The Lancet 2023 Series on Breastfeeding

The three papers:

• How baby behaviours – such as sleep and crying - are misunderstood and misconstrued to undermine breastfeeding, but multi-sectoral interventions can protect its extensive health impacts
• How the formula marketing ‘playbook’ targets parents, health professionals and politicians and undermines the health and rights of children and mothers
• How power imbalances and political and economic structures determine feeding practices, women’s rights and health outcomes

• Fewer than half of infants globally are breastfed within the first hour of life as recommended by the WHO.
• Formula milk sales are on the rise despite formula failing to offer the same nutrition, health, and developmental benefits as breastfeeding.
• The Lancet 2023 Series on Breastfeeding argues that formula milk companies exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women, and children.
• The Series highlights the economic and political power of the dominant formula milk companies and the public policy failures which mean millions of women are prevented from breastfeeding as recommended.
• Common infant adaptations to the post-birth environment, including crying, unsettled behavior, and short night-time sleep durations, are often misconceived as signs of feeding problems. Commercial milk formula (CMF) marketing reinforces and exacerbates these misconceptions and makes unsubstantiated claims that CMFs can ameliorate these behaviors.
• Nearly half of mothers globally self-report insufficient milk (SRIM) as the primary reason for introducing CMFs in the first few months of life. SRIM can generally be prevented or addressed successfully with appropriate support.
• Additional educational efforts are needed for health workers, families, and the public to inform them about normal early infant development, including common crying patterns, posseting, and short night-time sleep durations, to reduce the unnecessary introduction of CMFs and to prevent SRIM and early cessation of breastfeeding.
• Breastfeeding is not the sole responsibility of the mother. Reviews and country case studies indicate that improved breastfeeding practices at the population level are achieved through a collective societal approach that includes multilevel and multicomponent interventions across the socioecological model and different settings.

Human infants and young children are most likely to survive, grow and develop to their full potential when breastfed. Despite scientific evidence more infants are fed formula milks today than ever before:

• Only one in two newborns are put to the breast within the first hour of life.
• An estimated 341.3 billion US dollars per year is lost globally from unrealized benefits to health and human development because of inadequate investment in protecting, promoting, and supporting breastfeeding.

One in three babies in low and middle-income countries (LMICs) are given fluids other than breastmilk during the first 3 days of life, a practice that increases the risk for breastfeeding failure.