Breastfeeding in the 21st Century2016 Lancet Series

Laurence Grummer-Strawn, PhDDepartment of Nutrition for Health and Development

World Breastfeeding ConferenceJohannesburg, South Africa

December 12, 2016

What is the relevance of breastfeeding to women and children in low, middle and high income countries in the 21st century?

Outline

o Global BF patterns and trends (equity lens)o Consequences of BFo Modeling of BF impacto Interventions to improve breastfeeding

Global map of breastfeeding prevalence

Re-analysis of DHS and MICS surveys for 127 out of 139 LMICs

Literature review on 37 out 75 HICs

Patterns of breastfeeding vary by region

Breastfeeding: one of the few positive health behaviors more prevalent in LMICs than HICs

Breastfeeding practices over time

For each doubling in national GDP per capita, breastfeeding prevalence at 12 months decreases by 10 percentage points

Population-weighted averages from 217 surveys

Impact of breastfeeding on maternal and child health• Systematic literature

reviews (data from low-, middle- and high-income settings)- Short-term health

outcomes- Long term health

outcomes- Maternal outcomes

Consequences of BreastfeedingShort-term Long-term Maternal

Protection • Under-five mortality• Infectious morbidity

and hospitalizations• Diarrhea• Respiratory

infections • Malocclusion

• Overweight/ obesity• Types I and II

diabetes (?)• Intelligence

• Lactational amenorrhea• Breast cancer• Ovarian cancer • Diabetes (?)

No evidence

• Growth in weight or length – but lower BMI

• Eczema, allergies, rhinitis, asthma

• Blood pressure• Serum lipids

• Weight loss• Osteoporosis

Harm • Dental caries

Breastfeeding – exquisitely personalized medicine at a critical moment

Individualized components of breastmilk• Bacteria from the mother’s gut microbiome• Immune cells primed in the mother’s

intestine• Carbohydrates (HMOs) that shape the

baby’s microbiome• Small RNA’s and microvesicles (exosomes)

that control genes in the baby• Stem cells that survive in the baby

Impact modeling results

o Improvements in BF practices could result in annual prevention of o 823,000 deaths of underfive childreno 20,000 breast cancer deaths

o Economic gains: $302bn (0.47% of GDP) due to increased productivity associated with higher intelligence

The impact of interventions to improve breastfeeding practices

• Systematic review: 20,000+ papers screened and 300 studies examined

• Interventions according to settings– Health systems and services– Home and Family Environment– Community Environment– Work Environment– Policy

• Four outcomes assessed– Early initiation of BF / exclusive BF at 6 mo /

continued BF 12-23 mo / any BF at 6 mo

Interventions to improve breastfeeding practices• Breastfeeding practices highly responsive to

interventions • Health system and community interventions can

increase exclusive breastfeeding by 2.5X• Maternity leave and work-place interventions

also beneficial (few studies) • Largest effects of interventions achieved when

delivered in combination

Key messages

1. Magnitude of BF effects is astounding

2. Health effects extend beyond time of breastfeeding (child and maternal)

3. BF is important in high-income settings

4. BF practices are far from ideal5. BF interventions are effective

“If breastfeeding did not already exist, someone who invented it

today would deserve a dual Nobel Prize in medicine and economics.”

Keith Hanson, Vice President for Human Development,

World Bank Group

Acknowledgements

AuthorsRajiv BahlAluisio BarrosNita BhandariGiovanny FrancaNemat HajeebhoySue HortonJulia KrasevecChessa LutterJeevasankar MariJose MartinesSimon MurchEllen PiwozLinda RichterNigel RollinsCesar VictoraNeff Walker

Lancet Breastfeeding GroupKatie AllenRanadip ChowduryCL de MolaShyamali DharmageElsa GiuglianiBernardo HortaCaroline LodgeF MaiaKaren PeresBireshwar SinhaElizabeth SpeakmanSunite TanejaDaphne Wu

FundingBill & Melinda Gates Foundation

Other supportEuromonitor- Protea Hirschel- Danielle Le Clus-Rossouw- Maya Shehayeb