Special Collection - enabling breastfeeding for mothers and babies

Enabling women to breastfeed is a public health intervention with wide-reaching global implications. Not only is breastfeeding a fundamentally important human behaviour that strengthens attachment and psychological outcomes, but the use of breastmilk substitutes – either exclusively or partially – has substantive short, medium and long-term impact on survival, health and wellbeing for babies and women. The use of breastmilk substitutes weakens infants’ immune systems, and impairs their cognitive development, behaviour, and appetite regulation, and it increases women’s risk of developing breast cancer, and probably also ovarian cancer and Type 2 diabetes.[1] There are extensive economic implications for health systems, families, and society as a whole.[2,3] In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant’s diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.
Only around 37% of babies under six months worldwide are exclusively breastfed, and rates are continuing to decline, particularly in middle-income countries.[1] Rates in many countries, especially high-income, are much lower than this - e.g. fewer than 1% of babies are exclusively breastfed at six months in the UK.[4] Further to this, infant feeding is usually socially patterned and often reflects inequalities – e.g. in many high-income countries, women from low-income communities have the lowest rates of breastfeeding.[4]
Several factors have contributed to this sharp decline in breastfeeding, including the widespread availability and pro-active marketing of affordable breastmilk substitutes [3,5,6], despite the International Code on the Marketing of Breastmilk substitutes (1981 and subsequent resolutions).[7] Evolving cultural norms mean women are often not supported to breastfeed in the workplace or public spaces.[8,9] Concurrently, many health workers may lack skills in teaching and supporting women to breastfeed, and there is widespread public and professional acceptance of the near-equivalence of breastmilk substitutes and breastfeeding, despite evidence to the contrary.[3] Consequently, many women encounter problems they cannot resolve in the absence of skilled help and decide to supplement or stop breastfeeding, which causes distress, has widespread impact on infant survival and population health, and extensive economic implications for health systems, families, and society as a whole.[2,5]
This Cochrane Special Collection of systematic reviews on Breastfeeding has been developed to bring the best available evidence on effective care to the attention of decision makers, health professionals, advocacy groups, and women and families, and to support the implementation of evidence-informed policy and practice. The collection focuses on reviews on support and care for breastfeeding women, including treatment of breastfeeding associated problems; health promotion and an enabling environment; and breastfeeding babies with additional needs.
The reviews in this collection have been prepared by the authors and editors of the Cochrane Pregnancy and Childbirth Group and the Cochrane Neonatal Group.
You can also find further reading in the Lancet series on Breastfeeding published in January 2016.