyer and Castle, 1997), still practised today (Davies-Adetugbo, 1997), should not be underestimated.

à Breastfeeding has emotional and psychological benefits, which are very important elements of maternal and child health (Akr1989). Examples of these are the satisfaction and the confidence of the mother in her capability to nurture her infant in the best possible way. This also includes the emotional bonding between the breastfeeding mother and her infant.

The full benefits of breastfeeding may however not be realized if optimal breastfeeding, including exclusive breastfeeding, is not practiced.

Breastfeeding: benefits for the infant

à Breastfeeding reduces the severity and incidence of diarrhoea during the first year (Dewey et al., 1995; Howie et al., 1990; Popkin et al., 1990; Victora et al., 1989) which is one of the major causes of mortality among infants and young children in developing countries.

à Breastfeeding reduces the risk of lower respiratory infections (Wright et al., 1989), otitis media (Anniansson et al., 1994; Duncan et al., 1993), atopic disease (Chandra, 1997; Lucas et al., 1990; Saarinen and Kajosaari, 1995) and necrotising enterocolitis (Lucas and Cole, 1990).

à Breastfeeding may protect against insulin-dependent diabetes mellitus (Mayer et al., 1988; Virtainen et al., 1993) and urinary tract infections (Piscane et al., 1992).

à Breastfeeding may protect infants from the sudden infant death syndrome (Ford et al., 1993) as well as from chronic digestive diseases (Greco et al., 1988), Crohn's disease and ulcerative colitis (Koletzko et al., 1989; Whorwell et al., 1979) and lymphoma (Davis et al., 1988; Shu et al., 1995).

à Breastfeeding improves the infant's neurological development (Lanting et al., 1994; Lucas et al., 1992).

à Breastfeeding may reduce the risk of bacterial meningitis (Istre et al., 1985) and bacteremia (Cochi et al., 1986).

à Breastfeeding stimulates the infant's immune system (Pabst et al., 1997).

à Breastfeeding may reduce the risk of heart disease in later life (Routi et al., 1995).

à Breastfed infants show a better response to vaccines (Pabst, 1997) while being protected against hay fever and asthma for up to 17 years (Saarinen and Kajosaari, 1995).