Conclusions and policy implications

Most studies of the effects of breastfeeding on mental development have used correlational analyses, which means that there are limits to the conclusions that can be drawn from the data, particularly because of the numerous confounding variables. However, the consistency of the data suggests that there is a small benefit to children's development. There is a surprising lack of information from developing countries, where the benefits from breastfeeding for mental development are likely to be more substantial, in the context of all the other health benefits of breastfeeding.

There is no doubt that programmes to promote breastfeeding should be encouraged. An example of such programmes is the Baby-Friendly Hospital Initiative (BFHI), a UNICEF-WHO initiative designed to transform maternity hospitals around the world so that they offer breastfeeding support. BFHI has outlined 10 steps to successful breastfeeding [103] (table 5).

According to UNICEF reports [44], the BFHI has been extremely successful and has helped transform over 12,700 hospitals in 114 countries into centres of breastfeeding support in just six years. According to UNICEF, BFHI has resulted in substantial health gains. For instance, the Ministry of Health in Panama reported that in one year in one health facility, the BFHI resulted in a 58% reduction in respiratory infections and a 15% reduction in diarrhoea in infants. Similar results have been reported in Brazil, Gabon, Chile, China, Iran, Cuba, and the Republic of Moldova [44].