The main obstacle to sustaining exclusive breastfeeding in the region remains the persistence of inadequate feeding practices - and this links directly to particular concerns regarding severe malnutrition of under-fives in many countries.

One of the causes of malnutrition is the low rate of exclusive breastfeeding for infants up to six months; exclusive breastfeeding reaches 31% of infants in Morocco and an estimated 38% in Egypt.

Stepping up promotion of EBF and actual results at national level is crucial as some of the highest indicators come from middle income countries enjoying relative socio-economic and political stability (Tunisia 47%; Iran 44%).

Conflict serves as a catalyst to malnutrition in countries where the nutritional status of women and adolescent females is gravely threatened. This generates a vicious circle that has similarly dire consequences in terms of infant feeding and a baby's chance to survive beyond his/her first year.

Today, more than half of all Yemeni children under five are stunted and almost one-third of babies are born with low weight. Only one in four children (25%) aged less than six months are exclusively breastfed in Iraq. In spite of the critical conditions in the country at present, the rate of exclusive breastfeeding doubled from 17% in 2000 to 34% in 2006 among children less than four months of age. A model example of progress comes from the occupied Palestinian territory, where reports indicate that of all children born during the past five years, 97,5% were breastfed and exclusive breastfeeding remaining at 26,5% for infant in the 0-5 month age range.

Migration to the cities and an increasing number of (lactating) mothers entering the labor force is seen a combined phenomenon significantly contributing to the drop in exclusive breastfeeding. This also generates reduced awareness of the importance of breastfeeding and promotes the massive use of breast milk substitutes and complementary food.

The Rate of Progress
Exclusive breastfeeding: The infant has received only breast milk from the mother or a wet nurse, or expressed breast milk, and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements, or medicines.

Preliminary Reports, MICS 3, Multiple Indicator Cluster Surveys

The way forward
Several Arab countries are already promoting Infant and Young Child feeding strategies, with exclusive breastfeeding at the core of interventions. However, the promotion of Infant and Young Child feeding need to drastically scale up efforts in the immediate future.

Government policies and legislations are required to enable mothers to practice exclusive breastfeeding for six months. Similar action is needed with regards to the breastfeeding needs of female workers and the development of supportive environments encouraging mothers to breastfeed.

Scientific evidence and Key Advocacy Messages
Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival Millennium Development Goal.

16% of all neonatal deaths globally could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour.

Exclusive breastfeeding up to six months (13%) of all under-five deaths and complementary feeding between 6-9 months (6%) with continued breastfeeding could save around 20% of all under-five deaths.

Achievement of optimal infant and young child feeding and related maternal nutrition will yield the best survival, growth, and development outcomes, reduce chronic illnesses and when implemented fully will cut the under-five mortality rate in half.

Official journal of the American Academy of Pediatrics, Vol. 104 No. 1 July 1999, p. e3
The Lancet Child Survival series
UNICEF-LAS 2005, Understanding the Present, Shaping the Future

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© Press Release 2007