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First things first: what we mean is not always what we can define

March 2021

Infant feeding practices are highly complex and resist easy definition. Exclusive breastfeeding/chestfeeding and human milk feeding exist alongside a continuum of non-exclusive breastfeeding practices from predominant breastfeeding to minimal breastfeeding, each of them adapting over time within the context of a family.


A couple of years ago, I attended a session for researchers interested in infant feeding and particularly in the measurement of breastfeeding. In a room full of researchers and clinicians, we spent the day debating and re-debating how to define “breastfeeding” in a research study - and came away with considerably less definitive answers than I expected. It turns out that measuring breastfeeding is an elusive goal, even (or perhaps especially) with a great deal of expertise applied to it. A good many others have put their minds to the topic as well and their work can make good reading for a reflective afternoon.

For the purposes of BFHI, we’ll use the WHO’s definition from the Global Strategy on Infant and Young Child Feeding:

"Exclusive breastfeeding" is defined as no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive ORS, drops and syrups (vitamins, minerals and medicines). - WHO

Yet, we know clearly that breastfeeding is more than the transfer of a nutritious fluid from one human body to another. The act and relationship of breastfeeding/chestfeeding are fundamentally linked to the development of both the infant and the parent immunologically, neurologically and socially. Nutrition, while vital and unique to human milk, is now acknowledged as only one aspect of the importance of breastfeeding and increasingly not even as the most important one.

As we discuss measures, indicators and how to report and analyze data over the next few blogs, I encourage you to think back to what we lose with the need to define these practices and to actively integrate the full span of experiences of the families we care for.


Michelle Pensa Branco MPH IBCLC

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Labbok, M. H., & Starling, A. (2012). Definitions of breastfeeding: call for the development and use of consistent definitions in research and peer-reviewed literature. Breastfeeding Medicine, 7(6), 397-402. Accessed March 10, 2021 at https://www.liebertpub.com/doi/abs/10.1089/bfm.2012.9975
Noel-Weiss, J., Boersma, S., & Kujawa-Myles, S. (2012). Questioning current definitions for breastfeeding research. International breastfeeding journal, 7(1), 1-4. Accessed March 10, 2021 at https://www.liebertpub.com/doi/abs/10.1089/bfm.2012.9975

Yourkavitch, J., & Chetwynd, E. M. (2019). Toward consistency: Updating lactation and breastfeeding terminology for population health research. Journal of Human Lactation, 35(3), 418-423. Accessed March 10, 2021 at https://journals.sagepub.com/doi/abs/10.1177/0890334419851488

World Health Organization. (2015, January 29). The World Health Organization's infant feeding recommendation. Accessed March 10, 2021 at https://www.who.int/nutrition/topics/infantfeeding_recommendation/en/


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