US drug overdose deaths: a global challenge.

For more on breastfeeding and the Affordable Care Act see http://www.cdc.gov/ breastfeeding/pdf/BFGuide-508.PDF Breastmilk makes the world healthier, smarter, and more equal: these are the conclusions of a new Lancet Series on breastfeeding. The deaths of 823 000 children and 20 000 mothers each year could be averted through universal breastfe eding, along with economic savings of US$300 billion. The Series confi rms the benefi ts of breastfeeding in fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers. The Series represents the most in-depth analysis done so far into the health and economic benefi ts that breastfeeding can produce. However, although the Series is comprehensive, the message is not new. In 2013, a Lancet Series on maternal and child nutrition established that 800 000 child deaths could be prevented through breastfeeding, and called for further support. Despite consolidation of evidence for breastfeeding’s benefi ts in recent years, in particular the economic gains to be reaped, global action has stalled. Why has so little progress been made? Rates of breastfeeding vary wildly; it is one of the few health-positive behaviours more common in poor countries than rich ones. In low-income countries, most infants are still breastfed at 1 year, compared with less than 20% in many high-income countries and less than 1% in the UK. The reasons why women avoid or stop breastfeeding range from the medical, cultural, and psychological, to physical discomfort and inconvenience. These matters are not trivial, and many mothers without support turn to a bottle of formula. Multiplied across populations and involving multinational commercial interests, this situation has catastrophic consequences on breastfeeding rates and the health of subsequent generations. There are glimmers of hope. Despite—or perhaps, because of—the execrable provision for paid maternity leave in the USA, the Aff ordable Care Act provides protected nursing breaks and insurance cover for breast pumps. Such allowances, the Series predicts, could increase breastfeeding by 25%. But, more importantly, genuine and urgent commitment is needed from governments and health authorities to establish a new normal: where every woman can expect to breastfeed, and to receive every support she needs to do so. The Lancet Breastfeeding: achieving the new normal