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Data from the World Health Organization indicate that globally, 149 million under-five-year-olds are estimated to be stunted, 45 million are wasted, and 37 million are overweight/obese. Additionally, every year, it is estimated that 2.7 million child deaths are due to undernutrition1. Recent findings examining worldwide trends in underweight and obesity from 1990 to 2022 among 222 million adults, adolescents, and school-aged children have shown that in almost all countries and for all age groups, the combined burden of underweight and obesity has increased and was driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. In 2022, the double burden of malnutrition among 5-19-year-olds was dominated by a higher prevalence of obesity than thinness among girls in 133 countries (67%) and boys in 125 countries (63%). More than 90% of the double burden consisted of obesity among girls from 25 countries and boys from 17 countries2.
One of the internationally recommended practices to maximize impact in the prevention and reduction of the double burden of malnutrition, reduce child mortality and other morbidities, improve child development, and reduce health costs is the promotion and support of optimal nutrition during the first few years of life, including early initiation of breastfeeding, its duration, and exclusivity1,3. The benefits of breastfeeding for children`s and women's health in the short and long term and for society`s human capital and economy are well established4,5,6,7,8.
For babies, breastfeeding provides essential nutritional and immunologically active factors9,10 and is associated with the reduced risk of infectious diseases, respiratory tract infections, obesity, lower blood pressure, and reduced incidence of diabetes and asthma4,5,8,11,12,13. Given the immaturity of the immune system of newborns (especially the mucosal one), breastfeeding has significant relevance in protecting infants against infectious diseases. Through colostrum and breast milk, infants receive specific immunomodulatory and anti-inflammatory factors14,15 essential for safeguarding and directly modulating their immune system14.
The colostrum is a transparent or yellow secretion produced by the mammary glands during the first 3-5 days of newborns` lives16. The components of colostrum interact through a complex network to influence both innate and adaptive immune responses, primarily by producing cytokines and immunoglobulins14,17. After this initial breastfeeding stage, the breast milk adapts extraordinarily to babies’ ontogeny and immunological and nutrition needs15. The establishment of breastfeeding within the first hour after a baby's birth (known as the “Golden hour”) can help guarantee that babies receive the colostrum and is crucial for creating the mother-baby emotional bond, increasing the chance of successful breastfeeding18. Additionally, for mothers, breastfeeding also impacts positively on their health, including a reduced risk of ovarian and breast cancers19,20, lower incidence of type II diabetes21, and heart attack22. Breastfeeding also contributes to the lipid metabolism of mothers after giving birth, helping reduce blood levels of cholesterol and other lipids23.
In addition to the numerous benefits for both mother and baby, breastfeeding offers significant social advantages5,24. Investing in breastfeeding is one of the wisest decisions a country can make to ensure its future prosperity, as this action boosts national economies, reduces healthcare costs, and creates more competent workforces due to human milk's health and brain-building benefits24.
Breastfeeding has the power to save lives; it has been estimated that globally, the almost universal expansion of optimal breastfeeding rates could save the lives of more than 820,000 under-five-year-olds17 and 20,000 deaths due to breast cancer annually4. Not breastfeeding represents an economic loss of 302 billion dollars/year or 0.49% of the world's gross national income5. Social costs are also exacerbated by the lack of recognition of the value of breast milk production in the national gross domestic product (GDP). The market value of the production and sales of infant formula is included in a nation's GDP, while the value of breast milk production is not, impacting the misrepresentation of the economic contributions and health benefits associated with breastfeeding25. The main factors influencing the financial loss of not breastfeeding include spending on illnesses and healthcare, such as obesity, premature deaths from pneumonia and diarrhea, and breast cancer, all problems potentially avoided by the practice of breastfeeding5,6.
The combined benefits of breastfeeding make its protection, promotion, and support central to the global commitments within the 2030 Agenda for Sustainable Development26,27, as breastfeeding is intrinsically linked to advances in the 17 Sustainable Development Goals (SDGs)27. The link with SDG 12 (ensuring sustainable consumption and production patterns) is due to the environmental benefits of breastfeeding27,28,29,30,31.
Human milk is a sustainable and ecological diet that produces no waste and requires no packaging, preparation, or transportation31,32. Breastfeeding does not require intensive dairy farming and the use of freshwater. Breastfeeding does not produce waste once the supply equals the demand35,36. Exclusive breastfeeding directly at the breast has a minimal ecological footprint compared to feeding babies infant formula. Infant formula production increases greenhouse gas emissions and contributes to global warming and land, freshwater, and seawater pollution due to the processes involved in raw material extraction, production, use, and waste treatment24,28.
The Global Strategy for Infant and Young Child Feeding, developed by the WHO and UNICEF and launched in 2003, is intended to improve the nutritional status, growth, health, and survival of infants and young children through optimal feeding35. The Strategy represents a combination of recommendations and initiatives, including the nutritional recommendations36,37 and the Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition.
