World Breastfeeding Week: Practice associated with 33% reduction in infant mortality

• UNICEF, WHO advocate greater breastfeeding support across workplaces
Among nearly 10 million American infants born between 2016 and 2018, breastfed babies were 33 per cent less likely to die during the post-perinatal period (day 7-364) than infants who were not breastfed, reports a new study in the American Journal of Preventive Medicine, published by Elsevier.

The findings build on previous US research with smaller datasets, which documented the association between the initiation of breastfeeding and the reduction of post-perinatal infant mortality by a range of 19 per cent to 26 per cent

Lead investigator and researchers at the Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Centre for Breastfeeding Medicine, Dr. Julie L. Ware, said: “Based on these data, there is clear evidence that breastfeeding confers a protective benefit during the first year of life and is strongly associated with reduced post-perinatal infant mortality across the USA.”

Ware noted that the findings suggest there is an opportunity for breastfeeding promotion, protection, and support to be included as a key component in comprehensive infant mortality reduction initiatives in regions and states across the US.

With help from the US Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, birth certificate data on US infants born from 2016 to 2018 were linked with infant deaths occurring up to one year after birth. An analysis was conducted to demonstrate whether the initiation of breastfeeding, as recorded on the birth certificate (a practice adopted by all states in 2016), was associated with post-perinatal infant death, considering factors such maternal age, education, race and ethnicity, and geographical location.

Breastfeeding is recognised by the World Health Organisation, American Academy of Pediatrics, and other authorities as the preferred normative nutrition for infants, both recommending that families breastfeed their infants exclusively for six months, continuing with the addition of complementary foods for at least the first two years of life. These organizations consider breastfeeding a public health imperative with many short- and long-term improved health outcomes for both mother and child, including significant reductions in all-cause infant mortality and specific protection against sudden infant death syndrome and necrotising enterocolitis in preterm infants. Despite these recommendations, the rates for breastfeeding initiation, exclusivity, and continuation in the US do not meet breastfeeding goals, especially in certain racial and ethnic populations, and in some geographic regions.

Co-investigator and researcher at the University of Cincinnati College of Medicine, Dr. Ardythe Morrow, said: “Though breastfeeding is widely recommended, nevertheless, some may still consider it to be of minor importance. We hope that our findings will change the narrative. Human milk is replete with protective molecules, and breastfeeding offers significant protection.”

Addressing breastfeeding disparities may improve the health of mothers and their babies and help reduce adverse outcomes. Although most states advocate breastfeeding promotion, protection, and support activities, analysis of the association between breastfeeding and infant mortality had not previously been conducted at the state and regional levels. To this end, the investigators conducted a regional and state-by-state analysis.

Co-investigator and researcher at the Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Dr. Aimin Chen, explained: “We found that the effect was evident across the US, but with regional variations, ranging from 44 per cent in the Northeast and Mid-Atlantic, where breastfeeding initiation is the highest, and 21 per cent in the Southeast, where breastfeeding initiation is the lowest. Although regional and state variation in the magnitude of the association between breastfeeding and infant mortality exists, there was a remarkable consistency of reduced risk. Together with existing literature, our data suggest that breastfeeding promotion and support may be an effective strategy to help reduce infant mortality in the US.”

MEANWHILE, Executive Director, United Nations Children Fund (UNICEF), Catherine Russell, and Director-General, WHO, Dr. Tedros Adhanom Ghebreyesus, in a joint statement, on the occasion of World Breastfeeding Week, August 1 to 7, said, in the last 10 years, many countries have made significant progress to increase exclusive breastfeeding rates. Yet even greater progress is possible when breastfeeding is protected and supported, particularly in the workplace.

The World Breastfeeding Week, under its theme, “Let’s make breastfeeding at work, work” – UNICEF and WHO are emphasising the need for greater breastfeeding support across all workplaces to sustain and improve progress on breastfeeding rates globally.

They said, in the last decade, the prevalence of exclusive breastfeeding has increased by a remarkable 10 percentage points, to 48 per cent globally. UNICEF and WHO said countries as diverse as Cote d’Ivoire, Marshall Islands, the Philippines, Somalia and VietNam have achieved large increases in breastfeeding rates, showing that progress is possible when breastfeeding is protected, promoted, and supported.

They, however, said to reach the global 2030 target of 70 percent, the barriers women and families face to achieve their breastfeeding goals must be addressed.

Supportive workplaces are key. Evidence shows that while breastfeeding rates drop significantly for women when they return to work, that negative impact can be reversed when workplaces facilitate mothers to continue to breastfeed their babies.

According to the UN agencies, family-friendly workplace policies – such as paid maternity leave, breastfeeding breaks, and a room where mothers can breastfeed or express milk – create an environment that benefits not only working women and their families but also employers. These policies generate economic returns by reducing maternity-related absenteeism, increasing the retention of female workers, and reducing the costs of hiring and training new staff.

“From the earliest moments of a child’s life, breastfeeding is the ultimate child survival and development intervention. Breastfeeding protects babies from common infectious diseases and boosts children’s immune systems, providing the key nutrients children need to grow and develop to their full potential. Babies who are not breastfed are 14 times more likely to die before they reach their first birthday than babies who are exclusively breastfed,” they said.

Supporting breastfeeding in the workplace is good for mothers, babies, and businesses, and that is why UNICEF and WHO are calling on governments, donors, civil society, and the private sector to step up efforts to ensure a supportive breastfeeding environment for all working mothers – including those in the informal sector or on temporary contracts – by having access to regular breastfeeding breaks and facilities that enable mothers to continue breastfeeding their children once they return to work; sufficient paid leave to all working parents and caregivers to meet the needs of their young children.

This includes paid maternity leave for a minimum of 18 weeks, preferably for a period of six months or more after birth; and increased investments in breastfeeding support policies and programmes in all settings, including a national policy and programme that regulates and promotes public and private sector support to breastfeeding women in the workplace.