Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding

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Adopted by the WHO/UNICEF policymakers' meeting on Breastfeeding in the 1990s: A Global Initiative at Spedale degli Innocenti, Florence, Italy on 30 July-1 August 1990

Recognising that

Breastfeeding is a unique process that:

• provides ideal nutrition for infants and contributes to their healthy growth and development;
   

• reduces incidence and severity of infectious diseases, thereby lowering infant morbidity and mortality;
   

• contributes to women's health by reducing the risk of breast and ovarian cancer, and by increasing the space between pregnancies;
   

• provides social and economic benefits to the family and the nation;
   

• provides most women with a sense of satisfaction when successfully carried out; and that

Recent research has found that:

• these benefits increase with increased exclusiveness (1) of breastfeeding (exclusive breastfeeding means that no other drink or food is given to the infant; the infant should feed frequently and for unrestricted periods) during the first six months of life, and thereafter with increased duration of breastfeeding with complementary foods, and
   

• programme interventions can result in positive changes in breastfeeding behaviour;

We therefore declare that 
 
As a global goal for optimal maternal and child health and nutrition, all women should be enabled to practice exclusive breastfeeding and all infants should be fed exclusively on breast milk from birth to 4-6 months of age (1). Thereafter, children should continue to be breastfed, while receiving appropriate and  adequate complementary foods, for up to two years of age or beyond. This child feeding ideal is to be achieved by creating an appropriate environment of awareness and support so that women can breastfeed in this manner.
 
Attainment of the goal requires, in many countries, the reinforcement of a "breastfeeding culture" and its vigorous defence against incursions of a "bottle-feeding culture". This requires committment and advocacy for social mobilization, utilizing to the full the prestige and authority of acknowledged leaders of society in all walks of life.
 
Efforts should be made to increase women's confidence in their ability to breastfeed. Such empowerment involves the removal of constraints and influences that manipulate perceptions and behaviour towards breastfeeding, often by subtle and indirect means. This requires sensitivity, continued vigilance, and a responsive and comprehensive communications strategy involving all media and addressed to all levels of society. Furthermore, obstacles to breastfeeding within the health system, the workplace and the community must be eliminated.
 
Measures should be taken to ensure that women are adequately nourished for their optimal health and that of their families. Furthermore, ensuring that all women have access to family planning information and services allows them to sustain breastfeeding and avoid shortened birth intervals that may compromise their health and nutritional status, and that of their children.
 
All governments should develop national breastfeeding policies and set appropriate national targets for the 1990's. They should establish a national system for monitoring the attainment of their targets, and they should develop indicators such as the prevalence of exclusively breastfed infants at discharge from maternity services, and the prevalence of exclusively breastfed infants at four months of age.
 
National authorities are further urged to integrate their breastfeeding policies into their overall health and development policies. In so doing they should reinforce all actions that protect, promote and support breastfeeding within complementary programmes such as prenatal and perinatal care, nutrition, family planning services, and prevention and treatment of common maternal and childhood diseases. All healthcare staff should be trained in the skills necessary to implement these breastfeeding policies.
 
OPERATIONAL TARGETS:
 
All governments by the year 1995 should have:

• appointed a national breastfeeding coordinator of appropriate authority, and established a multisectoral national breastfeeding committee composed of representatives from relevant government departments, non-governmental organisation, and health professional association;
   

• ensured that every facility providing materity services fully practices all ten of the Ten Steps to Successful Breastfeeding set out in the joint WHO/UNICEF statement (3) (World Health Organisation, Geneva, 1989) "Protecting, promoting and supporting breast-feeding: the special role of maternity services";
   

• taken action to give effect to the principles and aim of all Articles of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions in their entirety; and enacted imaginative legislation protecting the breastfeeding rights of working  women and established means for its enforcement.

We also call upon international organisations to:

• draw up action stategies for protecting, promoting and supporting breastfeeding, including global monitoring and evaluation of their strategies;
   

• support national situation analyses and surveys and the development of national goals and targets for action; and
   

• encourage and support national authorities in planning, implementing, monitoring and evaluating their breastfeeding policies.
   

(1) World Health Assembly Resolution 47.5 and 49.15. adopted after this Declaration , as well as UNICEF policy now recommend exclusive breastfeeding for "about six months".