The World Health Organization (WHO) recommends three primary breastfeeding practices: initiation of breastfeeding within one hour after birth (also referred to as immediate breastfeeding), exclusive breastfeeding (EBF) through six months of age, and continued breastfeeding until 24 months of age (Dyson et al., 2005; WHO, 2008). Evidence associated with the recommendation for immediate breastfeeding is limited and likely operates through the effect of exclusive breastfeeding (Bhutta et al., 2013). The Lancet, therefore, includes only EBF and continued breastfeeding in the modeling of optimal breastfeeding practices cited above.
Despite the promise of optimal breastfeeding practices, rates for the three WHO recommended breastfeeding practices remain low, and negligible progress has been made to increase these rates over the past two decades (UNICEF, 2013). According to an analysis of data from 78 low and middle income countries, rates of immediate breastfeeding range from a mean of 36% in Eastern Europe to a mean of 58% in Latin America, and the rate of exclusive breastfeeding in children one to five months of age is just 30% (Black et al, 2013). According to the UNICEF global database of national surveys from 2007-2011, the current rate of breastfeeding at one year is 76%, while the rate of breastfeeding at age two years is 58%.12
This section reviews the effectiveness of social and behavior change communication (SBCC) approaches on improving breastfeeding practices.