The importance of breastfeeding has been well established. Indeed, leading health organisations recommend exclusive breastfeeding for the first six months, and then for breastfeeding to continue alongside complementary foods for 2 years and beyond.

Unfortunately, however, breastfeeding is no longer the norm in many countries, and breastfeeding rates still fall well short of these recommendations.

High-income countries have shorter breastfeeding duration than low-income and middle-income countries. Only 37% of babies less than 6 months are exclusively breastfed, even in low-income and middle-income countries.

This has led The Lancet, a world leading, peer-reviewed medical journal, to launch an interactive Breastfeeding Series to evaluate:

The importance of breastfeeding for the mother and child.
Economic aspects of breastfeeding.
Determinants of, and interventions to improve, breastfeeding rates.

The Lancet Breastfeeding Series includes an editorial, a podcast, webcast, commentaries, and two scientific review papers.

The first paper, Breastfeeding In The 21st Century: Epidemiology, Mechanisms, And Lifelong Effect, obtained information from 28 systematic reviews and meta-analyses (considered the highest level of scientific evidence). It confirms the importance of breastfeeding in low, middle, and high-income countries, as well as in both rich and poor households.

This first paper demonstrates the importance of breastfeeding for the health of mothers and children.

It showed that, for children, not breastfeeding increases the risk of:

Poorer performance in intelligence testing, with a pooled decrease of 3.4 IQ points. A clear dose-response association was found: the shorter the breastfeeding duration, the greater the risk of poorer performance in intelligence testing.
Infectious morbidity and mortality. According to the paper “Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections, and otitis media. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome.”
Dental malocclusions. The paper presents data, obtained mostly from low to middle-income countries, which demonstrates that not breastfeeding is associated with a 68% increase in the risk of malocclusions.

The paper also found that not breastfeeding might increase the risk of being overweight later in life, with a pooled increase in the prevalence of overweight or obesity of 13%.

For mothers, not breastfeeding increases the risk of breast cancer. According to the paper “Breast cancer is reduced by lifetime duration of breastfeeding in women, with a 6% reduction for every 12 months”. The paper also found that not breastfeeding might increase the risk of Type 2 diabetes and ovarian cancer.

Breastfeeding Could Prevent 20,000 Breast Cancer Deaths Every Year

The paper also estimated the number of mothers and children’s lives that could be saved through breastfeeding. For example, the paper showed that:

823,000 annual deaths in children younger than 5 years would be saved in 75 high-mortality, low and middle income countries in 2015, if breastfeeding were scaled up to near universal levels.
Existing global rates of breastfeeding prevent almost 20,000 annual breast cancer deaths compared with a scenario in which no women breastfed.

Why Invest, And What It Will Take To Improve Breastfeeding Practices?

The Lancet‘s second paper, Why Invest, And What It Will Take To Improve Breastfeeding Practices? discusses how breastfeeding support is still lacking worldwide. It highlights the fact that, ‘Success in breastfeeding is not the sole responsibility of a woman—the promotion of breastfeeding is a collective societal responsibility.’

Six Point Action Plan To Increase Breastfeeding Rates

The paper proposes the following six point action plan to increase breastfeeding rates:

Disseminate the evidence about the importance of breastfeeding for the health of mothers and children.
Promote positive attitudes towards breastfeeding.
Show political support and provide political investment for breastfeeding.
Improve regulation of the massive and growing formula industry, whose marketing undermines breastfeeding. The paper indicates “No new interventions are needed—the Code is an effective mechanism for action”. You can find more information here about the WHO Code and other ways to increase breastfeeding rates.
Scale up and monitor breastfeeding interventions.
Political institutions to remove barriers that hinder women’s ability to breastfeed.

Economic Importance Of Breastfeeding

The second paper also highlights the health and economic costs of suboptimal breastfeeding. For example, it estimated:

Economic losses from cognitive deficits associated with regional infant feeding practices, compared with every infant breastfeeding until at least 6 months of age. Losses of US $70.9 billion were estimated for low-income and middle-income countries, and US $231.4 billion for high-income countries.
That if breastfeeding rates improved from present levels to 90% for USA, China, and Brazil, and to 45% for the UK, it would reduce treatment costs of common childhood illness by at least $2·45 billion in the USA, $29·5 million in the UK, $223·6 million in urban China, and $6·0 million in Brazil.

Environmental Impact Of Not Breastfeeding

The environmental impact of not breastfeeding was also discussed. Eye-opening environmental factors included:

An estimated 4,000 litres or more of water are needed to produce just 1 kg of formula powder.
In the USA, 550 million cans, 86,000 tons of metal and 364,000 tons of paper are used annually to package formula.

Commentary Pieces Accompanying The Lancet Breastfeeding Series

Alongside The Lancet Breastfeeding Series, Commentary pieces have been published by other authors, including experts at Save the Children, UNICEF, Dundee University, and the World Bank Washington DC. Keith Hansen, from the World Bank, says: “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics. For while “breast is best” for lifelong health, it is also excellent economics. Breastfeeding is a child’s first inoculation against death, disease, and poverty, but also their most enduring investment in physical, cognitive, and social capacity.”

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The Lancet Breastfeeding Series clearly demonstrates the importance of protecting, promoting, and supporting breastfeeding around the world.