In view of the economic and environmental costs of low breastfeeding rates and the ability of relatively low cost interventions to enable women to breastfeed for longer, it makes a convincing case for governments and civil society to improve investment in breastfeeding.
The first paper considers: health outcomes; potential lives saved; recent understanding of some of effects on immunity and the microbiome; and estimates trends in breastfeeding rates globally. The second examines factors that influence breastfeeding rates and the effectiveness of promotion interventions (Rollins et al 2016). The changing understanding of breastfeeding in HIV transmission, marketing of breastmilk substitutes (BMS), and environmental and economic aspects are also summarised. This leads to the deduction that, as ‘potentially one of the top interventions for reducing under-5 mortality’, breastfeeding has a substantial contribution to make to future global development (Victora et al 2016:487).
Meta-analysis of studies in low- and middle-income countries (LMICs) found a strongly protective effect on mortality, with exclusively breastfed infants under six months having only 12% of the risk of death compared with those who were not breastfed. Any breastfeeding was associated with a 50% reduction in deaths among children aged 6–23 months. In high-income countries (HICs), breastfeeding was associated with a 36% reduction in sudden infant deaths and, for premature babies, 58% lower risk of necrotising enterocolitis.
The Lives Saved Tool was used to calculate the mortality associated with not breastfeeding in 75 LMICs in 2015. If breastfeeding was increased to near universal levels, this was equivalent to 13.8% of the deaths of children under two years of age; an estimated 823,000 child deaths. Considering only breast cancer mortality, 22,216 mothers’ lives would be saved by increasing breastfeeding duration to 12 months per child in HICs and two years per child in LMICs every year.
Breastfeeding was associated with lower risks of infectious diseases, including gastroenteritis, respiratory infections and otitis media. Approximately half of diarrhoea episodes and a third of respiratory infections would be avoided by breastfeeding, with greater reductions in hospital admissions of 72% for diarrhoea and 57% for respiratory infections. Breastfeeding is also associated with a 19% lower risk of childhood leukaemia.
No clear evidence of protection against allergic disorders, including eczema or food allergies was detected, although there was some evidence of a reduction in allergic rhinitis in pre-school children. A statistically significant reduction in asthma of 9% was indicated with breastfeeding in analysis of 29 studies. However, this was not significant when analysis was limited to 16 studies with tighter control of confounding.
Oral health outcomes demonstrated a reduction of 68% in malocclusions with breastfeeding. In contrast, breastfeeding for longer than 12 months and nocturnal feeding were associated with 2–3 times more dental caries in deciduous teeth, which the authors note is possibly due to inadequate oral hygiene after feeds.
Most studies of links between breastfeeding and outcomes related to non-communicable diseases are from HICs. Longer periods of breastfeeding were associated with a 26% lower risk of overweight or obesity which was consistent across different income groups. Considering only large, high-quality studies reduced this to 13%. In line with this there was a 35% reduction in the incidence of type 2 diabetes, but high-quality studies indicated a potentially important, but not statistically significant, reduction of 24%.
Dodds R. MIDIRS Midwifery Digest, vol 26, no 2, June 2016, pp 237–240.
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