Laos integrates Center of Excellence for Breastfeeding criteria in its national health monitoring system

Laos has integrated the Center of Excellence for Breastfeeding (COE) criteria into the country’s national hospital accreditation quality standards and the national reproductive, maternal, newborn, child, and adolescent health (2021-2025) strategy, laying the  foundation for Laotian hospitals to join the COE initiative. The decision came after the COE initiative was successfully piloted in Viet Nam, where 21 hospitals have been certified under the program over the past two years.

Laos integrate COE
The Centers of Excellence for Breastfeeding initiative is helping hospitals in Southeast Asia implement improvements that increase rates of early initiation of breastfeeding and exclusive breastfeeding, among other benefits.

Read more about the Alive & Thrive COE initiative in Southeast Asia.

COE, a novel implementation model to scale up the “Ten Steps to Successful Breastfeeding,” incorporates WHO’s updated global guidance on early essential newborn care to promote breastfeeding-enabling hospital environments. For the first time, indicators measuring performance to consistently implement breastfeeding counseling, prolonged skin-to-skin contact, early initiation of breastfeeding, rooming-in, and adherence to the International Code of Marketing of Breastmilk Substitutes are included in Laos’s national health monitoring system as the COE monitoring system is integrated.

COE assessment checklists, including for birth observations, maternal exit interviews, and medical record reviews, will now be incorporated into the national Integrated Quality Assessment mechanism. Then, a joint team composed of representatives from the Strategy Secretariat, Department of Healthcare & Rehabilitation, and local health authorities will evaluate whether Laotian hospitals fulfill COE criteria.

COVID-19 heavily impacts health systems, calling for concerted response

Around the world, COVID-19 has radically affected public health delivery, placing unprecedented stress on health systems that in many countries are under-resourced and ill-equipped.

c-section delivery Viet Nam COVID-19
A C-section delivery of twins in Viet Nam for a mother suspected of having COVID-19. A&T assisted hospitals to implement measures to reduce the risks of COVID-19 spread.

As the pandemic has upended daily life, Alive & Thrive has worked with government and other partners to design effective responses, providing technical assistance regarding breastfeeding and the maintenance of essential MIYCN services.


As the pandemic unfolded, guidance evolved regarding breastfeeding. The first guidance, issued in February, came from the China Consensus and called for separating mothers and their infants due to the risk of infection.

But by mid-March, experts agreed that breastfeeding did not pose a significant risk of transmission. The fast-evolving situation called for concerted efforts to ensure governments and their partners were providing consistent, accurate information.

An A&T review of guidance documents from around the world confirmed that guidance varied. Results were shared with stakeholders, including during a global webinar.

A&T’s participation in bodies that advise governments in the countries where it works facilitated the rapid sharing of the latest WHO guidance. And in one case – that of human milk banking – A&T supported the forming of a global online network of HMB stakeholders that is now leading efforts to promote the use of human milk banks, including issuing a call to action.

“The strengthening of human milk bank systems is required to ensure that safe provision of donor milk remains an essential component of early and essential newborn care during routine care or emergency scenarios, such as natural disasters and pandemics” – From the Call to Action of the Virtual Communication Network of milk bank leaders

In Niger, the Technical Group on Nutrition, an advisory body comprising nutrition partners including A&T, supported the development of IYCF guidance documents that emphasized the importance of early initiation of breastfeeding, exclusive breastfeeding, appropriate foods for complementary feeding and breastfeeding to the age of 2 years.

India poster COVID guidance
A&T assisted public health officials in India to produce materials like this poster to raise awareness of the latest guidance on breastfeeding and COVID-19.

The group also supported a joint statement on child nutrition with UNICEF and the Directorate of Nutrition, calling for concerted efforts across the health system and the private and public sectors to share the latest COVID-19-related breastfeeding guidance. It also included alerts regarding the marketing of breastmilk substitutes which, anecdotally, appears to have increased during the pandemic across A&T’s program countries.

