Reaching the Global Target to Increase Exclusive Breastfeeding: How Much Will It Cost and How Can We Pay for It?

Why Breastfeeding?

Exclusive breastfeeding during the first 6 months of life has the single largest potential impact on child mortality of any preventive intervention. ³ It boosts a child's immune system and thus prevents childhood illnesses such as diarrhea, respiratory diseases, and sepsis that can lead to increased mortality. ¹ Exclusive breastfeeding also has a protective effect against obesity and certain noncommunicable diseases later in life. ⁴

Optimal breastfeeding includes early initiation of breastfeeding, exclusive breastfeeding of newborns until 6 months of age, and continued breastfeeding with appropriate complementary food until at least 2 years of age. ⁵

Breastfeeding also confers significant cognitive benefits. The cognitive losses alone of not breastfeeding (even nonexclusive breastfeeding) to 6 months were estimated at 0.49% of world gross national income.

The recent Lancet Breastfeeding Series (2016) estimated that optimal breastfeeding could help prevent 823,000 child deaths and 20,000 breast cancer deaths each year. ⁶ In addition, the current low breastfeeding rates globally are estimated to result in economic losses of about $302 billion annually, or 0 · 49% of world gross national income. ⁷

More than 63% of children younger than 6 months are not being exclusively breastfed as recommended by World Health Organization in low- and middle-income countries. This means that more than 68 million children born this year will not be fed according to guidelines for exclusive breastfeeding. ⁶

Investing in Proven Interventions to Achieve the Global Breastfeeding Target

The analysis shows that an investment of an additional $5.7 billion over the next 10 years is required to meet the exclusive breastfeeding target within low- and middle-income countries (see Appendix). This estimate is based on a set of high-impact interventions, costed in 27 countries with the lowest rates of breastfeeding ^a and then extrapolated to all low- and middle-income countries. The interventions were selected based on their effectiveness in increasing exclusive breastfeeding rates. High-income countries were excluded from this study; however, it is important to note that suboptimal breastfeeding rates are a serious problem that affect all countries regardless of their income level.

The high-impact interventions identified as part of this study include counseling of mothers and caregivers on good infant and young children nutrition and hygiene practices, probreastfeeding social policies, and national breastfeeding promotion campaigns.

Counseling on good infant and young child nutrition and hygiene practices includes individual- or group-based counseling sessions that promote exclusive breastfeeding, which are delivered in the community and/or health facility, depending on country context. Breastfeeding counseling or education delivered at the community level may be required in countries with weak health systems and lack of access to health facilities. Studies have shown that breastfeeding counseling results in a 90% increase in rates of exclusive breastfeeding in infants of age 0–5 months. ⁸

Probreastfeeding social policies are designed to create an enabling environment for breastfeeding and motivate maternal and household decision making toward optimal child care and feeding practices. In particular, the adoption of national legislation that aligns with the World Health Organization's International Code on Marketing of Breastmilk Substitutes is considered useful in minimizing the coercive tactics of the infant formula industry in promoting breast milk substitutes. ^b The cost of extending maternity leave to 6 months was not included as part of the investment framework because costs are likely to be borne by other sectors. However, the extension of maternity leave is a proven enabler of optimal breastfeeding practices and should be incorporated into national policy discussion on how to best support women who are breastfeeding. ⁷

National breastfeeding promotion campaigns, especially mass media campaigns to promote breastfeeding, are important to increasing national breastfeeding rates and developing a culture that supports optimal breastfeeding. ⁹ As an example of what is possible, the integrated Alive & Thrive program in Vietnam, which includes a mass media campaign at scale, in addition to infant and young child feeding counseling and advocacy for probreastfeeding social policies, demonstrates a total 28.3% increase in exclusive breastfeeding for the first 6 months compared with control sites over the period 2010–2014. ¹⁰

Scaling-up investments of this package of interventions is projected to increase the exclusive breastfeeding rate in all low- and middle-income countries from 37% to 54%. It would result in an additional 105 million children being exclusively breastfed and 520,000 child deaths averted over the next 10 years.

This impact is based on the effects of only one intervention: the counseling of good infant and young children nutrition and hygiene practices. Although the other interventions are known to be important in increasing exclusive breastfeeding rates, precise impact is unknown. There is evidence that breastfeeding rates in countries with probreastfeeding social policies increased by 1% per year, twice as quickly as the global average, demonstrating that changes in national policy can make an important difference. ⁷

Meeting the Breastfeeding Target will Require Global Solidarity

Current investments in breastfeeding interventions fall well short of what is needed to increase breastfeeding rates. It is estimated that countries are currently spending only about $250 million annually, and donors are contributing only $85 million annually, on the interventions identified in the study. On average, an additional $570 million is needed each year from donors and countries to reach the exclusive breastfeeding target by 2025.

Countries and donors can fill this resource gap by together increasing their financial and political commitments to improve rates of exclusive breastfeeding. If countries commit to doubling their domestic investment by 2021, and continue to increase their spending up to 2.5 times by 2025, while donors accelerate investments in breastfeeding in the first 5 years by more than threefold, the breastfeeding target will be met and more than half a million children's lives will be saved.

The Shared Opportunity

The evidence is clear that exclusive breastfeeding during the first 6 months of life is one of the best actions that can be taken to support future health and prosperity of individuals and societies—the cost to do this is minimal compared to the potential impacts. Increasing exclusive breastfeeding rates to at least 50% can be achieved through a strong and coordinated effort by governments, civil society, and donors to support evidence-based interventions and strategies that ensure that mothers are supported to breastfeed and that breastfeeding is protected.

Every country and community will require a unique mix of breastfeeding promotion campaigns, supportive policies, and counseling interventions. It is worth noting that a number of countries have already demonstrated that quickly and dramatically improving breastfeeding rates is indeed possible. As stated previously, Vietnam achieved a 28.3% total increase in exclusive breastfeeding in the first 6 months in provinces where a national strategy to improve breastfeeding rates was implemented in 2010–2014. ¹⁰

In addition to the enormous body of evidence around the central role that breastfeeding plays in the health and well-being of mothers and children, as well as the societal and economic benefits of optimal breastfeeding, this investment framework to reach the global breastfeeding target makes the case for investing in proven interventions and in creating a global culture of breastfeeding.