Key family practices on child health care

Article Index

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Exclusive breastfeeding

Breastfeed infants exclusively for up to 6 months. (Mothers found to be HIV positive require counselling about possible alternatives to breastfeeding).

The current WHO public health recommendation, on a population basis, is to breastfeed infants exclusively up to 6 months, with introduction of nutritionally adequate, safe and appropriate complementary foods and continued breastfeeding thereafter (The optimal duration of exclusive breastfeeding – Results of a WHO systematic review, WHO Geneva 28–30 March 2001).

This recommendation had earlier been made also by the Forty-Seventh Session of the Regional Committee for the Eastern Mediterranean in resolution EM/RC47/R.10 (2000) and endorsed by the Fifty-fourth World Health Assembly (WHA 54/2).

The recommendation is supported also by a recent systematic review of the evidence (Optimal duration of exclusive breastfeeding (Review), The Cochrane Library, 2009, Issue 4).

The benefits of exclusive breastfeeding are widely established and associated with reduced childhood mortality, morbidity and enhanced cognitive development.

Despite this, exclusive breastfeeding rates are still low.

A review on child survival interventions published in The Lancet estimated that with universal coverage of exclusive breastfeeding (i.e. 90% of children under 6 months of age), 13% of under-five deaths could have been prevented in the 42 countries which contributed to 90% of worldwide under-five deaths, i.e. over 1.3 million deaths saved a year (Lancet 2003; 362:65-71).

Interventions to promote exclusive breastfeeding have included regulatory measures (legislation, policies), addressed hospital practices, used community support groups and health education and communication.

The potential impact, feasibility and sustainability of interventions on a large scale should be carefully considered when planning to embark on breastfeeding promotion. This should follow a comprehensive plan, including a combination of legislative and non-legislative regulatory initiatives, policies, guidelines, training, health education and communication interventions, based on a thorough situation analysis highlighting existing barriers and enabling factors for breastfeeding in the given context.