Social and Biological Determinants of Lactation

During the last decades breastfeeding rates have fallen to such a level that at least one million infant deaths annually have been attributed to the replacement of breastfeeding by formula-feeding. After the recent World Summit for Children, unprecedented efforts were targeted to reverse this trend. The evolution of breastfeeding patterns and related practices in Mexico is presented as a case study. Before the Baby-Friendly Hospital initiative, the rate of breastfeeding initiation and the average breastfeeding duration in Mexico were among the lowest in developing countries. The use of formula in hospitals was common. Knowledge about breastfeeding and awareness of its advantages were low among the public and health professionals. The International Code related to breastmilk substitutes became law, and the Baby-Friendly Hospital Initiative was included in the National Plan for Health in 1991. Formula manufacturers decided voluntarily to stop advertising their products. After five years, several surveys show noticeable changes in hospital policies and practices regarding breastfeeding promotion and improvement in the rate of breastfeeding initiation and exclusivity. Total duration of breastfeeding, public awareness, and mothers’ knowledge about the basics of breastfeeding are increasing. Despite continued inadequate post-partum support and counselling, and an inconsistent effectiveness in conveying to the public the benefits of breastfeeding, progress has been made in the last five years and will be reflected in improved infant health in the near future.