It Takes a Village and Innovation

By Nadra Franklin, Managing Director of FHI Solutions

“Breastfeeding is a collective responsibility that requires supportive policies and a society that prioritizes the health and well-being of mothers and their children, rather than undervaluing or undermining it.”
– Dr. Paul Zambrano, co-author of the Lancet series on breastfeeding and Regional Associate Director at Alive & Thrive East Asia Pacific.

At FHI Solutions, we believe that every child deserves the best start in life. That is why we are dedicated to using innovative solutions to create a society that successfully enables and supports every mother to breastfeed. 

The truth is, global commercial milk formula sales are on the rise. The industry uses targeted marketing tactics to sell products and reduce mothers’ confidence in breastfeeding, despite the fact that commercial milk formula feeding fails to offer the same nutrition, health, and development benefits as breastfeeding. At the same time, more than half a billion working women do not have access to adequate paid maternity leave that would enable breastfeeding. Furthermore, the production of formula milk has negative environmental impacts and affects low-income and middle-income countries disproportionately, contributing to socioeconomic inequality. Here is where the value of a multisectoral approach and innovation comes into play. A collective effort from society, the health system, policymakers, and businesses is necessary to promote, protect, and support breastfeeding effectively. 

The Power of Breastfeeding

Breastfeeding is a powerful tool in the fight to reduce malnutrition and ensure the health of mothers and babies. It is no wonder the World Health Organization recommends children initiate breastfeeding within the first hour of birth and exclusively breastfeed for the first six months of life, continuing along with appropriate complementary foods to two years of age and beyond. 

Breastmilk provides perfect nutrition for infants. It has nutrients and proteins—as well as antibodies and hormones that cannot be replicated in commercial milk formula—that are vital to a baby’s growth and brain development. A child that is exclusively breastfed during the first six months of life is 14 times less likely to die than a child who is not breastfed. Moreover, breastfeeding protects mothers’ health, reducing rates of postpartum depression, Type II diabetes, and breast and ovarian cancer. Increasing breastfeeding rates to near-universal levels would prevent more than 500,000 deaths each year: 420,000 child deaths from diarrhea and pneumonia alone and more than 90,000 maternal deaths from breast and ovarian cancer and Type II diabetes.

The Research

The recent publication of The Lancet Series on Breastfeeding supports a multisectoral approach to creating a supportive environment for breastfeeding. The series explores how breastfeeding is undervalued by governments and public health and exploited by the commercial milk formula industry. 

Many mothers face challenges that prevent them from initiating or continuing to breastfeed. These challenges can range from a lack of paid maternity leave and social support to the aggressive marketing of commercial milk formulas; removing these barriers to breastfeeding shows an association with improved maternal physical and mental health. Read the full paper here. 

Technology to Make Progress

In response to these challenges, FHI Solutions has developed a suite of innovative tools and programs to support and empower women and families as they embark on their breastfeeding journeys and provide advocates and policymakers with the data they need to increase investment in breastfeeding.

The cost of not breastfeeding is immense, with preventable deaths (510,000 annually), cognitive losses, and health system costs of inadequate breastfeeding leading to over $574 billion in economic losses annually. To combat this, the multisectoral approach must include, not only advocacy but also, innovative solutions and tools to support women in their breastfeeding journeys. For example, the Cost of Not Breastfeeding tool developed by Alive & Thrive and Nutrition International helps raise awareness about the economic losses associated with inadequate breastfeeding. This valuable tool can be used to educate policymakers and health systems about the importance of investing in breastfeeding promotion and support.

In 1981, the World Health Assembly passed the International Code of Marketing Breast-milk substitutes, read more on ‘The Code’ here, an international legal framework designed to end the promotion of commercial milk formula in order to protect the health and well-being of mothers and their infants. However, forty years later, the aggressive marketing of commercial milk formula continues to negatively impact breastfeeding rates, child survival, and the long-term health of mothers and babies. 

