Leith Greenslade, MPP, MBA
Despite decades of effort from global and national authorities and assistance from a large network of non-government organisations, foundations and academic institutions, current policies and programmes to increase breastfeeding rates have failed to meet public health goals. Just 44% of all babies are breastfed within an hour after birth and 40%, or two out of every five infants are breastfed exclusively for six months, in contrast to the global goal of at least 50%.
There are many interrelated factors that need to be considered to ensure breastfeeding support programmes are successful. While there have been numerous hospital and community-based initiatives aimed at promoting breastfeeding, these efforts have often been small in scale and conducted in isolation. Successful breastfeeding programmes require strong coordination between protection, promotion and support activities. Implementation research is necessary to develop effective programmes, and then clearly determine whether they are having the desired impact. It is critical that the behaviour of all stakeholders and their complex interrelationships are understood.
In Part IV (see Chapter 22), Professor Rafael Pérez-Escamilla, Professor of Epidemiology & Public Health at the Yale School of Public Health, discusses key components that countries must have in place to effectively expand breastfeeding support programmes. He begins by outlining the goals set out in the WHO Global Strategy for Infant and Young Child Feeding and continues with a discussion of different frameworks country leaders and decision-makers can pursue to achieve those goals. For example, the Complex Adaptive Systems (CAS) framework is a multi-disciplinary approach to understanding the ways in which multi-level, non-linear systems work together. Examples of successful CAS frameworks include the Assessing, Innovating, Developing, Engaging and Evolving Framework (AIDED) and, more specific to breastfeeding, the Breastfeeding Gear Model (BFGM). The BFGM is discussed as an innovative and critical model for breastfeeding expansion along with various indicator tools that can be used to measure success and support the scale-up process.
In the final chapter of the book (see Chapter 23), a major challenge that has been neglected for decades is comprehensively addressed – discrepancies in the terminologies used in breastfeeding and lactation. Emeritus Professor Peter Hartmann, Senior Honorary Research Fellow at The University of Western Australia, and Ms Melinda Boss, multidisciplinary group team leader developing evidence based protocols, have developed a detailed science based glossary of breastfeeding and lactation terms to build consensus around common terminologies and the terms have been reviewed by highly respected professors and research leaders in the field of human lactation. The glossary is part of a larger project to develop an online glossary, ‘LactaPedia’, which will be available for health professionals, researchers and mothers to ensure a comprehensive understanding of breastfeeding and lactation terms.
Countries that fully embrace these new tools, and support the development of further innovations, are well positioned to capture the benefits that high and sustained breastfeeding rates offer. It is promising for the future that there is an emerging global recognition that new approaches are needed to empower mothers to exercise a real choice to breastfeed in the decades to come.