Series L, Number 14
Issues in World Health

CONTENTS

Home (Key Points)

Breastfeeding Gains and Goals
Table 1. Breastfeeding Practices Improving
Web Table 1. Early Initiation of Breastfeeding Over Time
Web Table 2. Exclusive Breastfeeding Over Time
Web Table 3. Breastfeeding at Two Years
Table 2. Breastfeeding Common but Not Usually Optimal
Web Figure 1. Most Infants Breastfed Initially
Web Figure 2. Levels of Breastfeeding Vary Widely

Comprehensive Strategies Needed

Spotlight: Madagascar’s Comprehensive Approach Improves Breastfeeding

Breastfeeding Increases Women’s Contraceptive Options
Table 3. When Breastfeeding Mothers Can Begin a Family Planning Method After Childbirth Compared with Mothers Not Breastfeeding

Centerspread: Breastfeeding Is Best
Figure 1. Better Breastfeeding Reduces Diarrhea

Women with HIV Face Crucial Breastfeeding Decisions
Figure 2. Estimated Risk of HIV Infection in Infants and Young Children

Bibliography

Credits

• Counseling Aid: When Can a Woman Use LAM?
• Counseling Aid: HIV and Infant Feeding Counseling Flow Chart

• Box: Taking Ten Steps to Successful Breastfeeding
• Table: When Breastfeeding Mothers Can Begin a Family Planning Method

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A husband helps his wife breastfeed their newborn in the maternity ward at Singburi Hospital, Thailand. Involving spouses is an important aspect of building support for breastfeeding mothers in the household and community. (Photo: UNICEF, Roger Lemoyne)

KEY POINTS

Only breastmilk offers infants and young children complete nutrition, early protection against illness, and safe, healthy food—all at once. Nearly all babies are breastfed to some extent, but far less than half are breastfed in the most beneficial way. Better breastfeeding offers triple value: important improvements in child survival and health, better health for mothers, and temporary contraception. What can governments, programs, and health care providers do to support and enable women to breastfeed better?

Carry out comprehensive strategies. Successful strategies to improve breastfeeding include health care services, communities and families, and government. Health care services offer a valuable point of contact for mothers-to-be and breastfeeding mothers. Mothers also need information, support, and empowerment in the community and at home. Government efforts include enacting appropriate policies, such as supporting breastfeeding mothers in the workplace. Changes can begin in any of these areas, but an effective strategy works in all three.

Promote breastfeeding for birth spacing. Providers can advise women on appropriate contraception during breastfeeding, particularly the lactational amenorrhea method (LAM). A method based on full or nearly full breastfeeding, LAM provides the best health benefits of breastfeeding for the infant and also postpones the next pregnancy for up to six months.Then it encourages switching to another family planning method to space births.

Address the challenges that HIV/AIDS poses for breastfeeding. The AIDS crisis has focused concern on HIV transmission through breastmilk, while drawing attention away from the risks to infant health of not breastfeeding. World Health Organization (WHO) and United Nations (UN) agencies recommend, particularly where safe alternatives to breastmilk are not available, that HIV-positive women breastfeed their infants exclusively for the first months of life before switching completely to replacement foods when possible. Exclusive breastfeeding poses half the risk of HIV transmission as mixed breastfeeding, while preventing deaths from other illnesses.

How To Use This Report

With the help of this issue of Population Reports governments, programs, and health care providers can:

• Encourage and support better breastfeeding by carrying out comprehensive strategies involving governments, health care services, and families and their communities (see 'Comprehensive Strategies Needed').
• Counsel women on how breastfeeding can help space births up to six months postpartum and encourage switching to another contraceptive method thereafter (see 'Breastfeeding Increases Women's Contraceptive Options').
• Inform and advise women on HIV and breastfeeding and on weighing the risks of breastfeeding and replacement feeding for HIV-positive mothers (see 'Women with HIV Face Crucial Breastfeeding Decisions').