23 July 2021
Call to action: Countries could miss breastfeeding targets
Published online 18 June 2021
Breastfeeding rates in low- and middle-income countries in the Middle East and beyond are predicted to fall far short of targets set by the World Health Organisation (WHO).
An extensive study led by Natalia Bhattacharjee, Lauren Schaeffer and co-workers at the University of Washington in Seattle, US, together with international collaborators, has mapped the prevalence of exclusive breastfeeding of infants between 2000 and 2018 in 94 low- and middle-income countries across the world. They estimated the rate of change over time to track and predict continued progress of individual countries towards WHO targets of 50% exclusive breastfeeding prevalence by 2025 and 70% by 2030.
“Only giving infants breast milk for the first six months of life helps prevent leading causes of child mortality, including diarrhoea and pneumonia, hence the current WHO targets,” says Bhattacharjee.
The study provides a comprehensive picture of the unmet need for exclusive breastfeeding by mapping its prevalence and the absolute number of children not exclusively breastfed. Of the 94 countries mapped, only six are projected to meet the WHO target for 2030 at the national level, and only three will meet the target in all of their districts.
“The results demonstrate subnational inequalities otherwise masked by national level estimates, and highlight areas left behind in exclusive breastfeeding uptake,” says Schaeffer.
In the Middle East and North Africa (MENA) region, the team analysed data from nine countries including Egypt, Jordan, Morocco and Sudan. Considerable disparities exist within and between countries in the region, reflecting the trend across the world. National 2018 exclusive breastfeeding levels varied widely, with an average of 12.2% prevalence in Tunisia compared with a 51.3% prevalence in Sudan. Both Sudan and Morocco had among the highest rates of positive annual change in all their districts, with prevalence increasing by more than 5% in some districts between 2000 and 2018.
Among MENA countries, only Sudan is predicted to meet the WHO goal of 50% exclusive breastfeeding prevalence in all districts by 2025, and none will meet the 2030 target of 70%. Districts in Yemen and Tunisia had among the lowest exclusive breastfeeding levels in the study in 2000 and 2018. Geographic inequalities within countries increased in over a third of the 94 countries between 2000 and 2018, with the difference between districts with the highest and lowest prevalence doubling in seven countries, including Jordan. In 2018, over half a million children in Egypt were not exclusively breastfed.
“More research is needed into the drivers behind our results,” says Bhattacharjee. “We hope this study helps policy makers target resources for breastfeeding interventions and education, particularly in areas lagging behind. Although breastfeeding is a cost-effective intervention, it is not free, and requires investment from mothers and wider networks, including families, health systems and policy makers.”
Bhattacharjee, N. V. et al. Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000-2018. Nat. Hum. Behav. http://dx.doi.org/10.1038/s41562-021-01108-6 (2021).