Review of effective strategies to promote breastfeeding: an Evidence Check rapid review brokered by the Sax Institute for the Department of Health, May 2018

The purpose of this review is to provide evidence that indicates the effectiveness of key strategies for an enduring Australian National Breastfeeding Strategy (ANBS-E). This is undertaken through a review of academic and grey literature during a period of 10 years (2007–2017). The global public health recommendation of the World Health Organization (WHO) is that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants and young children should receive nutritionally adequate and safe complementary foods while breastfeeding continues until up to two years of age or beyond.5 In Australia, national dietary guidelines recommend that infants are exclusively breastfed until about six months of age, when solid foods are introduced, and that breastfeeding is continued until 12 months of age and beyond, for as long as the mother and child desire.6 However, only about one in 10 Australian children are breastfed according to national dietary guidelines, and only about one in 20 meet WHO optimal breastfeeding recommendations. Virtually all children (92%–96%) in Australia initiated breastfeeding in 2010–11, but one in three received non-human milk or formula before one month of age.3 Median duration of breastfeeding is less than 7–9 months, though 60% of babies still breastfeed at six months of age. About 18% of mothers continue to breastfeed their child beyond 12 months, and 7% are still breastfed at 19–24 months. However, the gap between the most disadvantaged and least disadvantaged families has widened.7 At the end of 2015, the Australian Health Ministers’ Advisory Council (AHMAC) requested that the Department of Health develop a high-level enduring breastfeeding strategy. The previous Australian National Breastfeeding Strategy (ANBS) 2010–2015 was a recommendation from a 2007 Senate inquiry that reported on the health benefits of breastfeeding. During consultations by the Department in 2017, stakeholders identified key strategies for the enduring Australian National Breastfeeding Strategy (ANBS-E). Potential ANBS-E strategies to be covered in this review included: • Public awareness and acceptance campaigns • Restriction of advertising of infant formulas, including full implementation of the WHO International Code of Marketing Breastmilk Substitutes and subsequent World Health Assembly (WHA) resolutions • Antenatal and postnatal education and support • The Baby Friendly Health Initiative (BFHI), previously called the Baby Friendly Hospital Initiative • Training of health practitioners (general practitioners, midwives, nurses, pharmacists, dietitians, students, etc.) on the benefits of breastfeeding and providing support for mothers who choose to breastfeed • Influence of support person/people Culturally sensitive and appropriate interactions/communication • Continuity of care, referral pathways and support networks • Targeted/specialist breastfeeding support services • Peer support programs • Influence of returning to work and access to childcare • Any other additional strategies that have been proven to increase breastfeeding identified during the review process. The review aimed to address the following questions agreed with the Australian Department of Health: Question 1: What does the literature report on the effectiveness of strategies to influence optimal infant and young child feeding (IYCF) practices in OECD countries? Question 2: What does the literature report on whether the effectiveness of these strategies differs for specific population groups?