LANCET BREASTFEEDING SERIES 2016
On 29th Jan the Lancet published a new Series on Breastfeeding (http://www.thelancet.com/series/breastfeeding). It presented new evidence on the health and economic benefits of breastfeeding. The Key conclusion is “Not breastfeeding is associated with lower intelligence and economic losses of about $302 Billion annually, or 0.49% of world Gross National Income. Breastfeeding provides short-term and long-term health, economic and environment advantages to children, women, and society”. According to the Lancet report breastfeeding could save 820,000 lives annually, i.e. preventing 13% of all deaths of children under five. Breastfeeding could reduce one third of respiratory infections and about half of all diarrhea episodes in low- and middle-income countries. The report says children who are breastfed longer have been found to have higher intelligence than those who are breastfed for shorter periods. This crucial difference could be 3 points across all income levels, in rich or poor, on average. Studies have shown this translates to improved academic performance, increased long term earnings and productivity as well.
1 : Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect– Cesar G Victora, Rajiv Bahl, Aluísio J D Barros, Giovanny V A França, Susan Horton, Julia Krasevec, Simon Murch, Mari Jeeva Sankar, Neff Walker,Nigel C Rollins, for The Lancet Breastfeeding Series Group*, January 29, 2016
2 : Why invest, and what it will take to improve breastfeeding practices?– Nigel C Rollins, Nita Bhandari, Nemat Hajeebhoy, Susan Horton, Chessa K Lutter, Jose C Martines, Ellen G Piwoz, Linda M Richter, Cesar G Victora, on behalf of The Lancet Breastfeeding Series Group* , January 29, 2016
The series refers to IBFAN initiatives such as World Breastfeeding Trends Initiatives (WBTi), World Breastfeeding Costing Initiatives (WBCi) and the Report on Carbon footprints titled “Formula for Disaster” (Please see links below)
Linnecar A, Gupta A, Dadhich J, Bidla N. Formula for disaster: weighing the impact of formula feeding vs breastfeeding on environment. BPNI/IBFAN Asia, 2014. https://ibfan.org/docs/FormulaForDisaster.pdf (accessed Nov 26, 2015).
Holla-Bhar R, Iellamo A, Gupta A, Smith JP, Dadhich JP. Investing in breastfeeding—the world breastfeeding costing initiative. Int Breastfeed J 2015; 10: 8. http://bpni.org/Article/IBJ-Investing-BF-article2015.pdf
Lutter CK, Morrow AL. Protection, promotion, and support and global trends in breastfeeding. Adv Nutr 2013; 4: 213–19.http://bpni.org/Article/Lutter-and-Morrow-Protection-Promotion-and-Support-of-BF.pdf
What science tells us about the risks when children are not breastfed
Breastfeeding as the norm for infant and young child feeding
Since time immemorial the human species has been fed and nurtured by mother’s milk. As the normal continuum from pregnancy, through birthing, breastfeeding is the bond that sustains the mother baby relationship and provides the perfect nutrition, immunological protection and optimal physical and neurological development for the first years of life.
Scientific research has shown us the critical importance of breastfeeding. It is irreplaceable as the way to feed children.. Its intricate composition to both protect and nourish; its capacity to perfectly match growth and development needs make it an irreplaceable way to feed babies. Breastfeeding is vital for child survival and also important for mothers’ health. Breastfeeding contributes positively to the nation’s economy, to employers, families and communities. Below readers will find basic information about the importance of breastfeeding.
Breastfeeding is important for Children
Before a baby is born, the uterus protects him or her against most of the germs to which the mother is exposed. After birth, the mother’s breastmilk continues to protect against many of the viruses, bacteria and parasites to which the baby is now exposed. Several substances in breastmilk not only prevent diseases;
some stimulate and strengthen the development of the baby’s immature immune system. This results in better health, even years after breastfeeding has ended. For these and other reasons, based on scientific evidence, the World Health Assembly has adopted, as a public health recommendation, that babies should be fed exclusively on breastmilk for six months and continue breastfeeding at least until two years of age (1).
Breastfeeding promotes child survival:
“If all babies were fed only breastmilk for the first six months of life, the lives of an estimated 1.5 million infants would be saved every year and the health and development of millions of others would be greatly improved,” states UNICEF in its 2002 edition of Facts for Life (2).
In resource-poor settings, exclusive breastfeeding may be the best option for HIV-positive mothers (3). This is confirmed by the November 2006 WHO Consensus Statement on HIV and Infant Feeding. http://www.who.int
Breastfeeding is an essential means of providing food security for millions of infants worldwide (4),
and even more so in developing countries and in regions having to cope with war, conflict, population displacement, natural disasters, or economic crises.
