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Protecting and promoting the health and nutrition of mothers, infants, and young children is the best investment to contribute to the population's well-being throughout their lives. Proper health and nutrition for children, pregnant women, and lactating women can save millions of lives annually and promote equity from the start of life. Nutrition in the early years of life is crucial, and as part of this, breastfeeding is a vital component. In the context of World Breastfeeding Week 2024, whose theme is: “Closing the Gap: Breastfeeding Support for All”, it is essential to highlight and remember the importance of breastfeeding and its main challenges. Breastfeeding significantly influences the biology of human systems, which in turn impacts health, development, and child survival throughout life. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend early initiation of breastfeeding (within the first hour of life), exclusive breastfeeding during the first 6 months, and subsequent complementary feeding with other solid foods up to 2 years. If children were breastfed according to these recommendations, approximately 800,000 child deaths could be prevented annually, as highlighted by the Lancet Breastfeeding Series 2023. Breastfeeding also impacts maternal health, reducing the risk of breast and ovarian cancers and cardiovascular diseases. It is estimated that around 100,000 maternal deaths from the mentioned diseases can be prevented. Despite all the benefits of breastfeeding, globally, only one in two children under six months received exclusive breastfeeding in 2019, and only 81.1% of children under 12 months continued breastfeeding at one year of age.

In many countries, the vast majority of women decide to breastfeed. Still, they and their families often face significant obstacles at multiple levels, interfering with their ability to breastfeed for the recommended duration or as long as mutually desired. Among the challenges women face are structural factors, including sociocultural factors, social norms and customs, and national policies that may favor or hinder breastfeeding practices. Environmental factors also play a role, where health systems, health professionals, family and community (including grandmothers, friends, and community leaders), and the workplace significantly influence breastfeeding. Individual factors are also important, including the characteristics of the mother and child and the bond between the mother and child dyad.

Focusing on those related to health systems and health professionals, it is recognized that their primary role is to provide counseling and support for mothers to breastfeed. However, they can also hinder the initiation and continuation of breastfeeding through limited training and skills and/or the promotion of commercial milk formulas (CMF). This has been identified in studies globally and in Mexico, as identified in various studies  by our research group.

In Mexico, breastfeeding remains a priority that urgently needs attention. By 2022, only 33.6% of children under six months received exclusive breastfeeding. Although breastfeeding practices have improved in recent years in Mexico, the country still needs to meet the global goals set by WHO to increase exclusive breastfeeding to 70% by 2030. Studies conducted by our research group have identified strengthening the health system and training health professionals in breastfeeding knowledge and skills to support women in establishing and continuing breastfeeding as a major area for improvement. Our research has identified that in Mexico, there are structural barriers at different levels of health care for the promotion, protection, and support of breastfeeding. In primary care, low utilization of health services and the lack of incentives for pregnant women and young children to attend these services are major barriers to promoting and supporting breastfeeding. Another significant barrier identified is the lack of health professionals, including a limited number of nutrition professionals trained to support women and their families in breastfeeding, as well as a lack of material resources, specific strategies, communication skills, and frequent recommendations for using CMF. In secondary care, significant barriers identified include hospital practices such as an excessive number of medically unnecessary cesareans, promotion of CMF, and non-compliance with the International Code of Marketing of Breastmilk Substitutes, a global public policy instrument aimed at regulating the indiscriminate promotion of breastmilk substitutes, including CMF, and the use of CMF within hours of birth. Common barriers between primary and secondary care are structural barriers of lack of time by health professionals, little or no training on breastfeeding topics (knowledge and skills) to support women, and the promotion of CMF as a common practice. Finally, it is highlighted that in Mexico, as worldwide, as shown by our research, pregnant women and mothers of young children confirmed that health professionals strongly influence their infant feeding decisions, often biased towards using CMF.

Therefore, if we want to contribute to supporting breastfeeding for all and closing the gap in Mexico, among other things, a national breastfeeding training model for health personnel at all levels of care and community personnel, including theoretical, practical, and communication skills recommended internationally and based on the Mexican context, is required.

Acknowledgment to colleagues with whom I collaborated on the various projects described: Mireya Vilar-Compte, Cecilia Tomori, Rafael Pérez-Escamilla, Vania Lara-Mejía, Bianca Franco-Lares, Natalia Rovelo-Velázquez, Keily Hayes, Mónica Ancira-Moreno, Elizabeth Hoyos-Loya, Soraya Burrola-Méndez, Matthias Sachse-Aguilera, Ana Lilia Lozada-Tequeanes.

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References:

Becoming Breastfeeding Friendly- Mexico- (BBF). Available at: https://bbf.ibero.mx/. Consulted on: July, 2024.

González-Castell LD, Unar-Munguía M, Bonvecchio-Arenas A, et al.(2023) Prácticas de lactancia materna y alimentación complementaria en menores de dos años de edad en México. Salud Publica Mex.;65(supl 1):S204-S210. https://doi.org/10.21149/14805

Hernández Cordero S. Lactancia materna. Un asunto de justicia social. (2023) Revista Universidad Iberoamericana. Revista electrónica. Vol. 87. ISSN 2594-2662. Disponible en: https://revistas.ibero.mx/ibero/

Hernandez-Cordero S, Vilar-Compte M,  Tomori C, (2023) Healthcare professionals and commercial milk formula recommendations in the urban Mexican context. Front. Public Health 11:1260222. doi: 10.3389/fpubh.2023.126022.

Hernández-Cordero S, Lozada-Tequeanes AL , Fernández-Gaxiola AC, et al. (2020). Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach. International Breastfeeding Journal 15:87. https://doi.org/10.1186/s13006-020-00327-3

Hoyos-Loya E, Pérez Navarro C, Burrola-Méndez S, Hernández-Cordero S, et al. (2024) Barriers to promoting breastfeeding in primary Health care in Mexico: a qualitative perspective. Front. Nutr. 10:1278280. doi: 10.3389/fnut.2023.1278280.

Pérez-Escamilla R, Tomori C, Hernández-Cordero S, et al. (023) Breastfeeding: crucially important, but increasingly challenged in a market-driven world,The Lancet. https://doi.org/10.1016/S0140-6736(22)01932-8.

Neves PAR, Vaz JS, Maia FS, et al. (2021) Rates and time trends in the consumption of breastmilk, formula, and animal milk by children younger than 2 years from 2000 to 2019: analysis of 113 countries. Lancet Child Adolesc Heal. 2021;5(9):619–30.