Zhu David T, Gupta Tarini, Pérez-Escamilla Rafael
Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.
Matern Child Nutr. 2025 Jan;21(1):e13753. doi: 10.1111/mcn.13753. Epub 2024 Oct 31.
Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices-namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years-low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies-such as strict monitoring and regulation of product labelling and digital media marketing-to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.
母乳喂养是一项关键的公共卫生战略，对儿童的最佳发育和母亲一生的健康都至关重要。《2021年全球疾病、伤害及风险因素负担研究》表明，尽管由于母乳喂养方式不当（即头6个月非纯母乳喂养或在头2年内过早断奶）导致的死亡率和伤残调整生命年（DALYs）有所下降，但低收入和中等收入国家（LMICs）与高收入国家相比，仍承受着高达50倍的惊人负担。这种不公平现象凸显了一项紧迫的全球卫生重点问题。因此，我们建议通过以下方式应对这些挑战：首先，通过社区驱动的努力，如“爱婴社区倡议”（BFCI）扩大“爱婴医院倡议”（BFHI）的覆盖范围，以加强临床和社区环境中的母乳喂养支持；其次，将母乳喂养咨询纳入国家卫生和社会保护计划，借鉴大规模母乳喂养同伴咨询计划的经验，如美国妇女、婴儿和儿童补充营养计划（WIC）正在实施的计划，填补文化上合适的护理方面的空白；第三，改善产假政策和为母乳喂养妇女提供的工作场所便利设施；第四，严格监管商业配方奶粉（CMF）的剥削性营销，以对抗错误信息并减少健康不平等。各国政府必须实施强有力的、基于证据的政策，如严格监测和监管产品标签及数字媒体营销，以建立防范CMF行业强大影响的保障措施。总体而言，这些战略将改善母乳喂养成果，减少健康差距，并推动各国在实现联合国可持续发展目标方面取得进展。
