Equity in Breastfeeding

Provision of accessible, high-quality, best-practice support for all people who want to breastfeed is a sound investment by society at large. As our basic scientific knowledge has grown, the evidence that justifies such investments now extends beyond the powerful breastfeeding protection against infectious diseases in early childhood to include protection against the development of chronic diseases in later adulthood. In addition, breastfeeding also offers protection to the mother against the risks of breast and ovarian cancer, hypertension, cardiovascular disease and type 2 diabetes. As a result, effective interventions to improve breastfeeding outcomes are highly cost-effective. The evidence for the health and economic benefits of breastfeeding to families and society as a whole is now so strong that access to breastfeeding protection and support has also been framed as a human right with issues of social justice and equity becoming paramount. Social justice in breastfeeding requires fair access for all to the multilevel intersectoral infrastructure needed to protect, promote and support breastfeeding so that individuals, families and society can partake in the numerous benefits derived from breastfeeding. Breastfeeding equity requires the involvement and participation of all people and stakeholder institutions in the support and benefits derived from breastfeeding, regardless of income, ethnicity, education, religion, country of origin, gender, sexual identity, and age, among many other dimensions of diversity within populations. Put differently, any social, economic, political, legal, or biomedical factors that prevent women from implementing their choice and right to breastfeed can be framed as a fundamental social injustice that needs to be understood through an equity lens. As this “Equity in Breastfeeding” special issue indicates, identifying inequities in access to support for breastfeeding and finding effective ways to address them needs to move to the forefront of global and local research, policy and advocacy agendas. Health practitioners and civil society are becoming more aware of the unique health benefits that breastfeeding offers throughout the entire life course. Yet, huge disparities in breastfeeding indicators have emerged both within and between countries which require urgent analysis and action to reduce. Improving breastfeeding matters because of its enormous value in building human and social capital, health and social well being. Emerging breastfeeding equity issues challenge us to reflect on the pressing need for better strategies to ensure the benefits of breastfeeding are accessible to all through equitable support and knowledge exchange and translation. The contributions in this special issue collectively shed light on key equity dimensions and provide diverse examples of the power of an “equity lens” in framing the issues, identifying barriers to breastfeeding that demand action, and map the evidence base into dynamic multilevel systems frameworks such as the breastfeeding gear model. This model calls for highly integrated and well-coordinated evidence-based advocacy, political will, legislation, funding, human capacity formation, breastfeeding promotion, and research and evaluation for large-scale breastfeeding programs to work for all. Space is taken in this issue to print echoes of voices from the underserved and the under-represented, or those with power and privilege who attempt to advocate for them. Achieving breastfeeding equity demands access to funding and infrastructure, which are essential for the ability of countries to properly train the breastfeeding professional and paraprofessional work force. Long and Bugg highlight the need to address class-based access to the lactation support professions to bring them to be representative of the diverse societies they aspire to serve. This is consistent with Payne’s previous call to take on the challenge of disparities in part by finding pathways to equity in lactation consultant training. Equity requires addressing the needs of underrepresented communities through an in depth understanding of power structures. Farrow makes clear the case for integration of inclusive knowledge about effective breastfeeding support among historically under-represented communities, with strong emphasis on LGBTQI families. Good Mojab suggests pathways through which institutional oppression can be countered through actions that expose and begin to diminish the “devastating effects” of privilege and power that hinder breastfeeding practices. Singleton, in her 2014 ILCA address reprinted in this special issue, outlines a vision for creating a “culture of breastfeeding,” founded on building 561062 JHLXXX10.1177/0890334414561062Journal of Human LactationPérez-Escamilla and Sellen editorial2014