e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Creating an environment in care facilities that supports breastfeeding

Intervention | Last updated: 9 August 2023


Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence..

To reduce infant mortality and ill health, WHO recommends that mothers begin breastfeeding their infants within one hour of birth. Infants should also be exclusively breastfed for the first six months of life to achieve optimal growth, development and health, with continued breastfeeding up to two years of age or beyond. In support of these recommendations, breastfeeding must be protected, supported and promoted in facilities providing maternal and newborn services. This includes:

  • establishing and maintaining breastfeeding policies that cover all established standards of practice *, which are fully implemented and publicly and regularly communicated to staff;
  • training of health workers to further develop relevant skills, ensure consistent messages and support implementation of policy standards according to their roles; and
  • planning and coordination of discharge from the facility, such that parents and their children have access to continuing and consistent breastfeeding support after leaving the facility.

* Standards of practice are described in the WHO document, Standards for improving quality of maternal and newborn care in health facilities, and include ensuring that women receive emotional support, are taken care of in facilities that are safe and adequately equipped, and that every woman and newborn receives routine, evidence-based care and management of complications during labour, childbirth and the early postnatal period, according to WHO guidelines.

WHO Recommendations


Facilities providing maternity and newborn services should have a clearly written breastfeeding policy that is routinely communicated to staff and parents.

Health-facility staff who provide infant feeding services, including breastfeeding support, should have sufficient knowledge, competence and skills to support women to breastfeed.

As part of protecting, promoting and supporting breastfeeding, discharge from facilities providing maternity and newborn services should be planned for and coordinated, so that parents and their infants have access to ongoing support and appropriate care.

Facilities providing maternity and newborn services should enable mothers and their infants to remain together and to practise rooming-in throughout the day and night. This may not apply in circumstances when infants need to be moved for specialized medical care.

Where facilities provide antenatal care, pregnant women and their families should be counselled about the benefits and management of breastfeeding.



Guidelines and guidance documents Learn More Alternate Text


GRC-approved guidelines


Other guidance documents


Evidence


Systematic reviews used to develop the guidelines


Antenatal breastfeeding education for increasing breastfeeding duration

Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M. Cochrane Database of Systematic Reviews. 2016; Issue 12. Art. No.: CD006425.

Summary of this review Alternate Text

Interventions for promoting the initiation of breastfeeding

Balogun OO, O’Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD et al. Cochrane Database of Systematic Reviews. 2016; Issue 11. Art. No.: CD001688.


Education and training of healthcare staff in the knowledge, attitudes and skills needed to work effectively with breastfeeding women: a systematic review

Gavine A, MacGillivray S, Renfrew MJ, Siebelt L, Haggi H, McFadden A. International Breastfeeding Journal. 2017;12:6.


Hospitals with a written breastfeeding policy statement and implementation of the steps of breastfeeding: a systematic review (publication pending)


Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding

Jaafar SH, Ho JJ, Lee KS.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD006641.

Summary of this review Alternate Text

Health Facility Staff Training for Improving Breastfeeding Outcome: A Systematic Review for Step 2 of the Baby-Friendly Hospital Initiative

Balogun OO, Dagvadorj A, Yourkavitch J, da Silva Lopes K, Suto M, Takemoto Y, et al. Breastfeeding Medicine. 2017;12(9):537-546.


Providing linkage to breastfeeding support to mothers on discharge to improve breastfeeding outcomes: a systematic review (publication pending)


Related systematic reviews


Breastfeeding Peer Counseling: From Efficacy through Scale-up

Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R. Journal of Human Lactation. 2010; 26(3):314–326.


Breastfeeding promotion interventions and breastfeeding practices: a systematic review

Haroon S, Das JK, Salam RA, Imdad A, Bhutta ZA. BMC Public Health. 2013; 13(Suppl 3):S20.


Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis

Sinha B, Chowdhury R, Sankar MJ, Martines J, Taneja S, Mazumder S, et al. Acta Paediatrica. 2015; 104:114–134.


Cost-effectiveness Learn More Alternate Text


Cost-effectiveness analyses


Potential economic impacts from improving breastfeeding rates in the UK

Pokhrel S, Quigley MA, Fox-Rushby J, McCormick F, Williams A, Trueman P, et al. Arch Dis Child. 2015; 100(4):334-40.


Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda

Chola L, Fadnes LT, Engebretsen IM, Nkonki L, Nankabirwa V, Sommerfelt H, et al. PLoS One. 2015; 10(11):e0142718.


Economic evaluation of enhanced staff contact for the promotion of breastfeeding for low birth weight infants

Rice SJ, Craig D, McCormick F, Renfrew MJ, Williams AF. Int J Technol Assess Health Care. 2010; 26(2):133-40.


Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis

Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE et al. Health Technol Assess. 2009; 13(40):1-146, iii-iv.