Nurses practice in a wide variety of settings where they have the opportunity to be strong advocates for the protection, promotion and support of breastfeeding in the broader context of comprehensive maternal and child health care. They may be pediatric or maternity nurses, nurse midwives, advanced practice nurses caring for mothers or children in a variety of settings, or nurses specialising in care of hospitalised high risk newborns. In the community, they interact with young families, across the childbearing continuum in a variety of venues such as public health clinics, doctor’s offices, or as home visiting nurses, where they can provide both education for breastfeeding promotion and clinical support for the initiation and continuation of breastfeeding. The nurse is instrumental in assuring continued mother-baby contact to facilitate timely initiation of breastfeeding, and continued frequent breastfeeding in various hospital settings from prenatal care clinics, labor and delivery units and postpartum care units, Some engage in research regarding the spectrum of breastfeeding protection, promotion and support issues. Nurses serve individual women, children and families as well as institutions, governmental and non-governmental organisations where they have opportunities to provide direct clinical care, prepare educational materials for families and other health professionals, as well as providing advice and expertise for policy development at all levels. There are many nursing organisations world-wide that include breastfeeding in their spheres of interest and influence, the International Council of Nurses being one of the main ones (http://www.icn.ch/fr/).

These health professionals are identified as International Board Certified Lactation Consultants (IBCLCs). They are the one health professional group whose only focus is on lactation and breastfeeding. Many are also nurses and physicians as well. IBCLCs practice in independent lactation consultancies, physicians’ offices, health clinics, hospitals and other venues where they provide education and direct clinical care to childbearing / breastfeeding families. They work in partnership with other maternal-child health professionals while providing lactation/breastfeeding focused care to mother-baby dyads. Some engage in research regarding lactation/breastfeeding issues. IBCLCs have opportunities to educate other health professionals regarding protection, promotion and support of breastfeeding, as well as advising institutions and governmental and non-governmental organisations regarding policy development as it relates to breastfeeding. They are organised in the International Lactation Consultant Association (ILCA) which is a professional association for lactation consultants world-wide (http://www.ilca.org). ILCA is a Core Partner of the World Alliance for Breastfeeding Action (WABA).

While many stakeholders have banded together to support breastfeeding, the role of the nutritionist in particular is to communicate to the mother and community at large the invaluable health benefits that breastmilk has on a child’s nutritional status, health and survival. Not only is breastfeeding the most sustainable and cost-effective means to feed an infant, it also provides a unique “cocktail” of nutrients and antibodies to promote optimal growth in the infant. Nutritionists can work through hospitals, government agencies and Universities to highlight what exactly makes breastmilk the best choice for infant feeding. Nutritionists work in diverse settings ranging from clinical to public health, research in humanitarian and development assistance and thus have unique opportunities to promote, protect and support breastfeeding. They can work with mothers to create a comprehensible working knowledge of diet diversity. For example, breastmilk provides essential vitamin and minerals along with a sufficient energy requirement that a meal of simple starch cannot provide. The lead UN agency working with nutrition issues globally is UNICEF (http://www.unicef.org/nutrition/index_role.html).

Obstetrical practices can negatively impact a woman’s ability to breastfeed. Birth and breastfeeding cannot be separated—they are part of the mother baby continuum--and the way birth proceeds can have a major impact on the way breastfeeding will proceed. Any procedure that interrupts the mother’s physiological systems or interferes with her self-esteem can be highly detrimental to breastfeeding, including separation of mother and baby after birth and the use of bottles or pacifiers in the hospital. The International MotherBaby Childbirth Initiative (IMBCI), www.imbci.org, is an evidence-based global effort developed in the early 2000s to improve maternal care during birth in order to save lives and prevent harm from the overuse of obstetric technologies, promote care during labour and birth and breastfeeding that is centered on physiology and normalcy, emphasise a humanistic women- and family-centered approach and all types of care most conducive to good outcomes, including collaboration among involved professionals, midwifery knowledge and skills, hands-on support for the mother, and recognition of the MotherBaby continuum and support the Ten Steps of the BFHI. The International Confederation of Midwives (ICM) is one of the largest associations of professional midwives globally (http://www.internationalmidwives.org/).

Breastfeeding is a normal part of a mother and child’s everyday live and not a medical matter. Doctors are in an ideal position to influence a mother’s decisions about infant feeding because they see them at so many key decision-points in their babies’ live. They can make a difference in increasing breastfeeding initiation rates and especially breastfeeding continuation rates by advocating breastfeeding, supporting breastfeeding mothers and providing appropriate evidence-based care for breastfeeding mothers. Physicians who are confident and capable in breastfeeding management will find many occasions to promote and support breastfeeding. Prenatal intention to breastfeed is influenced to a great extent by health care providers’ opinion and support.

If breast feeding, with all its benefits, is to be established as a majority activity, physicians must learn to recognise the elaborate web woven around them by formula manufacturers. Health professionals are an important target for the baby food industry promotion. If a company succeeds in persuading physician, it can influence the infant feeding choices of many mothers. Current attitudes concerning infant nutrition have been moulded by the manufacturers of human milk substitutes who have aggressively created markets for their products. They have advertised to physicians and directly to the public in ways that are inconsistent with the International Code of Marketing for Human Milk Substitutes. Infant formula companies continue to provide gifts to physicians and offer sponsorship to them and their professional organisations.

Breastfeeding is the best investment with great returns. Knowledgeable health-care providers are the key to promoting and protecting breastfeeding. They can play a pivotal role in helping to increase the prevalence and duration of breastfeeding among mothers. Physicians can empower their knowledge in Breastfeeding information from international organisations like Academy of breastfeeding medicine http://www.bfmed.org/; WellStart international www.wellstart.org