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Early initiation of breastfeeding

Early initiation of breastfeeding (within the first hour) provides benefits for infant and mother.

Benefits of early initiation of breastfeeding

  • Saves lives. Early initiation ensures that a newborn receives colostrum, the “first milk.” Colostrum is often considered the baby’s first immunization because of its high levels of vitamin A, antibodies, and other protective factors. Colostrum is clean and pure and protects against infection. Early and frequent breastfeeding, especially if accompanied by maternal-infant skin-to-skin contact, stabilizes the baby’s temperature, respiratory rate, and blood sugar level. Studies in Nepal and Ghana suggest that initiation of breastfeeding within the first hour could prevent 19-22 percent of neonatal deaths. Early initiation of breastfeeding can help prevent neonatal deaths caused by sepsis, pneumonia, and diarrhea. Read Alive & Thrive’s technical brief, “Impact of early initiation of exclusive breastfeeding on newborn deaths”
  • Helps establish breastfeeding. Early suckling is associated with successful establishment and maintenance of breastfeeding throughout infancy.
  • Fosters bonding between mother and child
  • Takes advantage of the newborn’s intense suckling reflex and alert state
  • Reduces maternal risk of postpartum hemorrhage

Promoting and supporting early initiation of breastfeeding

Despite its benefits, many women delay initiation of breastfeeding. Approximately 53 percent of newborns in developing countries are put to the breast within one hour of birth. Establishing good breastfeeding practices in the first days is critical to the health of the infant and to breastfeeding success. Initiating breastfeeding is easiest and most successful when a mother is physically and psychologically prepared for birth and breastfeeding and when she is informed, supported, and confident of her ability to care for her newborn. The following actions can increase rates of early initiation of breastfeeding.

  • Identify the practices, beliefs, concerns, and constraints to early and exclusive breastfeeding and address them through appropriate messages and changes in delivery and postpartum procedures
  • Counsel women during antenatal care on early initiation and exclusive breastfeeding and the danger of giving other liquids and foods to young infants
  • Upgrade the skills of trained attendants to support early and exclusive breastfeeding
  • Make the first routine skin-to-skin contact and initiation of breastfeeding after delivery
  • Practice the Ten Steps to Successful Breastfeeding in maternity services
  • Praise the mother for giving colostrum, provide ongoing encouragement, and assist with positioning and attachment

Exclusive breastfeeding

Exclusive breastfeeding means that an infant receives only breastmilk with no additional foods or liquids, not even water. The benefits of exclusive breastfeeding on child survival, growth, and development are well documented. Exclusive breastfeeding also provides health benefits for mothers.

Benefits of exclusive breastfeeding

Impact on neonatal and infant survival and health

  • Saves lives. Exclusive breastfeeding is the single most effective intervention for preventing child deaths, yet less than 40 percent of infants under 6 months old receive the benefits of exclusive breastfeeding. Diarrhea and pneumonia are the leading causes of death among infants in developing countries. Infants under 2 months old who are not breastfed are six times more likely to die from diarrhea or acute respiratory infections than those who are breastfed. More than 800,000 deaths could be prevented each year if exclusive breastfeeding rates increased to 90 percent. Read more on the impact of early and exclusive breastfeeding on neonatal mortality.
  • Protects against illness. Breastmilk, especially the first yellow thick milk called colostrum, contains anti-bacterial and anti-viral agents and high levels of vitamin A that protect infants against disease.
  • Promotes recovery of the sick child. Breastfeeding provides a nutritious, easily digestible food when a sick child loses his or her appetite for other foods. Continued breastfeeding during diarrhea reduces dehydration, the severity and duration of diarrhea, and the risk of malnutrition.

