Equipping mothers and breastfeeding advocates with three state-of-the-art advocacy tools

By Anna Kotenko, Associate Director of Communications.

As World Breastfeeding month kicks off, it’s time to pause and reflect on global progress towards the World Health Assembly (WHA) 2025 breastfeeding targets. Today, according to the Global Nutrition Report, 44% of infants up to six months are exclusively breastfed, although many countries lack up-to-date and comprehensive data. A year and a half away and time is quickening to meet the deadline for the WHA target, which calls for 50% of infants in the first six months to be exclusively breastfed. Measuring breastfeeding prevalence and enabling actions regularly is critical in all country’s fulfillment of the Convention on the Rights of the Child.

When it comes to improving immunity, building resilience from disease, and increasing human capital, breastfeeding is as close to a silver bullet as we can get. Exclusive breastfeeding in the first six months of life has the single biggest impact on child mortality than any other preventative measure. Breastmilk is a baby’s first vaccine since it provides protection against illness and disease. It is also critical in preventing diarrhoea and pneumonia – two major causes of child mortality. Studies indicate that children who are breastfed, go on to develop higher IQ and lifetime earnings and that for every $1 invested, breastfeeding generates $35 in economic returns.

Evidence indicates that by enabling a mother to breastfeed her baby reduces her risk of ovarian and breast cancer. The emotional bonds between mother and baby are also strengthened, helping to regulate the baby’s nervous system. In the long run, this is critical for physical and mental health.

Yet despite the proven protection of breastfeeding to mother, child and value to our wider communities, global breastfeeding rates are falling short. Why is this naturally medicinal and vitally important part of life being overlooked? And how can we aid policy makers and program implementers to make the connection between breastfeeding and other policy priorities?

At FHI Solutions, we have invested in three tools to make the investment case undeniable.

In 2019, an article in Health Policy and Planning showed the value of an econometric tool to value the cost of not breastfeeding. Later, in August 2022, Alive & Thrive and Nutrition International released an updated version of the Cost of Not Breastfeeding Tool with the latest data for more than 160 countries. Insufficient government protection, promotion and support for breastfeeding is costing countries around the world nearly $575 billion a year in economic and human capital losses, according to data generated by the tool. It measures the impact of not breastfeeding on childhood obesity, IQ losses and education. Where this tool differs is in its ability to test different scenarios, such as the impact on the economy for any country that meets world breastfeeding targets.

Governments have since used the tool to inform national policy and practice. The Nigerian government is holding Baby Friendly Initiative stakeholder consultations around the country covering facilities, communities, and workplaces, while paid maternity leave, workplace lactation programs, stronger national breastmilk substitute codes, and strengthened policies and practices at health facilities have been adopted across a number of countries.

To complement the cost of inaction arguments, The Mothers’ Milk Tool, backed by research in Frontiers in Public Health, fills a critical gap in breastfeeding economics and comes with an additional ask to include breastmilk in national food balance sheets and GDP by systems for national accounts. The individual calculator allows a woman to estimate the volume and value of her breastmilk, demonstrating her unpaid contributions within the household and to the economy. Aggregated at the country level, this tool has the potential to be a powerful lever for change.

In almost all countries, the economic contribution made by women who breastfeed and through their unpaid care work is invisible in economic data and fiscal decision making. The tool estimates that with global production at about USD 35.6 billion litres a year, and a value of USD 100 a litre, lost milk is valued at around USD 2.2 trillion annually. The macroeconomic value of mothers’ milk can be directly linked to the Sustainable Development Goals, and, in particular, SDG target 8.1 Sustainable Economic Growth, which is defined by the U.N. as: “Sustain per capita economic growth in accordance with national circumstances and, in particular, at least 7 percent gross domestic per annum in the least developed countries.” Enabling policy environments for breastfeeding uptake are therefore doubly important, reducing the value of lost milk, and strengthening economies in the long run by improving human capital.

Developed by the Australia National University and Alive & Thrive, supported by FHI Solutions, The Green Feeding Climate Action Tool estimates the carbon and water footprints of commercial milk formula for infants under six months of age, taking the investment case for breastfeeding to the climate change arena. Commercial milk formula is an ultra-processed product, intensifying water scarcity, increasing waste, and accelerating biodiversity loss.

The tool is designed to be used by a broad range of policy makers, project implementers, environmentalists, researchers, national accountants, statisticians, and breastfeeding advocates. Given the complexities surrounding food system transformation and the challenges of meeting the nutritional needs of growing global populations, the tool provides a mechanism to link breastfeeding data to climate action. This is the first time that data on national breastfeeding rates has been translated into environmental metrics, showing how supportive breastfeeding policies and simultaneous bans on harmful marketing of infant breastmilk substitutes are part of the roadmap towards zero carbon emissions. One actionable recommendation is to consider investments in policies and programs enabling breastfeeding as contributing to national carbon offsets.

So, what do these three tools have in common? And how can they be used to drive national system wide change?

Together, these innovations show the return on investment for countries in supporting breastfeeding ecosystems, illustrating the costs of not enabling women’s and children’s rights to breastfeeding. Secondly, they have been designed to grow the advocacy space for breastfeeding, by demonstrating how this first and natural intervention impacts both economies and our planet and by broadening the metrics. Thirdly, they tell us something important: that we cannot continue to overlook the unpaid care economy and women’s work within it. Finally, the tools illustrate the urgent need for low-cost, quality, and routine data.

The future challenge – and the opportunity – lie in the uptake. Given the breadth of policy spheres that these tools and metrics speak to, there will be ample opportunities for targeted outreach. One such opportunity took place last month in Rwanda at Women Deliver with over 40 organizations came together to build a framework of policies and actions to support women and girls’ nutrition: Closing the Gender Nutrition Gap: An Action agenda for women and girls. To learn more or to join the Close the Gender Nutrition Gap campaign, visit: https://gendernutritiongap.org.

For more information on the meeting global breastfeeding targets, visit our Innovation Incubator.