Transcript Presentation of recent Lancet Series on Breastfeeding

Breastfeeding in the 21st Century
2016 Lancet Series
Laurence Grummer-Strawn, PhD
Department of Nutrition for Health and Development
World Breastfeeding Conference
Johannesburg, South Africa
December 12, 2016
What is the relevance of breastfeeding to women
and children in low, middle and high income
countries in the 21st century?
Outline
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Global BF patterns and trends (equity lens)
Consequences of BF
Modeling of BF impact
Interventions to improve breastfeeding
Global map of breastfeeding prevalence
Re-analysis of
DHS and MICS
surveys for 127
out of 139 LMICs
Literature review
on 37 out 75 HICs
Patterns of breastfeeding vary by region
Breastfeeding: one of the few positive health
behaviors more prevalent in LMICs than HICs
Breastfeeding practices over time
For each
doubling in
national GDP
per capita,
breastfeeding
prevalence at
12 months
decreases by
10 percentage
points
Population-weighted averages from 217
surveys
Impact of breastfeeding on maternal and child
health
• Systematic literature
reviews
(data from low-, middle- and
high-income settings)
- Short-term health
outcomes
- Long term health
outcomes
- Maternal outcomes
Consequences of Breastfeeding
Short-term
Long-term
Protection • Under-five mortality • Overweight/
• Infectious morbidity
and hospitalizations
• Diarrhea
• Respiratory
infections
Maternal
obesity
• Types I and II
diabetes (?)
• Intelligence
• Lactational
amenorrhea
• Breast cancer
• Ovarian cancer
• Diabetes (?)
• Blood pressure
• Serum lipids
• Weight loss
• Osteoporosis
• Malocclusion
No
evidence
• Growth in weight or
length – but lower
BMI
• Eczema, allergies,
rhinitis, asthma
Harm
• Dental caries
Breastfeeding – exquisitely personalized medicine
at a critical moment
Individualized components of breastmilk
• Bacteria from the mother’s gut microbiome
• Immune cells primed in the mother’s
intestine
• Carbohydrates (HMOs) that shape the
baby’s microbiome
• Small RNA’s and microvesicles (exosomes)
that control genes in the baby
• Stem cells that survive in the baby
Impact modeling results
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Improvements in BF practices could result in
annual prevention of
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823,000 deaths of underfive children
20,000 breast cancer deaths
Economic gains: $302bn (0.47% of GDP) due
to increased productivity associated with
higher intelligence
The impact of interventions to
improve breastfeeding practices
• Systematic review: 20,000+ papers screened and 300
studies examined
• Interventions according to settings
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Health systems and services
Home and Family Environment
Community Environment
Work Environment
Policy
• Four outcomes assessed
– Early initiation of BF / exclusive BF at 6 mo /
continued BF 12-23 mo / any BF at 6 mo
Interventions to improve breastfeeding
practices
• Breastfeeding practices highly responsive to
interventions
• Health system and community interventions
can increase exclusive breastfeeding by 2.5X
• Maternity leave and work-place interventions
also beneficial (few studies)
• Largest effects of interventions achieved when
delivered in combination
Key messages
1. Magnitude of BF effects is
astounding
2. Health effects extend beyond
time of breastfeeding (child
and maternal)
3. BF is important in high-income
settings
4. BF practices are far from ideal
5. BF interventions are effective
“If breastfeeding did not already
exist, someone who invented it
today would deserve a dual
Nobel Prize in medicine and
economics.”
Keith Hanson,
Vice President for Human Development,
World Bank Group
Acknowledgements
Authors
Rajiv Bahl
Aluisio Barros
Nita Bhandari
Giovanny Franca
Nemat Hajeebhoy
Sue Horton
Julia Krasevec
Chessa Lutter
Jeevasankar Mari
Jose Martines
Simon Murch
Ellen Piwoz
Linda Richter
Nigel Rollins
Cesar Victora
Neff Walker
Lancet Breastfeeding Group
Katie Allen
Ranadip Chowdury
CL de Mola
Shyamali Dharmage
Elsa Giugliani
Bernardo Horta
Caroline Lodge
F Maia
Karen Peres
Bireshwar Sinha
Elizabeth Speakman
Sunite Taneja
Daphne Wu
Funding
Bill & Melinda Gates
Foundation
Other support
Euromonitor
- Protea Hirschel
- Danielle Le Clus-Rossouw
- Maya Shehayeb