The global burden of suboptimal breastfeeding from 1990 to 2019: results and insights of the Global Burden of Disease.

The practice of breastfeeding is universally recommended because of its beneficial short and long-term impact on maternal and child health. UNICEF and WHO are promoting a global call to action to reach the goal of 50% exclusive breastfeeding by 2025. This study aims to show the global epidemiological picture of suboptimal breastfeeding over the years and its impact on health due to diarrhea and lower respiratory tract infections. We explored non-exclusive and discontinued breastfeeding data from the Global Burden of Diseases study 2019. We compared risk-weighted prevalence (summary exposure values) and outcome measures for diarrheal diseases and lower respiratory infections (years lived with disability and years of life lost) across countries and macroareas and over time. In 2019, North America had the highest risk-weighted prevalence for non-exclusive breastfeeding (25.3 SEV) and discontinued breastfeeding (25.3 SEV). By contrast, YLDs were highest in the Middle East and North Africa (37.8 per 100,000) and YLLs in Sub-Saharan Africa (4693.2 per 100,000) due to non-exclusive breastfeeding. From 1990 to 2019, YLLs due to suboptimal breastfeeding in children under 5 years of age decreased by 70%, and the gap between high- and low-income countries also decreased (by 48% for diarrheal diseases and 13% for lower respiratory infections, comparing North America and sub-Saharan Africa).

Conclusion

Policymakers around the world should recognize the gap that persists between expectations and goals and work to meet international recommendations and improve child and maternal health. What is Known: • Exclusive and prolonged breastfeeding reduces infant mortality, improves nutrition, and has lasting positive effects on health • Health policies such as the International Code of Marketing of Breastmilk Substitutes and the Baby-Friendly Hospital Initiative have not fully fostered breastfeeding practices What is New: • Over the past 30 years, progress has been made in reducing mortality and disability associated with suboptimal breastfeeding • Suboptimal breastfeeding remains widespread globally and affects high-income countries as much or more than low-income countries.