The Scientific Evidence Calls upon Governments to Scale up Counselling on Breastfeeding and Complementary to Coverage of 99%

This is brief on new evidence generated by the publication of lancet series on maternal and child undernutrition in January 2008. The new evidence reiterates that promotion of breastfeeding and complementary feeding has to be scaled up to reach 99% coverage.The data also looks at combined effects of suboptimal breastfeeding and other nutrition related risk factors and concluded that even if all other nutrition risks were addressed, a substantial number of child deaths still require interventions related to breastfeeding practices.

In the opening comment the editor Richard Horton has said,

“…According to strict criteria around admissible evidence, breastfeeding counselling, vitamin A supplementation, and zinc fortification have the greatest benefits……”

“…The compelling logic of this scientific evidence is that governments need national plans to scale-up nutrition interventions, systems to monitor and evaluate those plans, and laws and policies to enhance the rights and status of women and children. .….”

For all developing countries 32% (178 million) children younger than 5 years are stunted, 20% (112 million) are underweight. Out of these 61 million are stunted in India. Risk of death increases with decreasing Z score of stunting or underweight. 16% babies are born below 2500 gm in all developing countries.DALY ( Disability Adjusted Life Year) is roughly one lost year of so –called healthy life. Underweight, stunting and wasting all are risk factors for DALYs.Globally there are 2.8 million child deaths (28% of under five deaths) and 114 million DALYs (27% of under five DALYs) attributable to childhood undernutrition. India alone has 0.6 million child deaths, and 24.6 million DALYs attributed to stunting.

The Evidence:

  • Predominant breastfeeding (breastfeeding plus water) increases the risk of child mortality by 1.48 times as compared to exclusive breastfeeding.
  • Partial breastfeeding (breastmilk plus other milks or foods) increases the child mortality by 2.8 times as compared to exclusive breastfeeding.
  • The relative risk for prevalence of diarrhea is 1.26 and 3.04 for predominant and partial breastfeeding as compared to exclusive breastfeeding.
  • The relative risk for pneumonia is 1.79 and 2.49 for predominant and partial breastfeeding as compared to exclusive breastfeeding.
  • Infectious diseases like diarrhea, pneumonia and malaria are important contributors to stunting.
  • There is epidemiological evidence to suggest that beginning breastfeeding within first day postpartum would have additional benefit with regard to mortality even in exclusive breastfed infants , reaffirming the recommendation to begin breastfeeding immediately after delivery.
  • ‘Breastfeeding promotion’ itself contributes to 11.6% reduction in IMR if coverage of promotion is 99%, and can avert 21.9 million DALYs at 3 years
  • 99% coverage of Complementary feeding promotion and other supportive strategies can reduce stunting by 19.8% by 1 year, and avert 5.5 million DALYs at 3 years.
  • 1.4 million deaths (12% of under five) and 43.5 million DALYs (10% of global under-5 DALYs are attributable to suboptimal breastfeeding. And out these attributable deaths 77% numbering 1.06 million child deaths are due to non-exclusive breastfeeding during 0-6 months of life. Similarly, 85% of DALYs lost are due to non exclusive breastfeeding.

What works for breastfeeding?

‘One to one individual counselling’ and ‘group counselling’, both have potential to increasing exclusive breastfeeding substantially at 1 and 6 months significantly. Other interventions are not very useful.

What works for complementary feeding?

Complementary feeding can be enhanced through education programmes, and counselling. However for food insecure populations food supplements are required.

What are current gaps in evidence related to breastfeeding and complementary feeding?

Few studies of large-scale interventions for promotion of breastfeeding have assessed their effects on feeding patterns and growth outcomes beyond infancy.

Dr Arun Gupta MD FIAP

National coordinator BPNI and Regional coordinator International Baby Food Action Network(IBFAN) Asia

February 18, 2008

The Scientific Evidence Calls to scale up Breastfeeding and complementary to 99.doc 1