At the same time, the A&T Southeast Asia office provided supportive evidence and updated references for breastfeeding to the National Nutrition Cluster in the Philippines, the Scaling-Up Nutrition Civil Society Alliance in Viet Nam and to partner hospitals. And in Nigeria, A&T supported the National Agency for Food and Drug Administration and Control (NAFDAC) to raise awareness via the media of the WHO guidance and the BMS Code.

In Madagascar, A&T also provided guidance regarding BMS Code enforcement and assisted in the planning of activities to enforce the Code. In India, A&T supported national professional associations to disseminate information on breastfeeding through a three-day webinar that reached over 700 medical professionals on breastfeeding and COVID-19, focusing similarly on BMS Code violations, referred to in the country as the Infant Milk Substitutes (IMS) Act.

Health system response and MIYCN program maintenance

Technical assistance also helped health systems respond and supported governments to maintain MIYCN services, a critical need in light of an expected spike in malnutrition globally, particularly in West Africa.

After it became clear that COVID-19 led to significant declines in people seeking services at health facilities, the Government of Ethiopia established a national task force. As members, A&T’s experts devised and then supported the government to conduct rapid assessment checklists to assess MIYCN service delivery status and provide guidance for frontline workers to continue non-COVID-19 services.

“Most health facilities’ services were significantly disrupted,” said Dr. Abdulaziz Oumer, A&T Country Director. “Some facilities had closed due to lack of personal protective equipment and mothers stopped coming for services due to the panic.”

The assessments provided insights on the scope of the problem and led to a concerted media campaign and delivery of personal protective equipment. The effort also led to the development of a focused action plan to strengthen antenatal care, post-natal care, delivery, and child health and nutrition services.

maternity ward Ethiopia
Across Ethiopia, fear of coronavirus led to significant declines in visits to health facilities, as evidenced by empty beds at this normally bustling maternity ward during recent assessment visits. Fearful of contracting coronavirus, expectant mothers may have delivered at home, which poses risks.

Swift response in Southeast Asia helped hospitals maintain early and essential newborn care despite the surge in COVID-19 cases, which initially filled hospitals to capacity. In a presentation during a WHO webinar, A&T Southeast Asia’s team discussed the technical assistance it provided to the hospitals to set up separate areas to treat suspected COVID-19 cases, implement measures to manage admissions, and adopt social distancing, among other strategies.

In India and Bangladesh technical support to  government and partners on MIYCN during COVID-19, in close collaboration with  UNICEF, USAID, the World Health Organization and the World Bank included, disseminating materials on breastfeeding; information on  safely initiating complementary feeding, and and guidance on continuing nutrition services during COVID-19.

In Burkina Faso, A&T worked directly with the Ministry of Health to develop materials and radio advertisements on IYCF and COVID-19 and collaborated with community radios to discuss COVID-19 and IYCF in six health regions, sharing knowledge and information and answering listeners’ questions during live call-in shows.

2020 World Breastfeeding Week activities

woman breastfeeding in office
Supporting breastfeeding at work promotes the health of infants and their mothers.

Every year, World Breastfeeding Week features thousands of activities worldwide to promote the importance of breastfeeding. A&T supports activities in every country we work in and at the global level as well.

See the World Breastfeeding Week Pledge Map for activities near you! Use the pledge form to add your activities.

Let’s make #2020WBW trend on social media! Join us on Twitter and Facebook to learn more about these activities and to share your activities.

Below is a selection of activities for 2020 World Breastfeeding Week from across the A&T initiative. Many, many more activities are planned – go to Twitter to learn about and share others!

July 28

Southeast Asia: Designation of a Center of Excellence for Breastfeeding and launch of the Human Milk Bank (HMB) and launch of the Little Sun IYCF Counseling Clinic in Quang Ninh Obstetrics and Pediatrics Hospital, the first hospital in Northern Vietnam to be both designated a Centre of Excellence and launch an HMB. The Vietnam Ministry of Health will be in attendance, and photos can be found here. Learn more about the Centers of Excellence initiative.

July 29

Southeast Asia: Q&A Session on breastfeeding on the SUN CSA Cambodia Facebook page in honor of #2020WBW.