The Plan set the global nutrition targets (GNTs) to be achieved by 202513,38, a posteriori updated with targets to be met by 203039, in alignment with the 2030 Agenda for the Sustainable Development Goals26,39. Recommendations are that global efforts should be made for all children to have a better nutritional start in life. This means infants put to the breast within one hour of birth, receiving breastfeeding exclusively for the first six months of life, and continuing to be breastfed to 2 years of age or beyond. From 6 months, breastfeeding should be complemented with safe, age-appropriate feeding of nutritious solid, semi-solid, and soft foods37. Exclusive breastfeeding to age six months represents one of the six core GNTs, and global initiatives have been recommended to reach a prevalence of at least 50% by 202540 and at least 70% by 203039.
Data from 2000 to 2019 from 113 low-middle-income and high-income countries on breastfeeding rates and trends and recent data from the Global Breastfeeding Collective have documented global progress in breastfeeding rates33,34. In 2023, 46% of infants were breastfed in the first hour after birth, and 71% and 45% of the children, respectively, were being breastfed at ages 1 and 2 years34. The prevalence of exclusive breastfeeding to age six months was 48%36, close to the global target for 202534. These findings resulted from a combined set of international recommendations to increase the prevalence of breastfeeding, but the degree of implementation of each varied widely globally.
These recommendations have been: i) to increase investment in programs and policies that promote, protect, and support breastfeeding; ii) to fully implement the international code of marketing of breast milk substitutes and legislation for effective enforcement; iii) to enact legislation to guarantee 100% paid maternity leave for at least 18 weeks and for workplaces to provide the facilities and support for mothers to continue breastfeeding when they return to work; iv) to implement the ten steps for successful breastfeeding in maternity facilities (babyfriendly hospital initiative); v) to improve access to skilled breastfeeding counselling in healthcare facilities; vi) to encourage community support programs and networks that protect, promote and support breastfeeding; vii) to invest in policies and programs that ensure breastfeeding continues during situations of emergency and; viii) to implement systems that monitor, evaluate, and track progress on breastfeeding rates, policies, programs, and funding34.
Despite recent global progress in breastfeeding, many children are still left behind and are not receiving the numerous benefits of breastfeeding. Significant inequities in breastfeeding rates were registered across global regions and countries4,8,33,34,41,42,43,44 and between areas and groups from different socioeconomic statuses and cultural backgrounds within countries44,45,46. Designing interventions that respond to specific challenges of groups and are delivered in a culturally appropriate manner requires the understanding that inequalities in breastfeeding protection, promotion, and support are shaped by economic, social, and cultural forces that interact in a given context5,6,31,47,48,49.
For an equitable increase in the prevalence of breastfeeding, it is also crucial that inequities in the frequency and availability of standardized indicators that are comparable worldwide are narrowed4,33,34,42. For example, the low frequency of data collection on breastfeeding indicators and the lack of standardization of indicators to allow global comparisons and agreed targets have been commonly reported for high-income countries4,8,33,34,42. For several high-income countries, data on the duration of exclusive breastfeeding to six months is lacking or is outdated4,8,33,44,42.
It is also equally crucial that countries continuously assess existing policies and programs so accountabilities for the inputs, outputs, outcomes, and impact can be drawn at global, national, and sub-national levels50. In 2023, globally, only 39% and 7% of the countries, respectively, provided information on rates of exclusive breastfeeding to 6 months and assessed their overall breastfeeding support programs in the past five years34.
The increase in the coverage and frequency of monitoring globally agreed breastfeeding targets and the assessment of the impact of breastfeeding programs are imperative to providing breastfeeding support for all and increasing breastfeeding prevalence equitably. Breastfeeding can be an equalizer in society; no one should be left behind. Only this way, breastfeeding mums can be celebrated in all their diversity and journeys, attending the call of the 2024 World Breastfeeding Week50.
Thus, the Journal of Human Growth and Development (JHGD) is a scientific journal dedicated to publishing studies on growth, human development, and health. Its editorial line is based on principles that reflect scientific rigor, interdisciplinarity, and social relevance.
Some of these principles include interdisciplinarity: The journal encompasses areas such as health, education, social sciences, and other related disciplines, fostering a broad and diverse scientific dialogue; focus on public health and equity: many published articles address public health issues, emphasizing topics that promote equity in access to health and well-being; ethical commitment and methodological rigor: the journal values ethical research practices, requiring all submitted articles to meet international standards for ethics in research involving humans and animals and open access: it ensures that research findings are freely available to the public, enhancing the dissemination and impact of scientific knowledge.
Additionally, the journal promotes internationalization by publishing articles in English and featuring studies by researchers from various parts of the world, offering a global perspective on the topics addressed. It also emphasizes social relevance, publishing studies that not only advance scientific knowledge but also have practical and policy implications, contributing to improving the quality of life for the population.
Its multiple contributions, presented in issue 3 of volume 3451,52,53,54,55,56,57,58,59,60,61,62,63,64,65, reflect these policies throughout its 34 years of uninterrupted publication, consistently aligned with the development of individuals.
These principles make JHGD an important platform for disseminating relevant studies, particularly in the fields of human development and public health.
