By Sinaida Cherubin, Consultant, Deloitte and Márcia Costa, Manager, Deloitte Centre for Health Solutions

World Breastfeeding Week (WBW), is held each year in the first week of August to promote the benefits of breastfeeding and its adoption worldwide. Substantial evidence shows that breastfeeding is one of the most effective ways to ensure child health, development and survival. A 2016 Lancet study showed that more than 820,000 children’s lives could be saved per year if all children younger than 24 months were optimally breastfed.¹ While globally the number of infants under six months who are breast fed has increased by more than 10 per cent to 48 percent in the past decade, 52 per cent are not.² Although some women might not be able or willing to breastfeed due to difficulties in establishing breastfeeding and other socio-cultural issues, many could breastfeed for longer if they had the right support. This year’s WBW theme is ‘Closing the Gap: Breastfeeding Support for All’ and focuses on how families, societies, communities and health workers can support breastfeeding.³ This week, we explore the benefits of breastfeeding and global strategies to support new mothers.

The health and economic benefits of breastfeeding

The World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF), who lead the Global Breastfeeding Collective, recommend early initiation of breastfeeding within the first hour of birth and exclusively breastfeeding for the first 6 months of life – meaning no other foods or liquids are provided, including water.⁴ This recommendation follows established evidence that breastfeeding provides substantial nutritional, cognitive, emotional, and immunologic benefits for the infants, protecting the health of babies and mothers across the life course. A 2016 Lancet Series showed that longer breastfeeding periods reduce the risk of various illnesses such as infections, diabetes, asthma, cardiovascular issues, obesity, and sudden infant death syndrome. Additionally, longer breastfeeding is associated with higher intelligence test scores and improved educational potential in children. Mothers who breastfeed have a lower risk of developing breast and ovarian cancers, heart disease, and type 2 diabetes.⁵

Besides health, breastfeeding also has economic benefits. Estimates from the same study suggested that lower intelligence levels due to low levels of breastfeeding could result in economic losses of about US$302 billion annually or 0.49 per cent of world gross national income.⁶ Moreover, other studies have shown than promoting breastfeeding can lead to substantial cost savings for healthcare systems, primarily due to reduced incidence of illnesses in both infants and mothers.^7,8,9

Disparities in breastfeeding rates worldwide

Due to its well-evidenced nutritional, health and emotional benefits, breastfeeding is crucial to reduce health inequities and support a more equitable start in life. Therefore, the World Health Assembly set a target of 50 per cent of infants to be exclusively breastfed by 2025, and 70 per cent by 2030.¹⁰

Important strides have been made in this direction. Data from UNICEF, from 2023, showed that globally 46 per cent of mothers initiate breastfeeding within one hour of birth. Moreover, 48 per cent of infants aged 0–5 months are exclusively breastfed, an increase of 10 per cent over the past decade. However, these rates vary widely worldwide (data was not available for certain regions, such as Western, South and Northern Europe, Australia and Canada). Whereas only 39 per cent of mothers in South Asia and 40 per cent in East Asia and the Pacific initiate breastfeeding in the first hour, in Eastern and Southern Africa this percentage is 69 per cent. The lowest 6-month breastfeeding rates are in North America, 26 per cent, and highest in Eastern and Southern Africa (58 per cent) and South Asia (60 per cent). While the 2025 target has been met in these two latter regions, all other regions, many encompassing low- and middle-income countries that might benefit from improved breastfeeding rates, still score below the goal set and might not be able to meet the 2030 target.

The complex factors affecting breastfeeding rates

The reasons for not breastfeeding tend to be complex involving a range of different factors. Although not all women will be able or wish to breastfeed, many might not have the support or knowledge necessary to breastfeed successfully. Research from the UK and the US shows that this results in many mothers stop breastfeeding earlier than they had intended.^11,12

Important cultural and social factors influence the decision on starting and continuing to breastfeed. For example, one study conducted in Africa on exclusive breastfeeding rates suggested that cultural and family norms such as concerns with having insufficient milk, beliefs about infant need for water and support for the early introduction of food and liquids can all be barriers to continue breastfeeding. The aforementioned studies in the UK and the US also cited cultural reasons for mothers stopping breastfeeding earlier, besides lack of appropriate support from heath providers (e.g., when they face issues to initiate breastfeeding) and unsupportive work policies or short maternity leave.