July 30

Southeast Asia: Launch of the Human Milk Bank (HMB) network service in Quang Nam province in Viet Nam. The Human Milk Bank network service will extend HMB services to other provinces, enabling more donors and recipients to benefit from the HMB.

August 1

#WBW2020 logo

Ethiopia: TV and Radio spots which promote breastfeeding will be disseminated through national, regional, and local media and news outlets.

India: A&T Staff and India Country Director Sebanti Ghosh and A&T South Asia Regional Director Thomas Forissier will speak in a global webinar on breastfeeding by one of India’s leading universities, Maharaja Sayajirao University of Baroda, together with UNICEF, the Gates Foundation, the Breastfeeding Promotion Network of India and Nutrition International. Register here; please note that times indicated are in India Standard Time. Click here to read the full program.

Southeast Asia: Launch of the social media fanpage for the #6la campaign. The “6 months mother’s milk is all you need” campaign” has been coordinated by Alive & Thrive, UNICEF and the Ministry of Health and Sports in Myanmar to combat the aspirational marketing of formula brands and show that exclusive breastfeeding for the first 6 months is best for mothers, babies, families and national well-being.

August 2

Burkina Faso: Representative from the Government Ministry of Health will be on Burkina national TV during the Sunday news, promoting the Stronger With Breastmilk Only campaign, which promotes exclusive breastfeeding in Francophone West Africa.

Ethiopia: Distribution of facemasks to protect against COVID-19 featuring breastfeeding promotion messages to beneficiaries.

India: The Breast Committee of the Federation of Obstetrics & Gynecological Societies of India is hosting a webinar to celebrate World Breastfeeding Week. Register here.

August 3

Nigeria: A&T and the Nigeria Federal Ministry of Health hosting a webinar on Breastfeeding and the Environment: Linkages and opportunities in Nigeria. Along with A&T and the Ministry of Health, speakers include Action against Hunger, Nutrition Society of Nigeria, National Agency for Food and Drug Administration and Control. 6PM West Africa Time (GMT+1). Register here.

Southeast Asia: Designation of three new Centers of Excellence for Breastfeeding in Quang Nam Province, Viet Nam. See the map of hospitals in Viet Nam that have signed up for the initiative.

August 4

India: The Global Virtual Symposium on MIYCN continues online, featuring a variety of speakers. Register here; keep in mind that the times indicated are in India Standard Time. Click here to read the full program.

billboard in Nigeria
The Start Strong/Zero Water campaign in Nigeria has raised awareness of the importance of exclusive breastfeeding. A&T and stakeholders across the country will use World Breastfeeding Week to promote the campaign’s life-saving messages.

Nigeria: Media roundtables in Lagos to highlight breastfeeding, World Breastfeeding Week, and contextualize IYCF in the COVID-19 era. The first is geared towards state and technical stakeholders, to discuss breastfeeding issues and sustainable IYCF practices in terms of COVID-19 and climate change; the roundtable will be attended by the State Ministry of Health and the Lagos State Health Service Commission. The second roundtable is for community stakeholders and beneficiaries, such as mothers who exclusively breastfeed, service providers, traditional birth attendants, and breastfeeding guardians.

Nigeria: Media roundtable in Kano State, with state media, to highlight the importance of breastfeeding amid a time of COVID-19 and climate change. In attendance will be His Excellency the Governor of Kano State, as well as the state’s Information and Health commissioners.

Southeast Asia: Video premiere, from A&T and our partner UNICEF, to raise awareness for workplace lactation support in Southeast Asia.

August 5

Global: Global leaders will discuss why investment in skilled breastfeeding support is essential to achieving equitable health outcomes in “Achieving health equity: providing skilled breastfeeding support universally,” a webinar sponsored by the Global Breastfeeding Collective, WHO and UNICEF.  The audience will include funders, implementing organizations and national government level leaders. The webinar will be conducted in English with simultaneous interpretation in French, Spanish, Arabic, and Russian. Learn more and register here.

Southeast Asia: #healthierbabies #healthierplanet TikTok dance challenge where mothers, families and young people will cover a dancing compilation, initiated by a famous dancer. This activity promotes the key messages that everyone can get involved in promoting breastfeeding and that supporting breastfeeding is protecting their own planet.