Bhutta et al. study shows how breastfeeding initiation immediately after birth is one of the more effectiven interventions. Read full article
Breastfeeding protects against infectious diseases:
Otitis media: Middle ear infections are one of the most frequent reasons for seeing the doctor. In a US study, infants from birth to twelve months who were not breastfed had twice as many ear infections as babies who were exclusively breastfed for about four months (5).
Diarrhoea: The antibodies in a mother’s milk protect her baby from the germs causing diarrhoea. In poor communities, diarrhoea caused by bottle-feeding is responsible for acute sickness. The cycle of illness, dehydration and malnutrition weakens the child, often fatally. A study from the Republic of Belarus
shows that infants exclusively breastfeeding at three months have 40% less risk of developing gastrointestinal infections (6).
Pneumonia: Worldwide, pneumonia is one of the leading causes of death in children under five years of age. A study in Brazil showed that the risk of hospitalization for pneumonia among non-breastfed
infants was 17 times greater than that for breastfed infants (7).
Breastfeeding protects against asthma and other allergies:
In Australia, risk of childhood asthma decreases by at least 40% in infants breastfed for four months(8).
A Medline review of twelve studies relating breastfeeding and asthma points out that exclusive breastfeeding reduced the risk of asthma by 30%, and showed still better results (48%) in families with a history of asthma-related illnesses (9).
Breastfeeding confers optimal cognitive, linguistic and motor development:
In Denmark a recent study confirmed that breastfeeding affected brain development as measured
in the child’s ability to crawl, to grip and to babble in polysyllables: the longer the duration of breastfeeding, the higher the child’s capacities (10).
Long-term importance of breastfeeding on health:
Bone mass: In Tanzania, a study demonstrated that there was significant association between breastfeeding in infancy and higher bone mineral density among the eight year-old boys examined, in comparison with children that had not been breastfed (11).
Haemophilus influenzae meningitis: In Sweden a study showed that low breastfeeding rates were followed, five to ten years later, by increased meningitis rates (12).
Obesity: In a number of countries (Germany, Czech Republic, the UK, the USA) research demonstrates that breastfeeding reduces the risk of obesity and overweight (13) (14).
Breastfeeding is important for Mothers
Breastfeeding is an integral part of the reproductive cycle: exclusive breastfeeding, followed at six months by the introduction of appropriate complementary foods. Continued breastfeeding until the age of two years or more brings the reproductive cycle full circle. Studies have shown that there are many women for whom contraception is unavailable, unaffordable or unacceptable. For these women, breastfeeding (according to the LAM criteria mentioned below) is the primary means of delaying pregnancy and spacing births. Moreover, breastfeeding develops emotional and psychological well-being in mothers, and has numerous health advantages.
Breastfeeding provides child-spacing (LAM):
As long as a mother breastfeeds fully or nearly fully and as long as her periods have not returned, her protection against pregnancy during the first six months is 98 % (15). This family planning method is called the Lactational Amenorrhea Method – LAM.
Breastfeeding results in the reduction of anaemia:
In the first hours and days after birth, early breastfeeding brings about uterine contractions, preventing excessive blood loss.
Over the following months, breastfeeding reduces the frequency and severity of anaemia by delaying the return of monthly periods and helping the mother build her iron reserves (16).
Long-term importance of breastfeeding on mothers’ health (17):
Breast cancer: Studies from the US, China, Japan, New Zealand, the UK and Mexico show that women who breastfed their children have reduced risk of developing breast cancer and that the risk declines with increased duration of breastfeeding (18).
Ovarian cancer: Breastfeeding for at least two months per child decreases the mother’s risk of developing epithelial ovarian cancer (19).
Osteoporosis: The risk of hip fracture amongst women over 65 is reduced by half for those who have breastfed. It decreases by another quarter for those who have breastfed each of their children at least nine months (20) (21).
Importance for Families
Preparing for the arrival of the new baby, undergoing the birth process, and adapting to the child’s first
months are among the most extraordinary, testing, and emotional periods that parents and families experience. Loving, caring for, nurturing, but also worrying about one’s child are normal feelings and are sometimes overwhelming. Any illness takes an emotional toll on families; sickness in a newborn baby or a working mother causes even more worry. Health care costs are constantly increasing and can represent considerable strain on the family budget.
Breastfeeding strengthens family ties:
Studies have shown the emotional and psychological importance, as well as the bonding effects of breastfeeding to both mother and child. The importance of bonding is even greater when mothers return to work (22).
Breastfeeding develops a mother’s confidence in her physical and emotional capacities (23).
Breastfeeding saves money and time:
Saving of time because there is no need to go out to buy breastmilk substitutes or other goods.
