Nutrition

Infant and Young Child Feeding and Care

Protecting, promoting and supporting breastfeeding

GOAL: Protect, promote and support optimal infant and young child feeding. The aim is to create an environment globally that empowers women to begin skin-to-skin with her baby and breastfeed after birth, to breastfeed exclusively for the first six months and to continue to breastfeed for two years or more with age appropriate, responsive complementary feeding. This is optimal infant and young child feeding, the Best Start to life. It is expected to improve the nutrition status, growth and development, health and thus the survival of infants and young children. It is closely linked to the related maternal nutrition that safeguards women's own well-being.

The Challenge

Breastfeeding is the perfect way to provide the best food for a baby’s first six months of life, benefiting children the world over. But breastfeeding is so much more than food alone; breastfeeding protects babies from diarrhoea and acute respiratory infections, stimulates their immune systems and improves response to vaccinations, and contains many hundreds of health-enhancing molecules, enzymes, proteins and hormones.

Attainment of this goal requires, in many countries, the reinforcement of a "breastfeeding culture" and its vigorous defense against incursions of a “bottle-feeding culture.”  Many mothers neither exclusively breastfeed for the first six months of the baby’s life nor continue breastfeeding for the reommended two years or more, and instead replace breastmilk with commercial or other substitutes. Formula feeding is expensive and carries risks of additional illness and death, particularly where the levels of infectious disease are high and where preparation and storage of these substiutes is not carried out properly. Many studies indicate that a non-breastfed child living in disease-ridden and unhygienic conditions is between six and 25 times more likely to die of diarrhoea and four times more likely to die of pneumonia than breastfed infants. A recent study of postneonatal mortality in the United States found a 25% increase in mortality when infant were not breastfed.

The Solution

If every baby were exclusively breastfed from birth for six months, an estimated 1.3 million additional lives would be saved and millions more enhanced every year. Breastfeeding also eliminates the expense of infant formula or other substitutes and the incalculable emotional and economic cost of illness and death resulting from problems associated with artificial feeding. In many countries, feeding a child on breastmilk substitutes can cost more than the average income of a family. Breastfeeding can also help families with birth spacing by delaying the resumption of fertility after childbirth.

The good news is that breastfeeding rates are no longer declining and have increased during the last decade, with up to a 48 per cent increase in exclusive breastfeeding in some regions. However, more than half of all infants are still not exclusively breastfed for the first six months of life, and poor continuation of breastfeeding with inadequate complementary feeding practices is still widespread.

The 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding

UNICEF's strategy for infant and young child feeding has been based upon the Innocenti Declaration for the protection, promotion and support of breastfeeding. The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, a definitive, policy-setting document, outlined the key objectives for the protection, promotion and support of breastfeeding. The Declaration was adopted in August 1990 and was subsequently endorsed by the World Health Assembly and UNICEF's Executive Board. The four targets of the Innocenti Declaration are:

• Appointment of a national breastfeeding coordinator of appropriate authority, and establishment of a multisectoral national breastfeeding committee;
• Ten Steps to Successful Breastfeeding (the Baby-Friendly Hospital Initiative) practised in all maternity facilities; 
• Global implementation of the International Code of Marketing of Breast-Milk Substitutes and subsequent relevant World Health Assembly Resolutions in their entirety;
• Enactment of imaginative legislation protecting the breastfeeding rights of working women; and establishment of means for enforcement of maternity protection.

The challenge of how to improve breastfeeding, with an overview of breastfeeding patterns in the 1990s, is summarised among the World Summit for Children goals.

