The decision not to breastfeed harms the long-term health, nutrition and development of children - and the health of women - around the world, conclude leading experts in a new series of papers on breastfeeding published in The Lancet. They also detail how this loss of opportunity damages the global economy.
The two-part series is the most detailed analysis of levels, trends and benefits of breastfeeding around the world.
By not being exclusively breastfed for the first 6 months of their lives, and not continuing to receive their mother's milk for another 6 months, millions of children are being denied the important health benefits of breastfeeding, note the authors.
Figures estimated for the series suggest if all countries were to increase breastfeeding for infants and young children to near-universal levels, over 800,000 child deaths (13% of all deaths in the under-2s), 20,000 breast cancer deaths and $302 billion in costs to the global economy could be prevented every year.
The authors say that by not doing enough to promote and encourage breastfeeding, the world's nations - both rich and poor - are overlooking one of the most effective ways of improving health of children and mothers.
Cesar Victora, a professor from the Federal University of Pelotas in Brazil and a leading author in the series, says the need to tackle this global issue is greater than ever. She notes:
"There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth. Our work for this Series clearly shows that breastfeeding saves lives and money in all countries, rich and poor alike."
Breast milk is a 'very exquisite personalized medicine'
The experts say their analyses - comprising 28 systematic reviews of available evidence, 22 of which were prepared for the series - show, for example, that breastfeeding has a significant benefit to life expectancy.
In wealthy countries, breastfeeding reduces sudden infant deaths by over a third, and in low and middle-income countries, breastfeeding halves cases of diarrhea and reduces respiratory infections by a third.
In a podcast interview for the series, Prof. Victora says while we are only "beginning to scratch the surface," a lot of evidence is emerging about the biology of breastfeeding and the components and properties of breast milk.
He quotes a colleague who likens breast milk to "very exquisite personalized medicine" because it reflects the biological interaction between the mother and her child, "something that formula will never be able to imitate," he notes.
Prof. Victora cites as an example the effect that receiving breast milk has on the development of the microbiome - the trillions of friendly bacteria that live in and on our bodies and play a key role in our health.
He says we are also beginning to understand that breast milk has epigenetic effects - that is, it influences the expression of genes that control cell activity and development. And, another recent discovery is that breast milk contains stem cells.
There is evidence, the authors note, that breastfeeding increases intelligence and may protect against obesity and diabetes in later life. And for mothers, breastfeeding for longer reduces their risk of breast cancer and ovarian cancer.
Promoting breastfeeding makes economic sense
The authors say countries should see promoting breastfeeding as an investment that benefits not only their public health, but also their economies.
They estimate that loss to economies due to impact of not breastfeeding on intelligence amounted to $302 billion in 2012, or 0.49% of world gross national income.
Prof. Victora and colleagues also calculate that if rates of breastfeeding in babies under 6 months were to increase to 90% in the US, China and Brazil, and to 45% in the UK, they would save these countries $2.45 billion, $223.6 million, $6.0 million and $29.5 million, respectively, due to reductions in treating common childhood illnesses like pneumonia, diarrhea and asthma.
This loss of opportunity to boost public and economic health is further highlighted by the fact that worldwide rates of breastfeeding are low, particularly in wealthy countries - for example the UK, Ireland and Denmark have some of the lowest rates of breastfeeding at 12 months in the world (under 1%, 2% and 3%, respectively).
Prof. Victora remarks that breastfeeding is one of the few "positive health behaviors" that is more prevalent in poor countries than in wealthy countries. Also, in poor countries, it is the poorer mothers that practice it more. He notes:
"The stark reality is that in the absence of breastfeeding, the rich-poor gap in child survival would be even wider."
He urges policymakers to take note of this and be reassured that promoting breastfeeding provides a rapid return on investment that takes less than a generation to come to fruition.
Aggressive formula marketing undermines breastfeeding promotion
One of the papers also touches on the effects that aggressive marketing of "formula" or breast milk substitutes is having, despite countries attending the World Health Assembly in 1981 adopting the World Health Organization (WHO) International Code of Marketing of Breast-Milk Substitutes, which the authors note has not been enforced effectively.
The multi-billion dollar breast milk substitute industry must be reined in, they urge, or it will continue to undermine breastfeeding as the best feeding practice in early life.
The WHO recommend babies start breastfeeding within 1 hour of life, are exclusively breastfed for 6 months. After this, there should be gradual introduction of adequate, safe and properly fed complementary foods with babies continuing to breastfeed for up to 2 years of age or more.
The authors note that global sales of breast milk substitutes are expected to reach $70.6 billion by 2019, as co-author Dr. Nigel Rollins, from the Department of Maternal, Newborn, Child and Adolescent Health at the WHO in Geneva, explains:
"Saturation of markets in high-income countries has caused the industries to rapidly penetrate emerging global markets. Almost all growth in the foreseeable future in sales of standard milk formula (infants <6 months) will be in low-income and middle-income countries, where consumption is currently low."
He cites the example of the Middle East and Africa, where estimates show per-child consumption of breast milk substitutes will likely grow by over 7% in the period 2014-2019.
And in wealthy nations, growth in breast milk substitutes will be largely driven by sales of follow-on and toddlers milk, which are set to increase by 15% by 2019, he notes.
Breastfeeding must become a key public health issue
The authors say governments and international organizations have to show powerful political commitment and provide the financial backing needed to protect, promote and support breastfeeding at all levels - national, community, family and workplace.
In an accompanying comment paper, leading experts in the field - including Frances Mason from Save the Children UK and Dr. Alison McFadden from the School of Nursing and Health Sciences at the University of Dundee, UK - say world leaders must not repeat the mistake of leaving out breastfeeding from the Millennium Development Goals when it sets the Sustainable Development Goals later this year.
They plead for breastfeeding not be tagged onto the child nutrition agenda but to be treated as a key public health priority that reduces disease, infant deaths and inequity, and also urge leaders at all levels to "end promotion of products that compete with breastfeeding."
Prof. Victora concludes:
"There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences."
In October 2015, Medical News Today learned of a report from the Centers for Disease Control and Prevention (CDC) that shows while breastfeeding support at US hospitals has improved since 2007, there are still many ways it could be better. Improved hospital care could increase breastfeeding rates nationwide, it concludes.