Savings on the purchase of breastmilk substitutes and other feeding equipment.
Formula feeding increases costs for medical care and medication.
Formula feeding increases costs for child spacing and birth control methods.
Less time preparing bottles, including fetching water, fuel, and cleaning utensils.
Less time and worry spent on having to care for illnesses that could often be avoided.
Importance for Employers
When infants and children are sick, mothers or fathers often stay home to care for them. National laws may allow parents to take holiday leave or to call in sick themselves. This absenteeism is costly to employers – and to national budgets for health care. Moreover, many employed women have only a short period of paid maternity leave. If they want to breastfeed their babies, it is important to set up favourable conditions at the workplace. Many labour laws provide paid or unpaid daily breastfeeding breaks, and many employers set up breastfeeding facilities on-site for their female workers. Adequate hygienic facilities for breastfeeding or expressing and storing breastmilk are relatively easy and inexpensive to provide.
Formula feeding increases staff absenteeism:
Studies in the USA and elsewhere have shown that breastfed babies had statistically fewer episodes of illness than formula-fed infants and that mothers of breastfed babies were less absent (only 25% of one-day maternal absences) than mothers of bottle-fed babies (24).
Breastfeeding contributes towards a more stable workforce:
Employers who support their female employees (maternity benefits, breastfeeding breaks, rest periods…) note improved staff morale, less turnover and increased loyalty to the enterprise.
Importance for Society
Breastmilk is a living substance. It is unique and irreplaceable, specifically tailored to the changing needs of each baby. It is the first human food par excellence, the best example of how humanity can sustain itself through provision of a complete food for human babies. Breastfeeding also makes economic sense because it is less costly to produce than formula; it also allows society to make considerable savings in health care costs.
Breastfeeding helps to protect the environment:
Environmentally-friendly in its production, consumption and disposal: breastfeeding is a natural and renewable resource.
Reduction in industrial production, transportation, packaging, and disposal pollution: breastfeeding produces hardly any waste.
Breastfeeding has economic importance:
Nations can save huge amounts on the purchase and distribution of commercial breastmilk substitutes (often in foreign exchange). In India for example, at the national level, women produce approximately 3,900 million litres of milk over a two-year period (which corresponds to the usual lactation period of Indian mothers). If the milk had been purchased in the form of tinned cow’s milk, it would have cost close to three billion dollars, or more than three times the combined budgets of the Departments of Education, Health and Family Welfare, and Science and Technology during that same period of time. In Guatemala, annual spending on breastmilk substitutes amounts to approximately 48 million dollars (25).
Savings on health care expenses for preventable acute and chronic illnesses: an Australian study calculated that if breastfeeding at three months of age increased in prevalence from 60% to 80%, Australian $3.7 million would be saved on treating gastro-intestinal diseases alone (26). Researchers in Newfoundland, Canada, estimated that improved prevalence of breastfeeding could save the province up to Canadian $370,000 per year on the care of babies with asthma and eczema (27).
Breastfeeding has a positive impact on society at every level, it is all the more important that the responsibility for protecting and promoting breastfeeding and for supporting women to optimally breastfeed is borne by society as a whole.
INFACT Canada, “The Benefits of Breastfeeding”, WBW kit, 2001.
IBFAN, “What Scientific Research Says …”, IBFAN Action Pack, December 1998.
IBFAN-GIFA, Breastfeeding Briefs, issues 30-41. October 2000 -2006.
International Women Count Network, “Breastfeeding: A Global Fact Sheet”, 1999.
Nurture – Centre to Prevent Childhood Malnutrition, “A Guide to Assessing the Economic Value of Breastfeeding”, 1990.
UNICEF, “Breastfeeding, the Foundation for a Healthy Future”, New York, August 1999.
UNICEF, Facts for Life, 3rd edition, 2002.
WABA, “Women, Work and Breastfeeding: everyone benefits”, WBW 1993.
WABA, “Breastfeeding: Nature’s way, WBW 1997.
WABA, “Breastfeeding: the best investment”, WBW 1998.
1. Infant and young child nutrition, 18 May 2001, WHA54.2, “…to protect, promote and support exclusive breastfeeding for six months as a global health recommendation, taking into account the findings of the WHO
expert consultation on optimal duration of exclusive breastfeeding, and to provide safe and appropriate complementary foods, with continued breastfeeding for up to two years of age or beyond…”.
2. UNICEF, Facts for Life, NY, 3rd edition, 2002, p. 39.
3. Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM, “Influences of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study”, The Lancet, 354: 471-476, 1999.
Mbori-Ngacha D, Nduati R, John G, Reilly M, et al., “Morbidity and mortality in breastfed and formula-fed
infants of HIV-infected women: a randomized clinical trial”, JAMA, 286:2413-20, 2001.