Impact on child nutrition

  • Provides total food security. Breastmilk is a hygienic source of food with the right amount of energy, protein, fat, vitamins, and other nutrients for infants in the first six months. It cannot be duplicated. Breastmilk is the only safe and reliable source of food for infants in an emergency.
  • Meets all water requirements. Breastmilk is 88 percent water. Studies show that healthy, exclusively breastfed infants under 6 months old do not need additional fluids, even in countries with extremely high temperatures and low humidity. Offering water before 6 months of age reduces breastmilk intake, interferes with full absorption of breastmilk nutrients, and increases the risk of illness from contaminated water and feeding bottles.

Impact on child development

  • Optimizes a child’s physical and mental growth and development. Infants fed breastmilk show higher developmental scores as toddlers and higher IQs as children than those who are not fed breastmilk. Breastmilk supplies key nutrients that are critical for health, growth, and development.

Benefits for women

  • Benefits maternal health. Breastfeeding reduces the mother’s risk of fatal postpartum hemorrhage and premenopausal breast and ovarian cancer. Frequent and exclusive breastfeeding contributes to a delay in the return of fertility and helps protect women against anemia by conserving iron.
  • Bonds mother and child. Breastfeeding provides frequent interaction between mother and infant, fostering emotional bonds, a sense of security, and stimulus to the baby’s developing brain.

Economic and environmental benefits

  • Saves money. Families save money that would have been spent to treat illnesses due to contaminated and inadequate breastmilk substitutes. Exclusive breastfeeding eliminates dependence on costly breastmilk substitutes, feeding equipment, and fuel for preparation.
  • Protects the environment. Breastmilk is a naturally renewable, sustainable resource that requires no fuel for preparation, packaging, shipping, or disposal.

Promoting and supporting exclusive breastfeeding

Despite its many benefits, many women do not breastfeed exclusively. Trend data from a subset of 77 countries that between 1995 and 2011 show that exclusive breastfeeding only increased from 32 to 40 percent. Obstacles to exclusive breastfeeding can be overcome in the following ways:

  • Prevent and treat early problems. Most breastfeeding problems occur in the first 2 weeks of life. These problems include cracked nipples, engorgement, and mastitis and all too often lead to very early infant supplementation and abandonment of exclusive breastfeeding. Proper positioning and attachment of the baby to the breast and frequent breastfeeding can prevent these problems. Support to the mother for early initiation is easy to provide via peer support networks and has been effective at prolonging exclusive breastfeeding.
  • Strengthen the skills of health providers and community health workers to provide quality counseling and support mothers to adopt optimal feeding practices.
  • Restrict commercial pressures. Aggressive marketing of infant formula often gives new mothers and families the impression that human milk is less modern and thus less healthy for infants than infant formula. Enforced restrictions on marketing of infant formula are part of efforts to support and prolong exclusive breastfeeding.
  • Provide timely and accurate information. Many women and family members are unaware of the benefits of colostrum and exclusive breastfeeding. Women must sort through myths, misinformation, and mixed messages about breastfeeding. Ensuring that women receive complete, accurate, timely, and consistent information is fundamental for any program promoting exclusive breastfeeding.
  • Address social barriers. Attitudes that undervalue breastfeeding discourage women from breastfeeding. These attitudes may be communicated in the media and reflected in the advice of relatives and friends. Successful efforts to promote good feeding practices focus not only on the mother but on those who influence her feeding decisions, such as her doctor, mother-in-law, and husband.
  • Create supportive work environments. Few mothers are provided with paid maternity leave or time and a private place to breastfeed or express their breastmilk. Legislation around maternity leave and policies that provide time, space, and support for breastfeeding in the workplace could reduce one of the barriers to exclusive breastfeeding.
  • Establish good practices in health facilities. Distribution of free samples of infant formula, the use of glucose water, and separation of mother from newborn are obstacles to the establishment of good feeding in health services. Adopting the Baby-friendly Hospital Initiative’s “Ten Steps to Successful Breastfeeding” and enhancing the skills of health care providers to support exclusive breastfeeding would help to ensure the best start for infants.

Alive & Thrive
Generation 2


Spring 2018


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