August 6

India: A webinar including private sector doctors and the Indian government continues a series that engages professional associations on maternal, infant and young child nutrition. The webinar engages CARE, Federation of Obstetrics & Gynecological Societies of India, and the Indian Academy of Pediatrics.

Nigeria: The Nigeria Breastfeeding Assembly and Alive & Thrive are hosting a webinar, “Protecting, Promoting and Supporting Breastfeeding in the context of COVID-19.” The webinar at 3pm West Africa Time (GMT+1) will center on how to ensure and achieve optimum breastfeeding of Nigerian children in the face of the current global pandemic. Register here.

Southeast Asia: Advocacy meeting with the Vietnam General Confederation of Labor to advocate for policy changes requiring lactation rooms in workplaces in Hanoi city and Dong Nai province. In attendance will be the General Federation of Labor, Women Union, UN Women, GIZ, Care International, SUN CSA Viet Nam, and popular media outlets from Viet Nam.

August 7

Nigeria: Stakeholders are invited to a webinar, “The Role of Critical Stakeholders in Improving Exclusive Breastfeeding Practices in Kaduna State,” at 10 a.m. West Africa Time (GMT+1). Register in advance for this webinar. After registering, you will receive a confirmation email containing information about joining the webinar.

Nigeria: Key resource persons within the Nutrition & IYCF sectors in Lagos state will appear on live TV programs over 3 days – August 3, 5, and 7 – to discuss breastfeeding and the environment and advertise the Start Strong/Zero water campaign. The three TV programs are: 1) Guides to planet-friendly breastfeeding practices in a developing country like Nigeria, 2) “Breastfeeding: Nature’s drink with superior packaging” and 3) Starting Children strong on the world’s healthiest fast food: Breastmilk

August 9

Burkina Faso: Representatives from A&T and UNICEF will talk about the Stronger With Breastmilk Only Campaign, which promotes exclusive breastfeeding in Francophone West Africa, on a TV show.

Burkina Faso launches campaign to promote exclusive breastfeeding

In June, the Government of Burkina Faso launched the Stronger With Breastmilk Only campaign, with support from UNICEF, the World Bank, the PRSS (Health Services Reinforcement Project) of the Government of Burkina Faso, and Alive & Thrive, aiming to raise awareness of the importance of exclusive breastfeeding. Due to COVID-19 restrictions, the campaign was launched online: a Zoom webinar,  Facebook Live broadcast, social media posts, and reports in national and regional media delivered the campaign’s messages.

mother breastfeeding her child
Stronger With Breastmilk Only raises awareness of the importance of exclusive breastfeeding. Across West Africa, infants often receive water during the important first six months of life, which is not as beneficial as breastmilk.

Several other countries will launch the Stronger With Breastmilk Only campaign during World Breastfeeding Week in August. This video from UNICEF offers some insight on the need for the campaign.

“This campaign challenges all stakeholders to focus on advocacy and communication in all its forms,” said Professor Léonie Claudine Lougue Sorgho, Minister of Health. “We can all promote exclusive breastfeeding as a member of the family unit and community, as a healthcare worker, and as communication, education or other development professionals by using the most powerful necessary tool: our voice.”

The Stronger With Breastmilk Only campaign seeks to mobilize partners, businesses, communities and families to ensure that mothers receive the appropriate information and support they need to adopt exclusive breastfeeding and thus give their children the best start in life.

In Burkina Faso, 4 in 10 infants receive fluids and food in addition to breast milk during their first six months of life, which contributes to malnutrition, illness and even death of children.

“Breast milk is an infant’s first vaccine and its best source of nutrients,” said Dr. Anne Vincent, UNICEF Representative in Burkina Faso. “Encouraging and helping mothers to give exclusively breastmilk, without water, for the first six months of their lives is a challenge which requires the support of not only medical personnel and political decisionmakers, but also the private sector and communities and families.”

To keep babies under the age of six months healthy, scientific data recommends giving them only breast milk on demand (day and night). Breast milk contains all the water and nutrients necessary for a child’s good growth. Infants who receive fluids and food in addition to breast milk before the age of six months are at increased risk of diarrhea, respiratory infections and undernutrition. The risk of death is up to three times higher than among those who are exclusively breastfed.

