Public Health Breastfeeding
Hector G. Balcazar, Holly J. Mata
  • LAST REVIEWED: 25 June 2013
  • LAST MODIFIED: 25 June 2013
  • DOI: 10.1093/obo/9780199756797-0110


Substantial evidence supports breastfeeding as promoting child and maternal health. International efforts to promote, protect, and support breastfeeding have resulted in global adoption of practices and policies that encourage breastfeeding. Evidence supporting breastfeeding is compelling and continues to grow; the World Health Organization and international public health organizations strongly support and advocate for breastfeeding. As with other health outcomes, breastfeeding is influenced by complex and multilevel determinants, and disparities exist in prevalence, acceptability, and sustainability of breastfeeding. From a health equity perspective—one in which all people have the opportunity to attain the highest possible level of health—it is imperative that determinants of breastfeeding be understood and addressed with culturally and linguistically appropriate services and support. Breastfeeding is influenced by factors at multiple levels, including biological (e.g., maternal physiological health), individual and contextual (e.g., social support, social norms, health care system support, breastfeeding knowledge, and confidence), and public policy (e.g., workplace policies, local, state, and federal regulations, maternity benefits). Although factors that influence breastfeeding practice and policy are increasingly identifiable and supported by a growing body of research, these factors and their role in breastfeeding adoption and success differ significantly by sociodemographic factors such as ethnicity, income, education, and cultural beliefs. This article examines breastfeeding from a public health perspective and highlights a diverse literature grounded in research, practice, and policy.

General Overviews

Several large bodies of work describe and synthesize the science behind the short- and long-term effects of breastfeeding on maternal and child health outcomes. Horta, et al. 2007 provides a review and summary of the evidence linking breastfeeding with long-term health outcomes, while Ip, et al. 2007 provides evidence summaries of short- and long-term effects. Kramer 2010 summarizes the results of one of the largest randomized controlled trials to examine the long-term effects of breastfeeding.

  • Horta, Bernardo, Rajiv Bahl, José C. Martines, and Cesar Victora. 2007. Evidence on the long-term health effects of breastfeeding: Systematic reviews and meta-analyses. Geneva, Switzerland: World Health Organization.

    This is a systematic review and meta-analysis of the evidence on the long-term effects of breastfeeding. Effects included: blood pressure, diabetes and related indicators, serum cholesterol, overweight and obesity, and intellectual performance.

  • Ip, Stanley, Mei Chung, Gowri Raman, et al. 2007. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Reports/Technology Assessments 153. Rockville, MD: Agency for Healthcare Research and Quality.

    Evidence from developed countries highlights relationships between breastfeeding and short- and long-term infant and maternal health outcomes. Breastfeeding was associated with reduced risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma, obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. Some information may be out of date, but this provides important historical perspective.

  • Kramer, Michael. 2010. Breast is best: The evidence. Early Human Development 86.11: 729–732.

    DOI: 10.1016/j.earlhumdev.2010.08.005

    One of the most recent and most comprehensive discussions of the Promotion of Breastfeeding Intervention Trial (PROBIT) study, which is the largest RCT of human lactation to date. Findings from the study continue to add to existing (and in some cases, conflicting) evidence regarding the role of breastfeeding on health and developmental outcomes—including cognitive ability—later in childhood. Contains helpful bibliography of related work.

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