Abstract
Introduction
ABM's Leadership in Advocacy, Physician Education, and Knowledge Exchange
I would like to salute the ABM for continuing to draw global attention to this fundamental issue, for its extensive training of physicians and for establishing opportunities to exchange information and strategies for promoting breastfeeding.
From the enthusiasm and energy of 13 founding members has grown a vibrant, dedicated effort to promote, protect, and support one of the most fundamental of all bonds across the human race—breastfeeding.
Everyone in this room is in agreement about this, and from this shared concern we can reinforce our advocacy and knowledge-sharing across borders. As you know, very often where America goes, the world follows—nothing is more important than for America to lead in promoting a healthy start for every child across the globe. The world is catching up with what ABM has been saying since 1994!
Right in Principle
UNICEF is the United Nations agency mandated to promote and support the fulfillment of children's rights around the world. For us, there is nothing more important than assuring for every child, everywhere—regardless of gender, ethnicity, nationality, location, or status of birth—the best start in life. That means healthy lives.
As a vital component in fulfilling a child's right to the highest attainable standard of health, the promotion, protection, and support for breastfeeding is enshrined in the Convention on the Rights of the Child. So important is breastfeeding that the Committee on the Rights of the Child now makes recommendations to states parties on the need to take appropriate measures on breastfeeding—as it did most recently in Thailand and Laos with regard to the International Code of Marketing of Breast-Milk Substitutes.
From a rights perspective, a healthy start—and by implication, breastfeeding—is necessary for growth and development, protection, and participation and therefore instrumental in the realization of other rights.
From an equity perspective, breastfeeding is a unique child feeding practice equally beneficial for all children, regardless of where they are born and the status of their family. In fact, by optimizing breastfeeding practices we are able to minimize many disparities in child survival, nutrition status, and development.
Thus, the importance of breastfeeding for the realization of children's rights, and for reducing disparities occasioned by status at birth, family income, geography, and other external markers, cannot be overemphasized.
Right in Practice
There is a 14-fold difference in survival rates in the first 6 months between exclusively breastfed children and nonbreastfed children in developing countries. Recent data from low-income countries show that the occurrence of growth faltering increases markedly from 3 months onward—highlighting poor breastfeeding practices. During the complementary feeding period—6–23 months—breastfeeding continues to provide an important source of nutrients and helps to reduce the burden of disease, which is such a major contributing factor to undernutrition in developing countries. With the increase in noncommunicable diseases—diabetes, cancer, cardiovascular and chronic respiratory diseases, and mental disorders—in developing countries, breastfeeding will be increasingly important.
Just a couple of weeks ago, a group of the world's leading economists in the Copenhagen Consensus, including four Nobel Laureates, listed interventions to reduce undernutrition in young children to fight hunger and improve education as the first of 16 smartest ways to allocate money to respond to the world's biggest challenges. Breastfeeding is fundamental to adequate nutrition, and when economists are on board, we know that there is economic sense in what we are doing!
The Current Situation Around the World
It deeply concerns me that the majority of babies in the world are not optimally breastfed, despite what we know about its importance. If we look at breastfeeding rates in developing countries, we see that some 37% of children 0–6 months old are exclusively breastfed, leaving much room for improvement (Table 1). Rates are higher in the least developed countries, but as these countries become more prosperous, breastfeeding rates can fall.
So why, when we know all of this, have the global rates of exclusive breastfeeding for infants under 6 months of age hardly improved since 1990? To answer that question, let's look at it from the mother's perspective:
• If she is lucky, she gives birth in a country where breastfeeding is encouraged and supported and not obscured by taboos and myths. • But if not, she may find it hard to begin breastfeeding and doesn't have access to people who are trained to help her. • She is bombarded with messages about breastmilk substitutes and maybe turns to them because she needs to feed her child. • If she does manage to breastfeed, can she do so in her workplace? • And who will support her, especially if her community is bombarded by a barrage of images and marketing emphasizing the benefits of breastmilk substitutes for her child, and how they can make her life so much easier?
Changing the Global Outlook
And what do we need to do to change that situation? How can we create a situation where this mother is encouraged and supported in breastfeeding her child?
