Introduction

I feel privileged and honoured to be here today to talk on such an important topic as breastfeeding. I am here not as an expert but as a woman, mother and a health worker in a non-industrialised country. Some may well question why breastfeeding should merit this attention when it is the simple and natural way of feeding our young. However, it is this very simplistic view of breastfeeding that may cause some to take it for granted and to consider breastfeeding promotion a waste of resources 'since women breastfeed anyway'. Yet, statistics indicate that most mothers do not practice optimal breastfeeding¹ and exclusive breastfeeding - defined by WHO as giving no other food or liquids including water to the infant for up to 6 months of age - is a rare practice. It is estimated that almost 1.5 million infant lives could be saved per year if exclusive breastfeeding was practiced for the first 6 months (UNICEF. 1997a).

¹ This is defined as exclusive breastfeeding from birth to about 6 months of age. Thereafter, children should continue to be breastfed while receiving appropriate and adequate complementary foods for up to 2 years of age or beyond.

International commitment to the protection, promotion and support of breastfeeding

Breastfeeding promotion has come a long way over the decades, and this is mostly due to the high profile it has been given through international-level commitment². In reference to the dangers of artificial feeding, Dr Cecily Williams spoke of 'Milk and Murder' as far back as 1939. La Leche League formed the first organized breastfeeding group in 1957, which has since grown to over 40,000 members. During the 1970s, attention was focused on breastfeeding through campaigns, including lawsuits to stop the aggressive promotion of infant formula to the detriment of breastfeeding.

² See AHRTAG Resource List: Breastfeeding Information Resources, published by Appropriate Health Resources and Technologies Action Group (AHRTAG), London UK.

The International Baby Food Action Network (IBFAN) was founded in 1979 - the same year that WHO and UNICEF hosted an international meeting on infant and young child feeding. The meeting called for the development of an International Code of Marketing of Breastmilk Substitutes, which was later adopted at the World Health Assembly in 1981. There have been various World Health Assembly resolutions thereafter on infant and young child feeding.

The Convention on the Rights of the Child was adopted in 1989 and came into legal force in 1990. ft referred to 'all segments of society, in particular parents and children being informed, having access to education and being supported in the use of basic knowledge of child health and nutrition, and the advantages of breastfeeding...'

The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding was developed and adopted in 1990 (UNICEF, 1990). It set specific goals for all governments to be achieved by the year 1995, as well as soliciting the support of international organisations. The Declaration called for the integration of breastfeeding policies into the overall health and development plans of governments, ft also emphasised the need to increase women's confidence in their ability to breastfeed, which should involve the removal of barriers to optimal breastfeeding. This Declaration was adopted by 32 governments and 10 UN Agencies.

...most mothers do not practice optimal breastfeeding and exclusive breastfeeding ... is a rare practice. It is estimated that almost 1.5 million infant lives could be saved per year if exclusive breastfeeding was practiced for the first 6 months...

The World Summit for Children was held in 1990 and one of its goals was the 'empowerment of all women to breastfeed their children exclusively for four to six months and to continue breastfeeding with complementary food, well into the second year'.

Individuals and organisations dedicated to the protection, promotion and support of breastfeeding formed an umbrella network - World Alliance for Breastfeeding Action (WABA) in 1991. During this same year, UNICEF/WHO launched the global Baby Friendly Hospital Initiative aimed at creating breastfeeding friendly environments at health facilities. The International Conference on Nutrition (ICN) in 1992, showed tremendous commitment to breastfeeding by incorporating it in most of its themes as well as in the World Declaration and Plan of Action for Nutrition.