Babies born in developed countries are far less likely to be breastfed than newborns in low- and middle-income nations, according to new data from the United Nations Children’s Fund (UNICEF). And the discrepancies continue, with wild variations in breastfeeding rates between different communities in the developed world.

The report, Breastfeeding: A Mother’s Gift for Every Child, is one of the first to attempt to draw a truly global picture of how many children are breastfed. The idea, according to the researchers, is that data can then guide efforts to figure out why breastfeeding is less common in certain contexts and to work to introduce new policies that might encourage more women to breastfeed their children.

Maaike Arts, a nutrition specialist with UNICEF, said the nutritional importance of exclusive breastfeeding has long been understood, but new evidence continues to emerge of the long-term health benefits it confers, including a reduced risk of maternal cancers. As the weight of evidence continues to grow, she said, it increases the pressure to better understand what is preventing women breastfeeding.

Malnutrition Deeply: What motivated you to produce this report?

Maaike Arts: We know breastfeeding is important for children’s health [and] for mothers’ health all over the world and we wanted to see what the situation actually is if you look at different countries – both high-income and low-income countries. We sort of knew that breastfeeding is practiced more in lower- and middle-income countries and less in high-income countries, but we didn’t know the magnitude of that.

We found that 7.6million – that is, 5 percent of – children [around] the world are never breastfed. That was quite a striking finding. In lower- and middle-income countries, it is the less wealthy families that are more likely to breastfeed and in high-income countries, it’s the opposite.

Malnutrition Deeply: Why is that?

Arts: The reasons for that are all different, but it comes down to support for women.

I think in high-income countries and among wealthier families in low-income countries there is a perception that breastfeeding is for the poor. It is for child survival.

That is misinformation, in a way, because part of that misinformation also comes from the fact that there is still a lot of marketing of breastmilk substitutes, bottles and teats going on, so many women don’t have impartial information. They can [sometimes] base their decisions … on impartial information and [sometimes have to rely on] biased information that says it’s just the same and it’s just easy and doesn’t matter.

Malnutrition Deeply: What about policies?

Arts: Information is one part of the support. And then, of course, policies on reducing or regulating or preventing marketing of breastmilk substitutes. Of course, these things go hand in hand, so what you would want is that a government can invest in promoting and supporting breastfeeding and that there is not the biased information from commercial sources.

And then, of course, policies like maternity leave or maternity protection in the broader sense of the word. If women don’t have maternity leave or very short leave and no time or space to breastfeed at work, that’s another reason why [they don’t].

And also, the support at the time of delivery. It could well be that wealthier women, even in lower- and middle-income countries, they might go to private clinics where we know there is much more influence from commercial sources. Even if governments are promoting and supporting breastfeeding at time of delivery, that might not have trickled down or might not be in place in private facilities.

Malnutrition Deeply: How are things changing?

Arts: I’ve been in this work for a while and the only thing I’m seeing is that the evidence is only getting stronger. It was already strong, but all these issues like reducing maternal cancers, the risk of maternal cancers, the importance of the whole microbiome and how there is a relationship with overweight and obesity, the brain development, all these things that people might not know or might not have thought about.

Malnutrition Deeply: Have high-income countries neglected public health policies on exclusive breastfeeding?

Arts: What you hear when you speak to colleagues and friends and then what you see in policies and in actions is that, yes, it seems that it is not an important topic for countries to invest in and it’s not happening enough.

There could be some country that has good maternity legislation in place, for example, but then again, how is it implemented? When you really go to your supervisor and you say, “Well, now I need to have time to express my milk,” then what is really happening?

Malnutrition Deeply: We link breastfeeding to stunting, but then we see that breastfeeding is actually higher in low- and middle-income countries, but those countries also have a high incidence of stunting. What is the relationship, if any?

Arts: Sometimes people say, “Oh, there is more mortality and more undernutrition and it is because of breastfeeding.” But, of course, it’s not like that. It’s actually the reverse. If there [were] not … breastfeeding, the rates would be even higher. That’s how I would see it, so it’s a very complex issue why children are stunted, why children die. There are many, many factors that come into play and, like I said, breastfeeding protects against all those things, so you need to look at other issues. The safe water, access to health facilities, access to information.

You can never be complacent because there have been countries that were better in the past and are sliding back when the investments reduce. For example, training of health workers or specific communication campaigns are good [but] when those investments stop, then sometimes you see the rates sliding.

So you need to keep it up and, of course, having policies already in place that prevent marketing of breastmilk substitute, that helps because then your policy is there. You need to implement it and you need to do the enforcement of that.