The 2002 Global Strategy for Infant and Young Child Feeding

Member States of the UN reaffirmed the relevance and the urgency of the four Innocenti targets in the WHO/UNICEF Global Strategy for Infant and Young Child Feeding adopted by the World Health Assembly in May 2002. The Global Strategy includes and supercedes the Innocenti goals, adding attention to support for mothers and the community and Breastfeeding creates a special bond between mother and baby and offers unique interaction and stimulation that along with the balance of protein and energy, micronutrients and active factors in the milk -- helps growth and development and gives a sense of well-being and security. Breastfeeding also benefits the mother’s health by helping the uterus to contract soon after delivery, thus reducing chances of prolonged bleeding. It also helps delay fertility return and decreases the mother’s risk of ovarian and breast cancer.  These benefits are even greater for underweight babies in emergencies and in other high-risk situations or conditions.

The Global Strategy includes five additional operational targets:

• Implementation of comprehensive government policies on infant and young child feeding;
• Full support from health and other sectors for two years of breastfeeding or more;
• Promotion of timely, adequate, safe and appropriate complementary feeding (addition of other foods while breastfeeding continues);
• Guidance on infant and young child feeding in especially difficult circumstances, and related support for families and caregivers; and
• Legislation or suitable measures giving effect to the International Code as part of the national comprehensive policy on infant and young child feeding.

UNICEF supports the tenets of the Infant and Young Child Feeding Strategy through its Medium Term Strategic Plan that underlines the importance of mulit-sectoral approach to improve health and nutrition.

These policies reflect Article 24 of the Convention on the Rights of the Child, by which governments must ensure that all sectors of society know about the benefits of breastfeeding. In the especially difficult circumstances of HIV/AIDS-positive women, such benefits must be weighed against the risk of mother-to-child transmission of the virus. Current policies aim to continue support for breastfeeding, especially exclusive breastfeeding, while ensuring informed choice on infant feeding options. Ongoing further research into the exact mechanisms of transmission will continue to inform guidelines on HIV/AIDS and infant feeding.

Especially difficult circumstances also include emergencies, in which continued breastfeeding must not be undermined by inappropriate donations and use of breastmilk substitutes. The Emergency Nutrition Network (ENN), of which UNICEF is a part, has generated common Operational Guidance for Emergency Relief Staff and Programme Managers. Associated training modules for relief workers are being field tested.

The 2005 Innocenti Declaration on Infant and Young Child Feeding

On the occasion of the 15th anniversary of the original Innocenti Declaration, an international meeting was held in Florence, Italy on 21 and 22 November 2005. The event took stock of progress made in the protection, promotion and support of breastfeeding since 1990, including the adoption of the Global Strategy for Infant and Young Child Feeding in 2002. The 2005 Innocenti Declaration on Infant and Young Child Feeding adopted at the anniversary builds on the 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, covering infant and young child feeding practices as a whole. It also seeks to identify roles and responsibilities of key players and emphasizes that these responsibilities need to be met in order to achieve a vision of an environment that enables mothers, families and other caregivers to make informed decisions about optimal infant feeding.

Two strategies that protect, promote and support breastfeeding are well underway: the Baby-friendly Hospital Initiative (BFHI) and the International Code of Marketing of Breastmilk Substitutes (the Code).

Maternity protection

Exclusive breastfeeding for six months is crucial for the health of mothers and infants everywhere, not just among those who do not have access to clean water and cannot afford artificial breastmilk substitutes. But we also know that everywhere women are entering the work force in greater numbers and need special support to be able to breastfeed exclusively.

Much of women's work is informal, poorly paid, or unpaid, unrecognized, and unprotected by labour legislation. Women usually take responsibility for unpaid household work and the nurturing work of child rearing. Thus, work includes income-generating activities in the recognized labour market and in the informal sector, as well as unpaid, unrecognized household and volunteer work. Only women have the capacity to breastfeed. But the integration of breastfeeding with other kinds of work requires new policies and actions to protect the rights of women, including the right to breastfeed.

This is particularly important today, as women workers face ever worsening conditions of work. Given the current process of economic globalization, conditions of paid work are becoming more uncertain and precarious. As a result many women are working more for less. Breastfeeding is a right of mothers and is a fundamental component in assuring a child's right to food, health and care. Governments and civil society should pursue full implementation of these as human rights.