Recognizing that most commercial milk formula promotion now occurs online, Alive & Thrive East Asia Pacific has collaborated with a Vietnamese start-up, Hekate, in collaboration with the Vietnamese Ministry of Information and Communications and Ministry of Health to develop a virtual assistant that uses artificial intelligence to detect violations of the Code on digital platforms. 

In 2022, VIVID  – a virtual violations detector, found 5,970 commercial milk formula advertisements that violated the Code and has since expanded to monitor other forms of marketing for alcohol and tobacco products. With an accuracy rate of 70%, VIVID is an effective tool in the fight against aggressive marketing tactics that negatively impact breastfeeding rates. Learn about its potential here.

Alive & Thrive is also using technology to provide evidence-based information on breastfeeding for health workers and parents and social media to facilitate peer-to-peer support for breastfeeding mothers. The Momby application uses artificial intelligence and machine learning to provide targeted messaging and support on infant and young child feeding; while vibrant online communities like Betibuti in Viet Nam and MayMayChoCho in Myanmar allow parents to share experiences and access peer and expert support through Facebook. In India and Bangladesh, an Android application called SAHYOG is providing real-time support to health workers to improve maternal and child nutrition services. The app, which recently won an MIT Solve Novel Measurement for Performance Improvement in Primary Healthcare Challenge award, was developed by Alive & Thrive and government partners in India and Bangladesh.

Empowering Women through Data and Advocacy

Despite its huge economic value, breastmilk is presently not counted in food systems or economic indicators like GDP. In response, FHI Solutions partnered with the Australian National University and Alive & Thrive to develop The Mothers’ Milk Tool. The user-friendly, online tool provides economic data to assist in policy decisions and acknowledges the role, health and economic contribution of mothers to society through women’s unpaid care work through breastfeeding.

Alive & Thrive is also scaling up mothers’ experience survey systems that collect and analyze user feedback to improve the quality of breastfeeding and newborn care services and amplify women’s voices. In Viet Nam, over 7,000 mothers were surveyed during 2022 alone, and a similar system has now been replicated in Laos with plans for a pilot in Cambodia this year. The surveys include questions on mothers’ experiences with care, including receipt of breastfeeding counseling and support, skin-to-skin contact, and exposure to Code violations in maternity facilities. Data is then shared with health facility leaders and policymakers and used to inform performance improvement plans.

The 1,000 Days initiative educates and inspires the U.S. government and policymakers to invest in nutrition interventions like breastfeeding especially for low- and middle-income countries where the needs are greatest. For example, in 2022 the Global Malnutrition Prevention and Treatment Act was signed into law, which provides USAID with the tools and direction it needs to implement evidence-based solutions to prevent and treat malnutrition, including breastfeeding. And it’s one of the reasons why we join a broad and diverse advocacy community to support the Power 4 interventions. 

Increasing Access to Paid Leave and Workplace Breastfeeding Support

Finally, we at FHI Solutions are also working to advocate for policies that enable women to breastfeed, including financing maternity protection for informal workers in Indonesia and the Philippines. Additionally, we are working with the private sector to facilitate the adoption of breastfeeding-friendly workplace environments, including breastfeeding breaks and spaces, to help mothers balance work and breastfeeding responsibilities. Recent economic evidence generated by Alive & Thrive highlights the significant benefits of maternity protection for informal workers in Indonesia and the Philippines. It underscores the importance of creating supportive environments that enable women to continue breastfeeding and provides a strong case for the implementation of workplace policies that support breastfeeding mothers. 

Build-up Breastfeeding Together

At FHI Solutions, we believe that every child deserves the best start in life. That is why we are dedicated to using innovative solutions to create a society that enables breastfeeding. It’s time for society to step up and take collective responsibility for breastfeeding. As Dr. Paul Zambrano stated, “Inaction is unacceptable.” Let’s work together to give every child the best possible start to life – join us.