Building a comprehensive support system

Improving breastfeeding rates require collective action from government, policymakers, local communities, and families. Addressing the complex determinants of breastfeeding behaviours requires interventions across different settings, supported by dedicated funding and strong political commitment, to create supportive systems that will enable all mothers to make the most informed decision for themselves and their babies. Building a comprehensive support system includes:

1. Pre-natal education: Providing expectant mothers with accurate information about the benefits of breastfeeding and practical guidance on how to breastfeed successfully can significantly increase breastfeeding rates.¹³ This education should be culturally sensitive and accessible to all.
2. Enhanced healthcare support: Hospitals and clinics should follow the advice of baby-friendly initiatives that promote skin-to-skin contact immediately after birth and provide lactation support during the crucial first hours and days in line with the ‘Ten steps to successful breastfeeding’ Continued support from healthcare professionals, over the first six to eight weeks, including follow-up visits and access to lactation consultants, midwives and breastfeeding support workers can help mothers overcome initial challenges and maintain breastfeeding for longer periods.
3. Community-based programmes: Accessible and inclusive peer support groups, led by experienced mothers from the same community, can provide practical advice and emotional support. These groups can be particularly effective in communities where breastfeeding rates are traditionally low.
4. Supportive workplace policies: Employers need to be encouraged or required to provide adequate facilities for breastfeeding mothers, including private spaces for pumping and storage facilities for expressed milk. Flexible working policies and paid breastfeeding breaks can make a significant difference in a mother’s ability to continue breastfeeding after returning to work.¹⁴
5. Policy advocacy: Development of strong, evidence-based policies at national and local levels that protect breastfeeding rights, such as implementation of laws against the aggressive marketing of breast milk substitutes according to the International Code of Marketing of Breast-milk Substitutes. Public health campaigns can also help shift public perception, reduce stigma, and promote breastfeeding as a normal, supported choice.
   
   

Conclusion

Evidence shows that breastfeeding is the most accessible and cost-effective public health intervention and one of the most effective preventative measures mothers can take to protect their children's health. It's important to recognise that breastfeeding is more than a personal health choice but is a fundamental component in the broader conversation about health equity as highlighted by this year’s World Breastfeeding Week. The research evidence is unequivocal, breastfeeding gives babies the best possible start in life, being an important step in reducing inequities. Supporting and promoting breastfeeding, particularly among disadvantaged groups, is an investment that pays dividends not just in terms of child and mother’s health, but in terms of social justice, equity and economic prosperity. Importantly, ensuring that the outcomes of policies are measured is crucial to ensure the world meets the 2025 and 2030 targets for breastfeeding rates.

Note: Breastfeeding rates in the UK: According to the UK’s Infant Feeding Survey, published in 2010, the UK has one of the worst breastfeeding rates in the world at six and 12 months (34 per cent and one per cent, respectively).¹ This 2010 survey was the last in a series of public health surveys conducted every five years since 1975. While data on breastfeeding at 6-8 weeks is available in England (52 per cent), in recognition of the evidence on the importance of exclusive breastfeeding until six months and a national ambition to improve rates, the Department of Health and Social Care conducted a survey in 2023, whose results are yet to be published.¹ We will monitor developments and consider writing a blog once they are available.

Márcia Costa - Manager, Centre for Health Solutions

Márcia is the research manager for healthcare in the Centre for Health Solutions, providing support and expertise to develop solutions to overcome today’s healthcare challenges. Working with the team, Márcia develops insights based on rigorous data analysis to improve outcomes for patients and increase health systems efficiencies. Originally from Portugal, Márcia has an MSc in biomedical engineering and biophysics and a PhD in cancer research. Márcia has previously worked in publishing for an oncology journal in London. Márcia is passionate about health equity.

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Sinaida Cherubin, Research Analyst, Deloitte

Sinaida Cherubin is a health analytics consultant with a keen interest in holistic digital solutions to fragmented healthcare systems. She has a doctoral degree in Population Health from the University of Oxford, and experience using several data analytics and visualisation tools (including R, Python, SQL, PowerBI and Tableau). She is purpose-driven, eager to learn and bring a unique global perspective to the table. 

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[i] Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect (thelancet.com)

[ii] Global breastfeeding scorecard 2023.pdf (unicef.org)

[iii] https://www.breastfeedingnetwork.org.uk/world-breastfeeding-week-august-2024-closing-the-gap/

[iv] https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

[v] Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect (thelancet.com)

[vi] Why invest, and what it will take to improve breastfeeding practices? (thelancet.com)

[vii] https://adc.bmj.com/content/100/4/334.long

[viii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369965/

[ix] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197147/

[x] WHO-NMH-NHD-19.22-eng.pdf

[xii] Facts | Breastfeeding | CDC

[xiii] Effects of prenatal professional breastfeeding education for the family | Scientific Reports (nature.com)

[xiv] Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women | International Journal for Equity in Health | Full Text (biomedcentral.com)