What will it take to increase breastfeeding?

Abstract 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.

essential element of optimal nutrition during the first 2 years of life because it saves lives, improves the short-and long-term health of infants, and enhances their cognitive development across countries, regardless of their level of economic development (Bartick et al., 2017;Horta et al., n.d.;Li et al., 2022;Victora et al., 2016).
Evidence about the constellation of benefits of breastfeeding for women and children and the biological mechanisms explaining them continues to accumulate (Bode et al., 2020;Parul et al., 2021). With advances in science and technology, more is now known than ever before, about the unique immunological, hormonal, and nutritional properties of breastmilk and how breastmilk composition gets tailored to the unique needs of the infants according to the environments surrounding them ("mother-breastmilk-infant triad") (Bode et al., 2020). This complex system developed, over millions of years of evolution, protects the health and stimulates the optimal development of the child and as it turns out it also protects maternal health. In mothers, epidemiological studies have shown that breastfeeding reduces the risk of hypertension, cardiovascular disease, type 2 diabetes, breast, and ovarian cancer and may reduce the risk of depression (Bartick et al., 2017;Tschiderer et al., 2022;Victora et al., 2016). Hence, optimal breastfeeding practices in the first 2 years is a fundamental component of a healthy diet since birth (i.e., the first food systems , and is considered to be a triple-duty action as it reduces the risk of undernutrition, obesity, and dietary related noncommunicable diseases and fosters child development (Pérez-Escamilla & Segura-Pérez, 2018). Beyond the individual and family benefits, breastfeeding is also critical for national development and planetary health (Pérez-Escamilla, 2017

Key messages
• Breastfeeding saves lives, improves the short-and longterm 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 While in the other hand, in all four countries, advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment for breastfeeding. In all studied countries, there was an urgent need to improve maternity protection and regulation of BMS marketing to protect women, mothers, parents, and relatives from aggressive BMS promotion that often times violates the WHO Code.
In Lastly, a critical issue that the ongoing COVID-19 pandemic has brought to our attention, is the need for countries to be well prepared to protect, support, and promote breastfeeding when public health humanitarian emergencies arise.

AUTHOR CONTRIBUTIONS
Sonia Hernández-Cordero and Rafael Pérez-Escamilla conceptualized and drafted the first version of the article They both critically reviewed the manuscript. Both authors read and approved the submitted manuscript and contributed equally to the article.

ACKNOWLEDGEMENT
This study was funded by the World Health Organization with a grant from the Bill and Melinda Gates Foundation (Award number: OPP1179886).

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT
No data were generated as part of this supplement introduction.