The lack of exclusive breastfeeding comes at a considerable cost. In addition to the thousands of preventable child deaths, stunted growth and reduced cognitive capacity of hundreds of thousands of children, the absence of breastfeeding costs more than 116 billion CFA francs per year in Burkina Faso.

Stronger with Breastmilk Only campaign aims to save lives, reduce child malnutrition in West and Central Africa

Seven out of every 10 babies in West and Central Africa receive liquids and foods in addition to breastmilk during their first six months of life, contributing to child malnutrition, illnesses and even death. The Stronger With Breastmilk Only multi-year campaign launched today by UNICEF and the Alive & Thrive initiative calls on Governments, partners, businesses, communities and families to ensure that mothers get the support they need to give their babies the best start in life.

Read Alive & Thrive’s advocacy briefs for countries across the region

Despite positive economic growth in West and Central Africa, the number of stunted children under five years has increased from 23 to 29 million between 2000 and 2018. In addition, the region is home to an estimated 4.9 million children suffering from severe acute malnutrition.

For babies under six months to stay healthy, scientific evidence recommends giving them breastmilk only and on demand (day and night). No water, other liquids or foods should be given from the moment of birth until they reach six months of life, even in hot and dry climates, as breastmilk contains all the water and nutrients a baby needs to grow well. According to studies in low- and middle-income countries, babies who receive liquids and foods in addition to breastmilk before six months of age are at greater risk of diarrhoea and respiratory infections. They are almost three times more at risk of dying than those who are exclusively breastfed.

Breastfeeding also has significant benefits for mothers by hastening recovery after childbirth, delaying the return of the menstrual cycle thus helping with birth spacing, and reducing the risk of cancer.

The costs of not breastfeeding are enormous: in addition to thousands of preventable deaths of children, it costs West and Central Africa hundreds of millions of dollars annually to treat illnesses, to buy infant formula, and in lost productivity due to cognitive losses associated with not breastfeeding.

Cost of Not Breastfeeding brief illustration
Alive & Thrive’s advocacy briefs provide country-by-country snapshots of the cost of not breastfeeding – and actions stakeholders can take to improve the situation.

“Breastmilk is a pure gift. It is a baby’s first vaccine and best source of nutrients. Promoting, protecting and supporting mothers to give breastmilk only, no water, for the first six months of life requires encouragement and support from family members, health care providers, employers, policymakers and all of society. Together, we can make a difference”, said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa.

A recent poll conducted by UNICEF in 10 countries in West and Central Africa revealed that 55 per cent of youth incorrectly believe that babies need water in the first six months of life. Additionally, 45 per cent of respondents thought that babies should be given something in addition to breastmilk in order to grow strong and healthy. The Stronger With Breastmilk Only campaign focuses on stopping the practice of giving water to babies younger than six months as an entry point for shifting norms and behaviours towards improved breastfeeding practices.

“Alive & Thrive’s successful experiences in Bangladesh, Ethiopia and Vietnam demonstrate that it is possible to significantly increase exclusive breastfeeding rates in a relatively short period of time. Alive & Thrive brings evidence-based frameworks, methods and tools to support countries in West and Central Africa to scale up evidence-informed programmes that work, including initiatives in Burkina Faso and Nigeria, which are already showing promise,” said Dr. Tina Sanghvi, Senior Technical Advisor of Africa Country Programs at Alive & Thrive.

Having a comprehensive national strategy that protects, promotes and supports breastfeeding is the most effective way to influence the environmental, social, economic and behavioural factors that influence a mother’s decision to feed a child breastmilk only in the first six months of life.

The Stronger With Breastmilk Only campaign aims to catalyse much-needed policy, social, institutional, community and family dialogue and change towards improving breastfeeding rates in 24 countries. It calls on governments, partners and businesses across West and Central Africa to take action and position exclusive breastfeeding as a public health priority to improve the health and prosperity of children and nations.

