World Breastfeeding Week 2025 - Breastfeeding-friendly environments support sustainable infant feeding
Published in Social Sciences, Sustainability, and Public Health
Published on behalf of Prof Lisa Amir, Editor-in-Chief of International Breastfeeding Journal.
World Breastfeeding Week is an opportunity of us to share some of our recent publications in International Breastfeeding Journal which highlight the importance of supporting breastfeeding. Breastfeeding is the method of infant feeding that creates a sustainable environment while reducing the impact of climate change caused by artificial feeding.
To create a breastfeeding friendly environment we need support at all levels: national, health, workplace and community.
In order to restrict the promotion of commercial milk formula (CMF), the International Code of Marketing of Breast-milk Substitutes was adopted in 1981 with subsequent resolutions adopted in later years, referred to as ‘the Code’, by the World Health Assembly. As CMF sales continue to increase worldwide, the WHO and UNICEF recommended countries legislate the Code into national laws. Topothai and colleagues conducted a review of outcomes of the Code implementation in countries where the Code has been legislated as national law. They found compliance for the media promotion of CMF for infants aged 0–12 months was generally high, but lower compliance for promotions at the point of sale, within health facilities, and among health workers across different countries. They concluded
“To bolster the effectiveness of law implementation, countries should adopt robust legislative provisions that restrict the promotion of CMF for children aged 0–36 months, address digital marketing and cross-promotion, and establish infrastructures to regularly monitor compliance, particularly at the point of sales and in healthcare settings.”
How can environmental factors support breastfeeding? Chen and colleagues looked at this question in Taiwan using a prospective cohort study. Exclusive breastfeeding at six months was associated with receiving Baby-Friendly Hospital Initiative practices, perceiving acceptance of breastfeeding in live-in families, and availability of lactation rooms in public settings.
In hospital support was effective in a randomised controlled trial in Brazil (Ruiz and colleagues). Mothers who received at least two breastfeeding counselling sessions during their postpartum stay were more likely to exclusively breastfeed to six months than mothers in the control group. Evidence from a time-series study in Canada by Hui and colleagues, showed the negative impact of withdrawing hospital lactation consultants in Manitoba. Infant formula use in hospital subsequently increased, and exclusive breastfeeding in First Nation infants dropped.
Infants born preterm face many challenges, in particular with establishing breastfeeding. To address the delay in infants in the NICU receiving colostrum Hellström and colleagues conducted a quality assurance program in Sweden. Implementing a colostrum-kit with instructions for mothers of infants admitted to the NICU significantly reduced the time to first colostrum administered to the infant in all gestational ages.
Women with medical conditions or living with disability may not be receiving support to breastfeed. Peripartum cardiomyopathy (PPCM) is a form of heart failure occurring towards the end of pregnancy or in the months following delivery. Noll and colleagues used chart review and patient survey to assess breastfeeding and cardiac outcomes following PPCM in the USA. Lactation was not associated with lower rates of myocardial recovery. Physician support for breastfeeding was low: the majority of patients received counselling that they should not breastfeed.
Women with high BMIs are less likely to breastfeed than other women, so Lyons and colleagues in the UK developed an intervention with the assistance of a Patient and Public Involvement (PPI) group of women with a BMI ≥ 30 kg/m2 who had breastfed, health professionals and researchers. They found that the intervention is acceptable and shows promise for increasing breastfeeding initiation and duration.
In South Africa, Zunza and colleagues tested an intervention using text messaging and motivational interviewing for women living with HIV. They found low rates of exclusive breastfeeding, and no difference between outcomes in intervention and standard care arms of the trial at 24 weeks. Return to work was the main reason given for stopping exclusive breastfeeding.
Mothers unable to provide a full milk supply for their infants may be supported by human milk banks or informal milk sharing. Harris and colleagues surveyed health professionals (HPs) and parents in New Zealand about donor human milk (DHM). They concluded:
“Informal milk sharing in NZ is common and highly supported by parents and HPs. However, limited structure, guidance and lack of standardised operations prevent equitable access to DHM. Establishing national and standardised guidelines for milk sharing is required to minimise the potential risks associated with informal HM donation. More support for HM banks in New Zealand is urgently needed to ensure all hospitalised vulnerable infants have access to DHM.”
Partners can be another source of support for breastfeeding. Zhou and colleagues identified eight relevant studies to include in their meta-analysis of paternal support interventions. They found consistent evidence that educational initiatives directed at fathers improved breastfeeding outcomes.
Mothers and their use of brelfies –a self-image capturing breastfeeding – were studied by Davis and colleagues in the UK. They found that women are using brelfies to positively represent their different identity shifts. “In this transitional time, they are finding a concrete form of representation not just to physically recognize themselves as mothers for the first time, but also to show their followers their new identity, thus actualizing themselves as breastfeeding mothers.”
