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The introduction for the Supplement in Maternal & Child Nutrition: What will it take to increase breastfeeding? describes the contribution of each of the articles included in this Supplement to the current evidence about the major structural challenges in place to overcome to improve breastfeeding practices, as well as the evidence‐based policies and interventions that can be effective at advancing breastfeeding on a large scale to promote, protect and support breastfeeding. Key messages: Breastfeeding saves lives, improves the short‐ and long‐term health and cognitive development of infants, and the health of their mothers across the globe.In most countries, the vast majority of women are choosing to breastfeed but very often cannot do it for as long as they wish because of major structural barriers across layers of the social‐ecological model.Caregivers need to learn the skills to manage normal baby behaviours such as crying and fussiness without placing breastfeeding at risk.Implementation of well‐coordinated evidence‐based programmes at the facility and community levels through a highly qualified and motivated workforce, as well as with adequate resources, is needed to improve breastfeeding.Improving maternity benefits for women working in the formal and informal sectors and enforcing the World Health Organization Code of Marketing of Breastmilk Substitutes are key to improving breastfeeding.Implementation science research is needed to translate into large‐scale policy and practice the vast knowledge that we have on what is needed to improve breastfeeding globally. [ABSTRACT FROM AUTHOR]

Scaling up effective interventions, policies and programmes can improve breastfeeding (BF) outcomes. Furthermore, considerable interest exists in learning from relatively recent successful efforts that can inform further scaling up, with appropriate adaptations, across countries. The purpose of this four‐country case studies analysis was to examine why and how improvements in BF practices occurred across four contrasting countries; Burkina Faso, the Philippines, Mexico and the United States of America. Literature reviews and key informant interviews were conducted to document BF trends over time, in addition to why and how BF protection, promotion and support policies and programmes were implemented at a national level. A qualitative thematic analysis was conducted. The 'Breastfeeding Gear Model' and RE‐AIM (Reach; Effectiveness; Adoption; Implementation; and Maintenance) frameworks were used to understand and map the factors facilitating or hindering the scale up of the national programmes and corresponding improvements in BF practices. Each of the studied countries had different processes and timing to implement and scale up programmes to promote, protect and support breastfeeding. However, in all four countries, evidence‐based advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment for BF. Furthermore, in all countries, lack of adequate maternity protection and the aggressive marketing of the breast‐milk substitutes industry remains a strong source of negative feedback loops that are undermining investments in BF programmes. Country‐specific best practices included innovative legislative measures (Philippines), monitoring and evaluation systems (United States of America), engagement of civil society (Mexico) and behavior change communication BF promotion (Burkina Faso) initiatives. There is an urgent need to improve maternity protection and to strongly enforce the WHO Code of Marketing of Breast‐Milk Substitutes. Key messages: The effective scale up of national breastfeeding (BF) policies and programs has been identified as a global health priority.There is a need to systematically conduct and compare case studies to understand drivers for the successful dissemination and scale up of national breastfeeding policies and programmes.Implementation science frameworks were key to systematically identify key drivers for the scale up of BF protection, promotion, and support policies and programmes in Burkina Faso, Mexico, the Philippines and the United States.Advocacy, multisectoral political will, financing, monitoring and evaluation, and coordination were key for enabling the BF environments.In all countries, there was a strong need to improve maternity protection and to tighten regulation and enforcement of the WHO Code of Marketing of Breast‐Milk Substitutes. [ABSTRACT FROM AUTHOR]

Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high‐ or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high‐income and upper‐middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social‐ecological model, including supportive workplace policies; implementation of the Baby‐Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper‐middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well‐established knowledge to scale up breastfeeding protection, promotion and support programmes. Key messages: Women globally continue to face barriers to breastfeeding. This review assessed effective interventions that address these barriers in the past 5 years.Studies disproportionately focus on high income and upper‐middle income settings, and on health systems, and on single settings.There is insufficient attention to policy and structural interventions, and there is a need for rigorous assessment of multilevel interventions.Research in the past 5 years strengthens the evidence base for effective breastfeeding interventions across all levels of the social‐ecological model.There is an urgent need to implement interventions that combine established and effective measures to improve breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