Highlights from World Breastfeeding Week 2019

Alive & Thrive celebrated World Breastfeeding Week 2019 in collaboration with partners and communities around the globe. From August 1-7, A&T planned and participated in events honoring the theme, “Empower Parents, Enable Breastfeeding,” to raise awareness about breastfeeding’s benefits and the need for supportive, enabling environments for mothers and families.

Check out some of the highlights of #WBW2019 around the world!


In July, A&T launched our Cost of Not Breastfeeding Tool, which quantifies the preventable losses of life, cognition, and health system costs in countries around the world due to inadequate breastfeeding. This video, published during WBW, illustrates the importance of the new tool.


The WBW inauguration ceremony, where A&T was presented with an award for contributions to IYCF practices in the country.

The Bangladesh National Nutrition Service presented A&T with an award during the WBW inauguration ceremony, recognizing our achievements in infant and young child feeding (IYCF) practices in the country. “Alive & Thrive is providing technical assistance and support to the Government of Bangladesh, strengthening nutrition services through the health system,” explains Zeba Mahmud, Country Director of A&T in Bangladesh. The award serves to recognize A&T’s varied work in the country –  since 2010, A&T has helped develop guidelines and strategies to promote breastfeeding and complementary feeding, assisting to raise exclusive breastfeeding rates. Collaborating with INGO and government partners, A&T has reached 126 million people in Bangladesh with mass media and interpersonal communications campaigns, and will continue to provide technical assistance to the Government of Bangladesh in implementing the Breastmilk Substitutes Act and its bylaws.


In Cambodia, A&T along with the Cambodia Center for Independent Media and SUN Cambodia hosted a media workshop to educate journalists on the importance of breastfeeding and breastfeeding policies in the nation. The participants developed practical tools to increase media coverage of breastfeeding, pledging to use their influence to build supportive environments and policies for nutrition. Following the workshop, the journalists joined visits to WBW celebrations in Siem Reap and rural areas. Check out the first article published about the workshop, advocating for enforcement of marketing regulations for breastmilk substitutes.

Hon Kroeun, Deputy Country Director of Helen Keller International Cambodia and Coordinator of the SUN CSA Cambodia, speaks with local journalists at the media orientation workshop, hosted by A&T and Cambodia Center for Independent Media in Phnom Penh.
Parents and children attend the World Breastfeeding Week launch event hosted by the Ministry of Health in Siem Reap, Cambodia. Participants in the media orientation attended the launch, interviewing stakeholders and providing media coverage.


To improve the quality and safety of human milk banks (HMBs) in Myanmar, A&T and UNICEF held trainings for hospital staff at Central Women’s Hospital and Yankin Children’s Hospital. Staff learned about new guidelines for the HMB process as well as strategies for breastfeeding counselling. For infants unable to receive breastmilk from their mothers, HMBs serve a vital role, giving vulnerable infants access to the benefits of breastmilk when they need it most.

Staff are trained on best practices for human milk banks at Central Women’s Hospital and Yankin Children’s Hospital.


Mothers in the Philippines simultaneously latch their babies as they take to social media to advocate for the normalization and support of breastfeeding.

The photographer Giacomo Pirozzi visited the Philippines to document breastfeeding practices and challenges. In alignment with the week’s theme “Empower Parents, Enable Breastfeeding,” his photographs focused on workplace lactation in both the formal and informal sectors, drawing attention to enabling environments for breastfeeding for working mothers. August 18th, he photographed Hakab Na! (Big Latch On), the biggest breastfeeding event in the Philippines, hosted by Breastfeeding Pinays, an online forum of over 270,000 breastfeeding families where thousands of mothers simultaneously latched their babies around the country.


In an important milestone for the Center of Excellence (CoE) for Breastfeeding initiative in Vietnam, two designation ceremonies were conducted, following a decision on August 6 from the Ministry of Health, approving a legal foundation to expand the CoE approach nationwide. The potential for impact is widespread.

“The designation of the first hospital in Ca Mau as a Center of Excellence gives us motivation to replicate the model towards building a brea

A&T Southeast Asia Regional Director Roger Mathisen with staff at Tran Van Thoi CoE designation ceremony.

stfeeding-friendly province,” said  Nguyen Van Dung, the Acting Director of the Department of Health in Ca Mau.

