Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends.

UNLABELLED Recommendations suggest exclusive breast feeding for at least the first 4 to 6 months after birth. Paradoxically, an overwhelming proportion of breast feeding (BF) data in Europe refers to all BF, i.e. not only exclusive but also partial BF (including formula, juices, water, sweetened water etc). This makes it difficult to estimate to what extent the recommendations are met. There is currently strong evidence for recommending exclusive breast feeding for at least 6 months. Exclusive BF has progressively gained scientific support. Prevention of infections, allergies and chronic diseases and a favourable cognitive development are highlighted in the recent scientific literature. Further long-term studies on the effects of BF on prevention of chronic disease in the adult are needed. Great differences exist in BF prevalence and duration both within and between European countries. Trends point towards higher prevalence and duration, with some exceptions. Young mothers breast feed less than older mothers; single and/or less educated mothers breast feed less than married mothers with more education. However, inefficient and unreliable monitoring systems prevail, and the data are scarce, not only on exclusive BF but also on demographic, socio-economic, psychosocial and medical determinants of BF patterns. National BF coordinators have not been appointed in many countries, and only every second country has promotion of BF incorporated into their national plan of action for nutrition. CONCLUSIONS Efficient surveillance systems, comparable across Europe and using common definitions and methodology, need to be developed. These should include determinants of breast feeding. A European consensus conference should urgently be organised, in which strategies for successful promotion of exclusive BF should be particularly considered. There is now strong evidence for a recommendation to breast feed exclusively for about 6 months, which is more than the duration recommended previously.