Coutsoudis A, Coovadia H, Pillay K, Kuhn L, “Are HIV-infected women who breastfeed at increased risk of mortality?”,AIDS, 15:653-655, 2001.
Iliff PJ, Piwoz EG, Tavengwa NV et al., “Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival”, AIDS, 2005;19:699-708.
Moreover, concerning the very controversial subject of transmission of HIV/AIDS from mother to child through breastmilk, WHO and UNICEF recommend that as long as artificial feeding is not acceptable, feasible, affordable, sustainable and safe, HIV+ mothers should exclusively breastfeed for the first months of their baby’s life. And in
all cases, mothers should be sufficiently informed to be able to make an informed decision about the way they will feed their child.
4. World Declaration and Plan of Action for Nutrition of the International Conference on Nutrition, Rome, 1991. Article 30 of the Plan of Action states that “Breastfeeding is the most secure means of assuring food security of infants and should be promoted and protected through appropriate policies and programmes.” See also Armstrong H, “Breastfeeding as the foundation of care”, Food and Nutrition Bulletin, UNU Press, 16:4, 299-312, 1995.
5. Duncan B et al., “Exclusive breastfeeding for at least 4 months protects against otitis media”, Pediatrics, 91(5): 867-872, 1993.
6. Kramer MS et al., “A Randomized Trial in the Republic of Belarus. Promotion of Breastfeeding Intervention
Trial (PROBIT)”, JAMA, 285: 413-420, 2001.
Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S, “Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums”, Pediatrics, 108:e67, 2001.
7. Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA, “Impact of Breast Feeding on Admission for
Pneumonia during Post-neonatal Period in Brazil: nested case-control study”, British Medical Journal,
318: 1316-1320, 1999.
Chantry CJ, Howard CR, Auinger P, “Full breastfeeding duration and associated decrease in respiratory tract infection in US children”, Pediatrics, 117;425-32, 2006.
8. Oddy WH et al., “Association between breast feeding and asthma in the 6-year old child: findings of a prospective cohort study”, British Medical Journal, 319: 815-818, 1999.
9. Gdalevich M, Mimouni D, Mimouni M, “Breastfeeding and the Risk of Bronchial Asthma in Childhood: a systematic review with meta-analysis of prospective studies”, J. Pediatr, 139: 261-266, 2001.
Other studies on asthma and breastfeeding:
Karanasekera KA, Jayasinghe JA, Alwis LW, “Risk Factors of Childhood Asthma: a Sri-Lankan study, J Trop
Pediatr, 47: 142-145, 2001.
Romieu I, Werneck G, Ruiz Vaelasco S, White M, Hernandez M, “Breastfeeding and Asthma among Brazilian Children”, J Asthma, 37: 575-583, 2000.
Wright AL, Holberg CJ, Taussig LM, Martinez FD, “Factors Influencing the Relation of Infant Feeding to Asthma and Recurrent Wheeze in Childhood”, Thorax, 56: 192-197, 2001.
Kull I, Wickman M, Lilja G, Nordvall SL, Pershagen G, “Breast feeding and allergic diseases in infants – a prospective birth cohort study”, Arch Dis Child, 87: 478-81, 2002.
10. Vestergaard M, Obel C, Henriksen TB, Sorensen HT, Skajaa E, Ostergaard J, “Duration of Breastfeeding
and Developmental Milestones during the Latter Half of Infancy”, Acta Paediatrica, 88: 1327-1332, 1999.
Lucas A et al., “Breastmilk and Subsequent Intelligent Quotient in Children Born Premature”, The Lancet, 339: 261-264, 1992.
Horwood LJ et al., “Breastfeeding and Later Cognitive Development and Academic Outcomes”, Pediatrics, 101, 1998.
Wang B, McVeagh P, Petocz P, Brand-Miller J, “Brain ganglioside and glycoprotein sialic acid in breastfed compared with formula-fed infants”, Am J Clin Nutr, 78:1024-9, 2003.
11. Jones G, Riley M, Dwyer T, “Breastfeeding in Early Life and Bone Mass in Prepubertal Children: a
longitudinal study”, Osteoporos Int, 11: 146-152, 2000.
12. Silfverdal SA, Bodin L, Olcen P, “Protective Effect of Breastfeeding: an ecologic study of Haemophilus influenzae meningitis and breastfeeding in a Swedish population”, International Journal of Epidemiology, 28: 152-156, 1999.
13. Kries R von, Koletzko B, Sauerwald T, Mutius E von, Barnert D, Gruneert V, Voss H von, “Breastfeeding and Obesity: cross sectional study”, British Medical Journal, 319: 1547-150, 1999.