WHO European Region has lowest global breastfeeding rates

Breastfeeding is the best option for infant feeding. It ensures the best trajectory for growth and development, while preventing noncommunicable diseases later in life; it should be exclusive during the first 6 months of life.  It is therefore considered one of the most critical behaviours for health promotion and protection.

Significant achievements in maternal and newborn health in the WHO European Region include better attitudes towards pregnant women, respectful collaboration and active engagement of women in decision-making during pregnancy and birth and better quality of care. However, the Region has the lowest breastfeeding rates of all the WHO regions.

In 2006–2012, only an estimated 25% of infants in the WHO European Region were exclusively breastfed for the first 6 months, as compared with 43% in the WHO South-East Asia Region. Recent data on exclusive breastfeeding from 21 countries in the Region show that, on average, 13% of infants are exclusively breastfed during the first 6 months. The average rate of exclusive breastfeeding thus remains far below the global recommendation, although the rates vary substantially across the Region. Even though the rate of early initiation of breastfeeding is very high in some countries, exclusive breastfeeding rates drop rapidly between 4 and 6 months of age and are very low at 6 months.

Mothers with lower socioeconomic status (less income, education and employment) are less likely to begin breastfeeding.

WHO recommends that breastfeeding be initiated within the first hour of birth and be exclusive for 6 months, with the introduction of complementary food after 6 months and continued breastfeeding up until 2 years or beyond.

Long-term health benefits for mothers who breastfeed:

• reduced risks for breast and ovarian cancers and obesity

Benefits for breastfed infants 

• reduced risks for diarrhoea and respiratory infections;
• protection against risk for obesity;
• protective effect on the incidence of noncommunicable diseases, notably childhood obesity, cardiovascular disease and diabetes mellitus;
• higher IQ; and
• reduced risk for allergies

In 2002, WHO Member States adopted the Global Strategy for Infant and Young Child Feeding, which advocates comprehensive national policies to promote, protect and support adequate infant and young child feeding practices. The Global Strategy recommends wider implementation of the International Code of Marketing of Breast-Milk Substitutes. The Innocenti Declaration, the Baby-friendly Hospitals Initiative, the WHO Maternal, Infant and Young Child Nutrition Implementation Plan and the World Health Assembly Global Targets for Nutrition 2025 collectively play an important role in promoting increased breastfeeding.

What factors discourage breastfeeding in the WHO European Region?

Poverty, difficulty in accessing health services, social marginalization, obesity (many pregnant women are now overweight or obese), policies in the workplace and the employment market, marketing of breast-milk substitutes, commercial "follow-on" and complementary foods are just some of the reasons for low breastfeeding rates and inequality in the WHO European Region.

Mothers with low socioeconomic status are up to 10 times less likely to begin breastfeeding, and this tendency is transmitted through generations.

What can be done to reduce inequity and improve breastfeeding initiation rates?

Promotion of and support for breastfeeding are critical for the development and appropriate nutrition of children. In order to reduce inequities and improve breastfeeding rates, WHO has introduced and promotes a number of initiatives:

• "Beyond the numbers", an approach to analysis of maternal mortality and morbidity rates for improved access to good-quality care;
• promotion and adoption of breastfeeding in hospitals at country level;
• sexuality education and improved quality of family planning services;
• policy assessment and planning at national, regional and local levels; and
• promotion of the rights of women and their families to choice, access and high-quality care.

The WHO Collaborating Centre in Global Nutrition and Health also suggests that the Baby-friendly Hospitals Initiative be extended to all birthing facilities and services, including in the community. Launched in 1991, the aim of the Initiative is to implement practices to protect, promote and support breastfeeding, such as procedures to encourage early initiation and continuing exclusive breastfeeding, in addition to restricting the marketing of breast-milk substitutes in health care settings.

The International Code of Marketing of Breast-milk Substitutes outlines measures that countries can take to limit aggressive, inappropriate marketing of breast-milk substitutes by:

• enacting legislation to restrict the marketing and promotion of infant formulas and other products used as breast-milk substitutes;
• monitoring and enforcing effective sanctions in case of violations; and
• engaging in partnerships with civil society organizations to help governments advocate for enactment, implementation, enforcement and monitoring of the Code.

An article entitled "Breastfeeding initiation at birth can help reduce health inequalities" can be read in the most recent edition of Entre Nous magazine, "Birth in Europe in the 21st century".  

World Breastfeeding Week

This year's focus during World Breastfeeding Week is supporting breastfeeding by encouraging family-friendly policies in the workplace. As members of the World Alliance for Breastfeeding Action, WHO and the International Labour Organization highlight how lawmakers, employers, trade unions and co-workers can protect, promote and support breastfeeding in the workplace.