To receive the CoE designation, multiple groups evaluate the hospital, including mothers who have recently given birth in the facility; the MOH or DOH then determines which hospitals qualify. Hospitals recognized as a CoE serve as best practice models for the promotion of breastfeeding and receive media attention to help pregnant women and their families make informed choices about their birth facilities. “The CoE initiative is a practically significant intervention to create and maintain a breastfeeding-friendly environment… and can bring great impact on ensuring nutrition and sustainable development of children,” said Nguyen Viet Tien, Deputy Minister of Health at the CoE ceremony.

Vietnam Television produced two videos, looking at the CoE approach and its impact for WBW.


A&T supported the Federal Government of Nigeria to launch the Start Strong/Zero Water Breastfeeding Campaign and unveiled the National Maternity Entitlement Assessment Report to mark the start of WBW. Start Strong/Zero Water is a major mass communication campaign designed to raise awareness of the importance of exclusive breastfeeding for infants in their first 6 months and early initiation of breastfeeding. With only one in three Nigerian children exclusively breastfed, the National Maternity Entitlement Assessment Report presentation highlighted that mothers were often not granted adequate time to breastfeed during work hours.

Dr. Mairo Al-Makura (2nd from right), a representative for Nigeria’s first lady, unveiled the Start Strong/Zero Water campaign logo at the WBW launch.

Kaduna State, Nigeria

Nutrition is crucial in Kaduna state – after the high level of malnourished children in the area prompted a state of emergency in malnutrition, exclusive breastfeeding has been prioritized. Hajiya Aisha Umma Garba El’Rufai, the First Lady of Kaduna State and chairperson of the Kaduna Emergency Nutrition Action Plan, held a parade in Kaduna as well as a panel dialogue called “Breastfeeding: Family friendly policies are key to enabling exclusive breastfeeding.” The panel focused on the need for community support towards nursing mothers to reduce child mortality through exclusive breastfeeding, while the parade raised awareness about exclusive breastfeeding and celebrated the recent legislation passed in the state guaranteeing six months maternity leave.

Her Excellency Hajiya Aisha Ummi Garba El’Rufai wife of the Governor of Kaduna State addressing onlookers during the fun parade.

Watch Madame El Rufai in this Facebook Live interview with A&T’s technical advisor Chinweuba Ezeigwe. 

Lagos, Nigeria

In Lagos, a baby show was held, in recognition of mothers who practice exclusive breastfeeding. The Alive & Thrive team, along with 112 other stakeholders, including representatives from the Lagos State Ministry of Health, the Primary Health Care Board, Traditional Medicine Board, implementing partners, health workers, and breastfeeding mothers from A&T supported public health facilities in Lagos participated in the event. The babies, presented by their mothers, were assigned points based on their health behaviors, encouraging stakeholders in Lagos to adopt best practices in infant health. Judges evaluated factors such as early initiation of breastfeeding; exclusive breastfeeding for babies under 6 months; weight, as a measure of proper nutrition; and adherence to immunization schedule. While only one baby was named the winner, entire communities benefit from raising awareness about the importance of breastfeeding and engaging stakeholders to prioritize infant health.

Winners of the baby show activity at the Lagos Mainland Local Government Area pose with their gifts.


On August 5th, A&T held a panel in India to raise commitment to the creation of enabling environments for breastfeeding, in public and in private. Under the leadership of the Ministry of Health and Family Welfare (MoHFW) and in collaboration with the Indian Academy of Pediatrics and Centre for Advocacy and Research, the panel also informed the development of a guidance note for health facilities to improve adherence to the Infant Milk Substitutes Act, which bans the promotion of milk substitutes to encourage optimal breastfeeding.

Dr. Khera, from the MoHFW, delivering the keynote address at the panel to promote optimal breastfeeding.