Milk formula sales have grown globally, particularly through follow‐up formulas (FUF) and growing‐up milks (GUM). Marketing strategies and weak regulatory and institutional arrangements are important contributors to caregivers' decisions about child feeding choices. This study describes maternal awareness, beliefs, and normative referents of FUFs and GUMs among Mexican pregnant women and mothers of children 0–18 months (n = 1044) through the lens of the theory of reasoned action (TRA). A cross‐sectional survey was undertaken in two large metropolitan areas of Mexico. Descriptive analyses were conducted following the constructs of the TRA. One‐third of the participants had heard about FUFs, mainly through health professionals (51.1%) and family (22.2%). Once they had heard about FUFs, the majority (80%) believed older infants needed this product due to its benefits (hunger satisfaction, brain development, and allergy management). One quarter of the participants were already using or intended to use FUFs; the majority had received this recommendation from doctors (74.6%) and mothers/mothers‐in‐law (25%). Similarly, 19% of the women had heard about GUMs. The pattern for the rest of TRA constructs for GUMs was similar to FUFs. Mexican women are exposed to FUFs and GUMs, once women know about them, the majority believe older infant and young children need these products, stating perceived benefits that match the poorly substantiated marketing claims of breast‐milk substitutes. Health professionals, particularly doctors, act as marketing channels for FUFs and GUMs. Marketing of FUFs and GUMs represents a threat to breastfeeding in Mexico and a more protective regulatory and institutional environment is needed. Key messages: Mexican pregnant women and mothers are highly exposed to FUFs and GUMs.Most women who know FUFs and GUMs believe older infants and young children need these products.The perceived benefits of FUFs and GUMs match those displayed in BMS marketing.Health providers are being used as marketing channels for FUFs and GUMs.Stronger regulatory and institutional frameworks for BMS are urgently needed in Mexico. [ABSTRACT FROM AUTHOR]

Aim: We aimed to examine the advertising and marketing of breast milk substitutes (BMS) through the internet, social media and television in Mexico.Methods: We recorded the programming of four main TV channels at peak times to identify BMS advertisements. In addition, we identified the main BMS products and companies present on the internet, as well as related home pages and social networks (Facebook, Twitter and YouTube). After that, we examined current BMS' marketing practices using the International Code of Marketing of Breast-milk Substitutes ('the Code') as a framework for ethical marketing. Qualitative and statistical analyses are presented.Results: BMS manufacturers have a presence on television, social media and the internet. Violations of the Code, as well as promotional practices unforeseen by the Code, were identified in all the studied media. These include text and images idealising the use of BMS, as well as mechanisms for boosting sales and making contact with consumers.Conclusions: The Mexican population is exposed to BMS advertisements that breach the Code on the internet, on social networks and on television. Emerging challenges related to the use of electronic means to market BMS may call for new strategies for monitoring and enforcing the Code through local regulations. [ABSTRACT FROM AUTHOR]

This study estimated the prevalence of violations of the International Code of Marketing of Breast‐milk Substitutes (BMS) and subsequent resolutions of the World Health Assembly (Code) at health facilities, points of sale (POS), and on BMS labelling and media in Mexico. We carried out a cross‐sectional survey among 693 mothers with children aged less than 24 months and 48 health providers at public and private health facilities in two states of Mexico. Observational assessment at 20 POS and the health facilities was conducted as well as an analysis of labels on BMS products for sale. Women attending public and private health facilities reported receiving free BMS samples in the previous 6 months (11.1%), and about 80% reported seeing BMS promotion in the mass media. Health providers reported contact with BMS manufacturer representatives in the previous 6 months (15.5%), and only 41.6% of the health providers had knowledge of the Code. BMS promotions were identified at nearly all POS. Analysis of 190 BMS labels showed that 30% included pictures/text idealizing the use of BMS, and all labels incorporated health and nutrition claims. Violations of the Code are prevalent within the health services, POS, and labelling of BMS products. The high percentage of health providers with no knowledge of the Code calls for action at national level to better disseminate and comply with the Code. A transparent, free from commercial influence, and continual monitoring system for Code compliance is needed, including a follow‐up component on sanctions for contraventions of the Code. [ABSTRACT FROM AUTHOR]