These are just ten of the articles published in the last 12 months investigating ways to support breastfeeding around the world. Evidence shows successful breastfeeding is not women’s individual responsibility: we need governments, institutions, families and the community to provide supportive environments that enable women to reach their breastfeeding goals.
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International Breastfeeding Journal
This journal encompasses articles about breastfeeding, focusing on nursing, midwifery, paediatric, obstetric, family medicine, public health, immunology, physiology, sociology and many other topics.
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Implementing the International Code of Marketing of Breast-milk Substitutes: Legislation, monitoring, enforcement, advocacy
Breastfeeding is the most cost-effective intervention available to protect and promote health and well-being of children, women and populations worldwide. The evidence shows that breastfeeding save lives, reduces the burden of infectious and chronic diseases, supports optimal cognitive development, and contributes to maternal health by reducing the risk of breast and ovarian cancer, type 2 diabetes, and postpartum depression. The 2023 Lancet Breastfeeding Series has documented that scaling up breastfeeding to near universal levels could prevent over 800,000 child deaths annually and avert an estimated 20,000 maternal deaths from breast cancer each year. Beyond its individual health benefits, breastfeeding carries implications for planetary health. It is a sustainable, zero-waste, low-carb food system that requires no packing, no supply chains, and no manufacturing.
Yet despite the strong evidence, breastfeeding rates remain far below recommended levels in almost every region of the world. Among the main and well-documented barriers to optimal breastfeeding are the inappropriate marketing practices of the breastmilk substitutes (BMS). Aggressive, misleading, and pervasive commercial promotion of the commercial milk formula and related products, targeting mothers, families, and health workers through advertising, free samples, sponsorships, and increasingly through digital and social media, systematically undermines breastfeeding initiation, exclusivity, and duration.
The World Health Organization responded to this challenge more than four decades ago with the adoption of the International Code of Marketing of Breastmilk Substitutes (the Code) by the World Health Assembly (WHA) in 1981, subsequently strengthened through multiple WHA resolutions. The Code and resolutions establish a framework to restrict inappropriate BMS marketing, protect health systems from commercial influence, and ensure that parents and caregivers receive accurate, unbiased information about infant feeding. Most recently, WHA resolution reaffirmed the urgency of regulating digital marketing of BMS and commercial foods for infants and young children.
Despite this international regulatory framework, frequent and continuous violations of the Code and of local legislation have been extensively documented globally. The 2026 WHO/UNICEF/IBFAN status report confirms that while 148 countries have enacted at least some Code-related legal measures, only 37 countries are substantially aligned with the Code, and 46 still have no legal measures. More critically, even among countries with legislation in place, implementation remains insufficient. One of the most significant and persistent gaps is the absence of clear, functional mechanism for monitoring compliance with the Code and local legislation. Equally concerning is the widespread lack of meaningful sanctions for violations. While 95 countries define sanctions, enforcement remains weak, inconsistent, and in many cases absent, allowing the BMS industry to operate with impunity. These structural failures allow unethical marketing practices to persist, undermine breastfeeding practices, and contravene obligations under international human rights instruments, including the Convention of the Rights of the Child.
The International Breastfeeding Journal invites submissions for this special collection dedicated to advancing the science, and practice of Code implementation and enforcement globally. The central purpose of this special collection is to build a comprehensive knowledge base that documents real-world experiences of Code implementation: what has been attempted, what has worked, what has failed, and what lessons can be drawn for strengthening regulatory and enforcement framework worldwide.
This special collection seeks contributions from all global regions, with particular interest in experiences from low-and-middle income countries and from context that are frequently underrepresented in international literature. We are interested not only in success experiences but also in the challenges, barriers, and setbacks that countries, institutions, and advocates have faced in their efforts to implement and enforce the Code.
We welcome original research articles, systematic and narrative reviews, and countries case studies addressing, but not limited, to the following themes:
- National legislative processes: Experiences of the Code enactment, strengthening, and reform including political, legal, and industry-related barriers and facilitators.
- Monitoring and enforcement mechanisms: Design, implementation, effectiveness, and outcome of compliance monitoring systems.
- Sanctions and accountability: Experiences with the application of sanctions for Code violations, and their impact on industry behavior and breastfeeding outcomes.
- Conflicts of interest in health systems: Evidence of industry influence on health workers, professionals’ associations, and health facilities, and strategies for protecting against commercial interference.
- Civil society, community, and media roles in Code monitoring, reporting, and advocacy.
- Health system protections: Implementation and enforcement of bans on free supplies, gifts, and incentives to health workers, and industry sponsorship of professional and scientific meetings.
- Digital and social media marketing surveillance and regulation: Scope, strategies, and methodologies for detecting and documenting online and social media Code violations, and regulatory responses.
This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being and SDG 2, End hunger, achieve food security and improved nutrition and promote sustainable agriculture.
All submissions in this Collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee. We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.
Publishing Model: Open Access
Deadline: Apr 30, 2027
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