One answer is that we can spread the good news. We know from a growing number of countries that progress is possible. With sufficiently committed leadership, resources, good policies, programming, parental education, and public awareness, breastfeeding rates can be increased significantly. An analysis of exclusive breastfeeding data shows that breastfeeding is increasing in 54 of 90 developing countries, many of them facing significant development challenges and emergencies. Just under half of these countries had increases of 20 percentage points or higher—and there were improvements as high as 62 percentage points. And the good progress in these countries has in most cases been sustained. This tells us that a country CAN shift from almost no exclusive breastfeeding to a norm of very high exclusive breastfeeding.
In addition to spreading the good news, there are some things we need to do better:
• We need to ensure that the legislation we have worked so hard to secure is implemented. • We can encourage all countries to adopt, implement, and enforce the International Code of Marketing of Breast-Milk Substitutes—this means working more closely and constructively with the private sector. • We can support countries in developing comprehensive programs, at scale, starting at the community level and in healthcare facilities through the Baby-Friendly Hospital Initiative. Promotion of breastfeeding has been identified as part of a key package of interventions that are being implemented by countries as part of the Scaling Up Nutrition (SUN) Movement, a global effort to reach children with adequate nutrition in the critical period from pregnancy to age 2. • We need to work with thought leaders at all levels of society to change attitudes, cultural myths, beliefs, and social norms that impede breastfeeding.
You would agree with me, distinguished participants, that the last point was brought home very clearly by the recent Time cover Are You MOM Enough? In entertainment and politics, we often hear that any publicity is good publicity—the jury may be out on this one! What is important is that all of us who support and promote breastfeeding seize the proverbial 15 minutes of global attention to emphasize the importance of breastfeeding—its benefits not just for health, but for learning, for creating a protective bond between mother and child, for birth spacing and therefore family well-being, among other benefits. We need to reach out to the media—because of their influence—to go beyond the sensation and urge that they share with the world the essential service that breastfeeding provides for child, parent, and society!
UNICEF's Contribution
Distinguished participants, let me conclude by sharing just a bit of the work in which UNICEF is engaged in 190 countries and territories across the globe.
UNICEF assists governments, in many instances through civil society, private sector, the media, celebrities, parliamentarians, traditional and local leaders, and professionals and their associations, in development and humanitarian contexts, to design, plan, implement, and monitor effective, comprehensive programs for child survival, development, protection, and participation. In many countries, these programs include large-scale infant and young child feeding (IYCF) programs, with breastfeeding as their core. UNICEF supports countries with guidance, programmatic tools, materials, and training courses on IYCF, including an e-learning course with Cornell University. All of the information about these materials and initiatives can be found on the Nutrition page of the UNICEF Website.
I am pleased to say that more and more countries are reporting increased emphasis on IYCF, as per a recent assessment of IYCF programs in 65 countries.
We are constantly on the alert for innovative ways to identify and overcome barriers and bottlenecks that marginalize and exclude children from beneficial practices like breastfeeding. We are also seeking to become better advocates and are currently conducting a landscape analysis of advocacy for commitment to breastfeeding. Wide consultations with a range of stakeholders as well as UNICEF Country Representatives will examine some key questions—for example:
• Why has the strong scientific evidence not translated into more political leadership and donor commitment for breastfeeding at the global level or in the large countries with no progress on exclusive breastfeeding rates? • What are views on the current barriers and opportunities facing advocacy for breastfeeding? • Would a global breastfeeding advocacy strategy or more focused country-specific efforts, or both, be beneficial, and what are the pros and cons of associating a global strategy with the SUN movement?
We expect to have final recommendations and approach for breastfeeding advocacy by October, and we invite each of you to accompany us in this analysis and charting the way forward.
In closing, I'd like to highlight, as I always do, that for UNICEF breastfeeding is at the top of the worldwide child survival, growth, and development agendas and that we will continue to focus our efforts on finding better ways to ensure that it receives the attention and support it deserves, producing discernible results for children.
I'd also like to emphasize that as the development community starts to debate and strategize around the post–millennium development goals agenda, we will work to ensure that child nutrition—and breastfeeding in particular—remains central, and we count on all of you for support. We ask for your help with this. We are all advocates, and we must make our voices heard.
Please allow me, once again, to express my appreciation for reaching out to UNICEF. Your commitment strengthens our resolve. I hope that the brief glimpses of the situation around the world, the reasoning behind UNICEF's commitment, and my own personal conviction about the importance of breastfeeding will affirm your vision and encourage your on-going work to go beyond the borders of America. Please—do not underestimate the importance of your efforts. What you do matters!
Disclosure Statement
No competing financial interests exist.