A&T in Ethiopia collaborated with partners to organize events at national and regional levels to raise awareness about gender-equitable parenting and social protections to support breastfeeding. Nationally, together with the Ethiopia Federal Ministry of Health, the Ethiopia National Nutrition Program (NNP), and media agencies, A&T helped orchestrate a week of activities raising awareness for breastfeeding, including a press conference, features on national TV programs, and community engagement in health facilities. The breastfeeding promotion extended to regional levels; in Amhara, Tigray, SNNP, Afar, and Somali, A&T provided technical guidance to TV roundtable discussions, radio programs, and communications materials. In each regional city, panel discussions were organized with representatives from NNP, religious leaders, hospitals, implementing partners and breastfeeding mothers, to advocate for optimal breastfeeding strategies and environments in Ethiopia.

Breastfeeding mothers supporting breastfeeding-friendly policies at a regional panel in Ethiopia.

New cost of not breastfeeding tool launched

A new research study and online tool illustrates the dramatic costs – in human lives and to the global economy – due to inadequate breastfeeding: almost 700,000 lives annually and a billion dollars a day.

Listen to Dr. Dylan Walters, lead author of the Cost of Not Breastfeeding, in this interview with Voice of America:

The cost of not breastfeeding tool allows users to explore data on breastfeeding in 34 countries. Click on image to go to the tool.

The tool was developed by health economist Dr. Dylan Walters with support from Alive & Thrive, an international maternal and child nutrition initiative funded by the Bill & Melinda Gates Foundation.

“Each year not breastfeeding newborns and young children according to recommendations costs global society nearly 700,000 lives and US$341 billion dollars, or 0.7% Gross National Income, in health system costs and lost productivity due to premature mortality, and cognitive losses,” Dr. Walters said. “The world must act to mobilize financial resources necessary and political commitment to achieve the World Health Assembly Global Nutrition Target of exclusive breastfeeding prevalence of 50% by 2025 because it is a human right, it saves lives, and improves the prosperity of economies.”

The online tool, available on Alive & Thrive’s website, provides background on the impacts of not breastfeeding in 34 countries. The tool is based on Dr. Walters’ research published by Health Policy and Planning Journal on June 24 (, which provides data on estimates for the human and economic costs of not breastfeeding for over 100 countries.

“We need to be sensitive to the constraints and hardships faced by mothers and families in a world that lacks basic support systems for their physical, psycho-social, and economic well-being,” Dr. Walters said. “Even more, mothers and families are up against a constant barrage of corporate marketing of alternatives and misinformation spread that undermines what should be boringly second nature and not stigmatized by society.”

Expanding paid family leave to the minimum 18 weeks as recommended by the International Labor Organization would enhance the ability for mothers to exclusively breastfeed. It would further benefit mothers to align this duration with the recommended 6 months of exclusive breastfeeding.

Launched just three weeks before World Breastfeeding Week (Aug. 1-7), the tool is a valuable resource for advocates, said Roger Mathisen, program director of Alive & Thrive’s office in Southeast Asia and a co-author of the paper.

“The data are sending us a compelling message: we must do more to support breastfeeding,” Mathisen said. “With this tool, we hope advocates around the world will be emboldened further in their efforts to obtain greater support from governments.”

Dr. Linh TH Phan, Regional Program Coordinator in Southeast Asia for Alive & Thrive, said the tool was valuable for efforts to increase support for breastfeeding worldwide.

“Low- and middle-income countries, particularly in sub-Saharan Africa and South Asia, and their people, have the most to gain from adopting universal breastfeeding within the first hour of life, exclusively for the first 6 months, and continued for more than two years,” Dr. Phan said. “But wealthier countries also have room for cognitive gains and probably reductions in the burden of childhood obesity and maternal cancers and Type 2 diabetes.”

People can do many things to improve support for breastfeeding mothers. Demanding government adopt policies that promote breastfeeding, compelling employers to provide breastfeeding support at work sites, and ensuring health workers are adequately trained to support mothers to breastfeed are just a few positive actions that can help the world reach the goal of 50% exclusive breastfeeding prevalence by 2025. Additionally, governments should enforce the International Code of Marketing of Breast-milk Substitutes.

For seven actions implementers and donors from governments, philanthropies, international organizations and civil society can take to create a more enabling environment for breastfeeding, visit the Global Breastfeeding Collective: