Collection of research on breastfeeding and substitutes

04 May 2017

A special collection of research on breastfeeding highlights the key benefits of breastfeeding and the risks of using breast milk substitutes.

The prestigious Cochrane Library has released the special collection of systemic research into breastfeeding and breastfeeding substitutes, such as formula.

The collection notes that despite breastfeeding being an internationally important health priority, only 37% of babies worldwide are exclusively breastfed.

The introduction says breastfeeding promotes infant attachment and psychological outcomes, while substitutes:

  • Weaken infant immune systems
  • Impair infant cognitive development, behaviour and appetite regulation
  • Increase the mother’s risk of developing breast cancer.

The authors say several factors have contributed to a sharp decline in breastfeeding, including

  • The widespread availability and pro-active marketing of affordable breastmilk substitutes
  • Cultural norms mean women are often not supported to breastfeed in the workplace or public spaces
  • Many health workers may lack skills in teaching and supporting women to breastfeed
  • Widespread public and professional acceptance of the near-equivalence of breastmilk substitutes and breastfeeding, despite evidence to the contrary.

They say this means many women encounter problems they cannot resolve in the absence of skilled help and therefore decide to supplement or stop breastfeeding.

The special collection of articles focuses on a range of breast feeding issues including:  

  • Support for breastfeeding women
    Women who breastfeed need skilled support, especially in societies where breastfeeding is no longer the norm.  Support is needed to prevent and treat physical problems, and to build confidence.  Health workers often lack essential skills in helping women to breastfeed, and additional support from professional or lay workers with knowledge and skills in breastfeeding is often needed.


  • Health promotion and enabling environment
    In all countries, but especially those where breastfeeding rates have been low for many years, policies and practices are needed to enable women to breastfeed. These include the promotion of breastfeeding, public policies to protect breastfeeding women in the workplace, and the education and training of staff.

  • Care for breastfeeding women and their babies
    To enable women to breastfeed, it is important to ensure that routines in care promote and optimise the normal physiological processes of milk production and release. There is a serious problem in many countries where routine care has interfered with these processes, for example by separating mothers and babies, providing supplements of breastmilk substitutes, and timing and limiting feeding.  

  • Treatment of breastfeeding problems
    Problems with breastfeeding should be treated as both serious and acute, as they have the potential to cause the discontinuation of breastfeeding and, pain and infection for the mother.  Many problems can be prevented with good quality care, but when they do occur, it is important that evidence-informed skilled care is available.

  • Feeding practices for pre-term babies and babies with additional needs
    Breastfeeding is especially important for babies born too soon or too small or who are sick. Yet the use of breastmilk substitutes is common for these vulnerable babies. Particular challenges for these babies and their mothers include separation of babies from their mothers when they are cared for in incubators, and the baby’s immature development and problems with suck/swallow coordination, as well as the frequent use of breastmilk substitutes in neonatal units.

You can view the Cochrane Special Collection on breastfeeding here.  The collection includes links to the original articles listed in each section.