A Recap of the 2023 Lancet Series

by Lisa Mandell, ILCA Global Advocacy Advisor and Zoe Faulkner, ILCA Board of Directors

The Lancet published a powerful 2023 Series on Breastfeeding during an in-person event held 8 February 2023 in London, United Kingdom.

International Lactation Consultant Association® (ILCA®) Board Member Zoe Faulkner, who is also Chair of Lactation Consultants of Great Britain, attended the in-person launch and shared, “It was a real privilege to be in person at an event that was being live-streamed internationally. There was an incredible atmosphere in the room, with a sense of hope and excitement that these papers may play a part in enabling positive change.”

During the Series’ Q&A portion, she asked if now was the time to also focus attention on the workforce that is so vital to counseling and supporting breastfeeding families.

“It appears that the lack of understanding of the importance of breastfeeding for public health is also reflected in a lack of understanding of the infant feeding workforce, inclusive of the knowledge, skills, and the range of roles that provide the support services that mothers and lactating individuals need. This workforce is inclusive of peer supporters, breastfeeding counselors, International Board Certified Lactation Consultants, midwives, and health visitors such as community public health nurses – all of whom collectively play a role in providing vital support.”

The 2023 Lancet Series on Breastfeeding builds on the 2016 Lancet Series on Breastfeeding and explores how the value of breastfeeding is undervalued and underinvested in by governments and public health, and how the vulnerabilities of women and children are exploited by the Commercial Milk Formula industry. The three-paper series is structured around the following themes, as outlined at the launch:

1. How baby behaviors, such as sleep and crying, are misunderstood and misconstrued to undermine breastfeeding, but multi-sectoral interventions can protect the extensive health impacts of breastfeeding
   • Unsettled infant behaviors such as crying, fussiness, posseting/spitting up, and short night-time sleep duration are common and normal
   • These behaviors often result in parents changing from breastfeeding to commercial milk formula (CMF) or from one CMF to another or to a specialized CMF that claims (without evidence) to resolve the issue
2. How the formula marketing ‘playbook’ targets parents, health professionals, and politicians, and undermines the health and rights of children and mothers
   • CMF sales worldwide have grown from $1.5 billion USD in 1978 to $55.6 billion USD in 2018 (a 3,700% increase in 41 years)
   • Health professionals are targeted by CMF companies due to their capacity to encourage sales
   • CMF companies are large and powerful. The four largest companies together generated $187 billion USD in revenue in 2022These four CMF companies employed more than 535,000 people globally in 2018, which is greater than the entire health workforce of South Africa, Zimbabwe and Lesotho combined
   • “CMF marketing impinges on the human rights of women and children, harms their health, and adversely affects society”
3. How power imbalances and political and economic structures determine feeding practices, women’s rights, and health outcomes
   • Breastfeeding and breastmilk are not included in most countries’ gross domestic product (GDP), so improving breastfeeding rates does not impact GDP, while increasing CMF sales does
   • The monetary value of the milk produced by breastfeeding women globally is estimated to be about $3.6 trillion USD
   • Unpaid care work, including breastfeeding, is primarily performed by women; not including the value of this unpaid care work shifts policy priorities away from it and exacerbates gender inequities
   • The CMF industry exacerbates economic disparities and health inequalities; the harms associated with CMF concentrate in low and middle income countries, while the shareholders of CMF companies who increase their wealth through increased CMF sales are almost exclusively in high-income countries

A number of critical points were made throughout the series, with the following quotes being especially relevant to the role of lactation consultants and International Board Certified Lactation Consultants (IBCLCs):

“…universal access to improved breastfeeding-supportive maternity care, evidence-based breastfeeding counselling, and public and health worker education are crucial for preventing common early lactation problems, avoiding attempts to address common behaviors of infant development by introducing CMFs, and helping mothers improve their breastmilk production and self-efficacy.”

“Skilled counselling and support should be provided prenatally and post-partum to all mothers to prevent and address self-reported insufficient milk and avert the introduction of prelacteal feeds or CMF early on…”

“Health professionals, mothers, families, and communities must be provided with better educational support and skill development, free from commercial influence…”

Key Takeaway

“Breastfeeding success is a collective responsibility that depends on multifaceted policy and societal responses. Fact-based information on feeding infants and young children that is free from commercial influence is a human right that must be made available to all.”

What You Can Do

The Series offers excellent, well-researched support for any policy decisions related to breastfeeding and supporting new families, and highlights the importance of regulation and the legal protections governments can and should provide. ILCA encourages all involved in infant and young child feeding to read these papers, amplify the messages, and act on the recommendations they provide. Lactation consultants, especially IBCLCs, should be part of every solution, from providing training for health professionals, helping to make policy decisions, and providing care to breastfeeding families.

ILCA is committed to providing the latest, quality education free from commercial influence, and upholds the WHO International Code of Marketing of Breast-milk Substitutes and subsequent resolutions. ILCA strives to support and empower all lactation consultants and IBCLCs to advocate locally, nationally, and globally for breastfeeding and for the policies that promote, protect and support breastfeeding.

The USA launch of the 2023 Lancet Series on Breastfeeding will be held on 18 April in New York, NY. Learn more about it and register for the livestream here.