How data can support policies to protect, promote and support breastfeeding: Swedish experience

During World Breastfeeding Week, WHO/Europe highlights Sweden’s experience in gathering data to understand the reasons behind its declining breastfeeding rates. 2 online surveys conducted in 2020 in the region of Skåne showed that the local population is unaware of the health benefits breastfeeding gives for both the child and mother, and that infant feeding services need more coordination. This helped Swedish authorities to update local practices and reimplement WHO-recommended tools.

The best option for infant feeding

Sweden’s breastfeeding initiation and duration are relatively high in the WHO European Region, with a recorded initiation of 94% in 2018. However, in the same year only 11% of mothers met WHO’s standard recommendation of exclusive breastfeeding for the child’s first 6 months. Overall, there has been a recent decline of the breastfeeding levels since the 1990s and early 2000s.

In response, the Regional Council of the Swedish region of Skåne commissioned the Center of Excellence Women’s health and Child Health Services to develop a strategic plan to explore and address the negative trend in efforts to protect, promote and support breastfeeding.

“Breastfeeding is the best option for infant feeding,” said Clare Farrand, Technical Officer for Nutrition at the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office). “It delivers emotional, nutritional and health benefits, such as protection against noncommunicable diseases such as heart disease and cancer to both children and mothers. It also forms part of a sustainable food system.”

Reasons behind numbers

In order to better understand the situation in Sweden, 2 surveys were administered; one aimed to evaluate the current status of breastfeeding in health facilities and the second survey aimed to explore breastfeeding attitudes and knowledge among the local population and to gain a deeper understanding about the underlying factors that influence whether and how Scanian women choose to breastfeed.

The surveys found the following.

  • Widespread uncertainty remains about the health benefits for both the child and mother. 99% of the respondents agree that breastfeeding is natural, but only 3 out of 10 are aware that it reduces the risk of breast cancer.
  • Currently, there is no regional coordinating body to support breastfeeding in Skåne. Health workers who completed the survey reported that they feel that written breastfeeding and infant feeding policies they can refer to are insufficient. In addition, counselling on breastfeeding is categorized as low priority in newborn care.
  • Violations of the International Code of Marketing of Breast-milk Substitutes are common in healthcare facilities. 91% of nurses working in child health care services reported being contacted by representatives from the baby food industry during the last year. 80% of them were given free formula samples to distribute to families.
  • There is a need to assess and strengthen staff competency. Since pre-service education, only 32% of respondents completed further training in breastfeeding counselling, and the majority considered themselves in need of further training on how to counsel women to breastfeed.

WHO tools and best practice solutions

The presence of baby food companies in Swedish health care facilities has urged the Regional Council to implement best practice and put into place a rigorous monitoring and evaluation process. To protect breastfeeding, the regional pay-provider contract was revised from 1 January 2021 to include a commitment for all facilities providing antenatal care and child health services to fully comply with the International Code.

“We have felt the need for urgent reimplementation of the Baby-Friendly Hospital Initiative (BFHI), which was implemented in the early 90s but has not been comprehensively evaluated since,” said Anna Kjellbom, General Practitioner from the Center of Excellence Women’s health, Regional Council of Skåne. “To promote breastfeeding, raising awareness about the health benefits of breastfeeding among the population should be a public health priority. Educating both healthcare workers and parents would encourage an overall positive attitude towards breastfeeding and have far-reaching benefits for families and the community.”

The NCD Office supports all countries in the Region in scaling up implementation of the Baby-Friendly Hospital Initiative, strengthening the International Code of Marketing of Breast-milk Substitutes, as well as improving health literacy and surveillance of breastfeeding practices.

The NCD Office also hosts a regular webinar series ‘Promoting, protecting and supporting breastfeeding in the WHO European Region’, focusing on contemporary public health, clinical and physiological aspects of breastfeeding, human milk and lactation. The series is designed to provide information to Member States to improve their evidence-based advocacy as well as policy design and programme implementation efforts.


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