Increasing Breastfeeding Could Massively Reduce Child and Breast Cancer Deaths

01 Feb 2016 --- Just 1 in 5 children in high-income countries are breastfed to 12 months, whilst only 1 in 3 children in low and middle-income countries are exclusively breastfed for the first 6 months. As a result, millions of children are failing to receive the full benefits provided by breastfeeding. The findings come from the largest and most detailed analysis to quantify levels, trends, and benefits of breastfeeding around the world, published in The Lancet.

New estimates produced for the two-part Series reveal that increasing breastfeeding to near-universal levels for infants and young children could save over 800000 children’s lives a year worldwide, equivalent to 13% of all deaths in children under two, and prevent an extra 20000 deaths from breast cancer every year.

Although breastfeeding is one of the most effective preventive health measures for children and mothers regardless of where they live, it has been overlooked as a critical need for the health of the population, say the authors.

“There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth”, says Series author Professor Cesar Victora from the Federal University of Pelotas in Brazil. “Our work for this Series clearly shows that breastfeeding saves lives and money in all countries, rich and poor alike. Therefore, the importance of tackling the issue globally is greater than ever.”

Analysis of data from 28 systematic reviews and meta-analyses, of which 22 were commissioned specifically for the Series, indicate that breastfeeding not only has multiple health benefits for children and mothers, but it also has dramatic effects on life expectancy. In high-income countries breastfeeding reduces the risk of sudden infant deaths by more than a third, while in low-and middle-income countries about half of all diarrhoea episodes and a third of respiratory infections could be avoided by breastfeeding. It also might protect against obesity and diabetes in later life. For mothers, longer-duration breastfeeding reduces the risks of breast cancer and ovarian cancer.

Furthermore, the authors calculate that boosting breastfeeding rates for infants below 6 months of age to 90% in the USA, China, and Brazil and to 45% in the UK would cut treatment costs of common childhood illnesses and save healthcare systems at least US$2.45 billion in the USA, US$29.5 million in the UK, US$223.6 million in China, and US$6.0 million in Brazil.

Yet, worldwide rates of breastfeeding are low, particularly in high-income countries. For example, the UK (<1%), Ireland (2%), and Denmark (3%) have some of the lowest rates of breastfeeding at 12 months in the world “Breastfeeding is one of the few positive health behaviours that is more common in poor than richer countries, and within poor countries, is more frequent among poor mothers”, explains Professor Victora. “The stark reality is that in the absence of breastfeeding, the rich-poor gap in child survival would be even wider. Our findings should reassure policymakers that a rapid return on investment is realistic and feasible, and won’t need a generation to be realised.”

Aggressive marketing of breast milk substitutes is undermining efforts to improve breastfeeding rates, with global sales expected to reach a staggering US$70.6 billion by 2019.

“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 will be in low-income and middle-income countries, where consumption is currently low,” explains Series author Dr Nigel Rollins from the Department of Maternal, Newborn, Child and Adolescent Health at WHO, Geneva.

Persistent underinvestment in protecting, promoting and supporting breastfeeding by governments and international funders has exacerbated the issue. “Currently, breastfeeding promotion focuses on encouraging women to breastfeed without providing the necessary economic and social conditions such as supportive health-care systems, adequate maternity entitlements and workplace interventions, counselling, and education”, says Dr Rollins.

Countries can significantly improve breastfeeding practices by scaling up known interventions, policies, and programmes identified in the Series. For example, Bangladesh has increased exclusive breastfeeding rates by 13%, which has been attributed to a number of key interventions including 6 months of maternity leave, comprehensive health-worker training, community mobilisation, and media campaigns. In Brazil, the length of breastfeeding increased dramatically from 2.5 months in 1974–75 to 14 months in 2006–07 due to a combination of policy, health service, civil society, and mass media initiatives.

The authors say more needs to be done to regulate the multi-billion dollar breast milk-substitute industry which undermines breastfeeding as the best feeding practice in early life. The authors point out that the International Code of Marketing of Breastmilk Substitutes could be an effective mechanism if adequate investment is made to ensure its implementation and accountability across all countries.

According to Professor Victora, “There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences. The evidence outlined in the Series, contributed by some of the leading experts in the field, leaves no doubt that the decision not to breastfeed has major long-term negative effects on the health, nutrition and development of children and on women’s health.”