Breastfeeding Rates and Programs in Europe – A Survey of 11 National Breastfeeding Committees and Representatives

Introduction: Among the world's regions, the WHO European Region has the lowest rates of exclusive breastfeeding at age 6 months with around 25%. Low rates and early cessation of breastfeeding have important adverse health consequences for women, infants and young children. Protecting, promoting and supporting breastfeeding are a public health priority. Objectives: National breastfeeding data and monitoring systems among selected European countries and the WHO European Region are compared. Mechanisms for the support, protection and promotion of breastfeeding are reviewed and successes and challenges in implementation of national programs are presented. Methods: National representatives of national breastfeeding committees and initiatives in eleven European countries, including Belgium, Croatia, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Sweden and Switzerland, participated in a standardized survey. Results are evaluated and compared in a narrative review. Results: Variation exists in Europe on breastfeeding rates, methodology for data collection and mechanisms for support, protection and promotion of breastfeeding. Directly after birth, between 56 and 98 % of infants in all countries were reported to receive any human milk, and at 6 months 38–71% and 13–39 % of infants to be breastfed or exclusively breastfed, respectively. National plans addressing breastfeeding promotion, protection and support exist in 6 of the 11 countries. Conclusions: National governments should commit to evidence-based breastfeeding monitoring and promotion activities, including financial and political support, to improve breastfeeding rates in the Europe. Renewed efforts for collaboration between countries in Europe, including a sustainable platform for information exchange, are needed. Address correspondence and reprint requests to Berthold Koletzko, MD PhD Dres.h.c, LMU-Ludwig-Maximilians-University of Munich Dr. von Hauner Children's Hospital, Univ. of Munich Medical Center, Campus Innenstadt Lindwurmstr. 4, D-80337 Muenchen, Germany (e-mail: office.koletzko@med.lmu.de). Received 6 October, 2018 Accepted 17 November, 2018 Declaration of funding source: BK is a member of the Nutrition Commission of the German Association of Pediatrics and Adolescent Medicine, the National Nursing Commission, the Scientific Advisory Board of the Young Family Network, and President-Elect of the International Society for Research on Human Milk and Lactation and therefore tends to be biased towards breastfeeding. The work of the authors is supported in part by the European Commission's funding in the Early Nutrition (FP7-289346), DYNAHEALTH (H2020-633595) and LIFECYCLE (H2020-SC1-2016-RTD) projects through the European Research Council (Advanced Grant META-GROWTH, ERC-2012 AdG 322605), the Erasmus Plus Programs Early Nutrition eAcademy Southeast Asia (573651-EPP-1-2016-1-EN-EPPKA2-CBHE-P) and Capacity Building to Improve Early Nutrition and Health in South Africa-598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP, the EU Interreg Programme Focus in CD-CE111, the European Joint Programming Initiative Project NutriPROGRAM, and the EU Interreg Program Focus in CD (CE111). Additional support was provided by Federal Ministry of Education and Research (No. 01 GI 0825), German Research Foundation (KO912/10-1), and McHealth Innovation Initiative of the LMU-Ludwig-Maximilians-Universität Munich. LMU and its employee BK have received support for scientific and educational projects form healthcare and nutrition enterprises, mainly in context of publicly funded research projects supported by the European Commission, the European Research Council and the Federal Ministry of Education and Research. None of this has influenced the writing and content of this manuscript. All authors declare no conflict of interest, based on the guidelines of the US Institute of Medicine. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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