The protection, respect and fulfillment of these rights requires universal recognition of the importance of maternity as a social function supported by public funds. "Maternity protection is a precondition of genuine equality of opportunity and treatment for men and women." (International Labour Organization [ILO], Maternity Protection at Work, pg. 51, 1997)

Read the following Country Situation files to access basic information on nearly every country in the world on breastfeeding rates, working women and maternity protection benefits, with sources listed.

Infant Feeding and HIV

Mothers are will decide how to feed their infants but, to make an informed choice, they need counselling to know the benefits, risks and costs associated with all infant feeding options.

© UNICEF/HQ95-0355/ Charton

A mother breastfeeds her baby as the grandmother looks on. Myanmar.

The “Global Strategy on Infant and Young Child Feeding,” was approved by the World Health Assembly of WHO in May 2002.  In September 2002, the Global Strategy was endorsed by the UNICEF Executive Board as the foundation for UNICEF's action in support of optimal infant and young child feeding for survival, growth and development of children worldwide.  

It is reflective of rights-based, lifecycle programming, recognition of gender needs, supportive of the mother and family, and directly improving early childhood survival, growth and development.

These activities support the World Fit for Children:

• “Exclusive breastfeeding for six months, (significantly reducing child mortality and malnutrition)
• Continued breastfeeding with safe, appropriate and adequate complementary feeding up to 2 years or beyond” (addition reductions in mortality and reducing stunting), as well as
• Related nutrition and reproductive health care for the mother, including delay of first birth and spacing of births three to five years apart, which also contributes to the best nutritional and survival outcomes for both mother and child.

UNICEF efforts will recognize children’s and families’ rights and responsibilities and include suggested proven activities for advocacy and support of government and non-governmental actions at three levels: National Commitment, Health Care Improvements, and Community.

1. Support Multi-sectoral National Commitment by encouraging the development of:

• National breastfeeding/complementary feeding authority and a multi-sectoral national committee
• Policy, protocols and standards on IYCF in the context of national policies, programming, and professional health organizations
• Advocacy materials addressing policy and legislation, new and ongoing, to all relevant groups, such as health workers, political leadership, stakeholders and partners.
• Legislation and enforcement of the International Code of Marketing of Breastmilk Substitutes, subsequent relevant WHA Resolutions, the ILO Maternity Protection Convention
• New legislation or other suitable measures

2.  Enhance Implementation of Health Services and Training Reform (Baby-Friendly Health Care):

Develop and maintain Baby-Friendly Health Care (BFHC) by: 

• Supporting full implementation of the Baby-Friendly Hospital Initiative in all maternity services, including Step 10, which is the development of community activities to support the breastfeeding mother. 
• Advocating and providing technical assistance in the development of standards for BFHC, and for their inclusion into the National Health Information Systems.
• Reviewing all health system contacts to ensure that each contact includes age-appropriate feeding support for mother and child.
• Providing technical assistance for revision of pre-service training curricula to include appropriate breastfeeding and complementary feeding support skills, and appropriate job-aids to support improved healthcare practices at all levels.
• Including support for birth spacing of at least 3 years for the health and survival of mother and child (preferably 3-5 years) in all programs.

3.  Provide Support for Communications/Community/Social Advocacy Programming by:

• Encouraging emphasis on community social support for the mother and the ability to refer for medical support when needed, and on family and societal support for an optimal infant and young child feeding norm and at least three years birth spacing.  National communications and social mobilization activities will be supported.

4. Address Cross-cutting and Partnership Issues:

This includes building capacity, monitoring and evaluation, and provision of guidance on feeding infants and young children in exceptionally difficult circumstances and on the related support required by mothers, families, and other caregivers, in unstable situations such as in families/communities living with HIV/AIDS or in manmade or natural emergencies.