by University of Tokyo

Infographic based on the WHO and UNICEF's Ten Steps to Successful Breastfeeding. Credit: 2023, Nicola Burghall

Exclusive breastfeeding for the first six months of life is proven to protect both mother and child health. According to the World Health Organization (WHO), between 2015 and 2021, 48% of mothers breastfed exclusively, meaning that their babies were not given any other food or liquids.

However, this figure is based on data collected from surveys that report what a child was given in the previous 24 hours. A research team, including members from the University of Tokyo, has found that this "24-hour recall" method overestimates exclusive breastfeeding by about six times compared to a "since-birth recall" method.

The 24-hour recall data also do not reflect the positive impact of in-hospital breastfeeding support and guidance. More indicators to assess child-feeding practices and mothers' experiences are needed to increase exclusive breastfeeding and to improve breastfeeding outcomes for both.

Breastfeeding is a natural and learned behavior that requires appropriate support. The World Health Organization and the United Nations Children's Fund (UNICEF) recommend that babies be exclusively breastfed until the age of six months. Breast milk contains antibodies and hormones, along with nutrients, which can help build babies' resistance to common childhood illnesses and can even reduce the risk of some diseases in adulthood.

According to the Centers for Disease Control and Prevention in the U.S., breastfeeding also benefits the mother by reducing the risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure. However, many women breastfeed without sufficient help or guidance, which can result in mothers struggling with this demanding task and stopping earlier.

The WHO has set a global target to increase exclusive breastfeeding in the first six months from an estimated 38% between 2006 and 2010 to over 50% by 2025. To assess progress toward this target, the WHO and UNICEF collect data on child feeding from population-based household surveys every three to five years.

These surveys ask what babies under the age of 5 months were fed and how often within the past 24 hours. However, this 24-hour recall method has been criticized for not giving a true picture of breastfeeding practices.

"We have found that merely asking mothers whether they are currently breastfeeding overestimates the prevalence of breastfeeding and also overlooks the importance of providing proper support in maternity facilities," said Assistant Professor Keiko Nanishi from the Graduate School of Medicine at the University of Tokyo.

"I have long thought that 24-hour recall used by the WHO as an indicator does not reflect the responsibilities of health staff and facilities. As a mother, a pediatrician, a lactation consultant, and a researcher in maternal and child health, I think breastfeeding promotion should focus on creating a mother- and baby-friendly environment, including health staff and facilities implementing evidence-based infant-feeding practices."

In a study of over 4,000 mothers in Japan, Nanishi and the team compared responses to questions about breastfeeding using the 24-hour recall method and the since-birth recall method.

For the latter, additional questions were asked about when breastfeeding started and finished during the months since birth when formula milk was introduced and stopped, and when complementary feeding began. Participants were also asked about in-hospital breastfeeding support, measured against the WHO's recommended Ten Steps to Successful Breastfeeding, along with their intentions to breastfeed, social background, and factors related to their experience of childbirth.

More information: Keiko Nanishi et al, Challenging the utility of 24-hour recall of exclusive breast feeding in Japan, BMJ Global Health (2023). DOI: 10.1136/bmjgh-2023-013737

Journal information: BMJ Global Health 

Provided by University of Tokyo