Proposal submitted by UNICEF for the Global Breastfeeding Collective

Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture

Target 2.2: By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons.

3b. For “ADDITION” proposals, please enter the name of the indicator you are proposing to add:

Exclusive Breastfeeding among infants 0-6 months old

4. Background and rationale for the proposal (please provide a summary of the rationale for the proposal)

Breastfeeding is essential for child survival and health. Breast milk is a safe, natural, nutritious, and sustainable food for infants and young children. Breast milk contains antibodies that help protect against many common childhood illnesses such as diarrhoea and respiratory diseases. It is estimated that inadequate breastfeeding is responsible for 16% of child deaths each year.

The benefits of exclusive breastfeeding reach far beyond optimal nutrition for infants. Breastfed infants have a lower risk for childhood obesity and leukemia, as well as a significant reduction in the life-threatening necrotizing enterocolitis (NEC) and sudden infant death syndrome (SIDS). The benefits extend to the mother as well, lowering her risk of cancers such as breast, ovarian, cervical, and thyroid. Together, these unparalleled benefits make this indicator paramount even in high-income countries.

In 2012, the World Health Assembly Resolution 65.6 endorsed a comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets. One of the targets is to increase the rate of exclusive breastfeeding among infants less than 6 months of age up to at least 50% by 2025.

Only four of the six nutrition target indicators are currently in the SDG indicators list – childhood stunting, wasting, overweight, and anaemia (indicators 2.2.1, 2.2.2, and 2.2.3) – and this is insufficient to effectively capture the SDG goal to end all forms of malnutrition.

Globally, rates of exclusive breastfeeding in the first 6 months of life have increased by 10 percentage points over the past decade and are at 48% in 2023, close to the World Health Assembly target of 50% by 2025. Progress is happening across different regions, with numerous countries in Africa, Asia, Europe and Oceania documenting large increases in exclusive breastfeeding, including 22 countries up more than 10 percentage points since 2017.

The Global Breastfeeding Collective is co-led by UNICEF and WHO in partnership with 28 organisations calling on donors and policy makers to increase investments in breastfeeding. The Collective has set a target of 70% for exclusive breastfeeding rates by 2030. Despite the remarkable progress made in exclusive breastfeeding rates over the past decade, there is still a long way to go to reach this target of 70%. By adding these indicators under target 2.2, governments can focus on various actions required to eliminate all forms of malnutrition, including increasing exclusive breastfeeding rates.

The WHA chose six targets based on their epidemiological and public health relevance, available evidence-based interventions, alignment with relevant policies, and the ability to monitor changes. Achieving these targets is feasible for all countries, regardless of income level. The global nutrition targets  and SDG target indicators on nutrition don’t completely overlap. The 2024 SDG review presents an opportunity to  align them. Currently, there is only one target (target 2.2) and four indicators that cover nutrition within the SDGs.

5. Please indicate how and when the methodology has become an international standard and who is the governing body that approves it (except for proposals to only delete an indicator).

Global indicators for evaluating infant feeding practices, including exclusive breastfeeding, were first introduced in 1991 through the publication of the document “Indicators for assessing breastfeeding practices.” This document provided a set of indicators to measure the progress of breastfeeding promotion efforts. Since then, there have been significant advancements in the recommendations for infant and young child feeding (IYCF) and scientific knowledge about optimal breastfeeding and complementary feeding practices. As a result, the World Health Organization (WHO) released an extended set of IYCF indicators in 2008 to keep up with these developments. In 2021, UNICEF and WHO

8. Conclusion/other comments (please enter any other information about the proposal):

Indicators for assessing infant and young child feeding practices: definitions and measurement methods.” The methodology for assessing exclusive breastfeeding remains the same as in the past 3 decades.

Baby Milk Action Comment:

I believe that this proposal  is an essential addition to the SDGs – for all the reasons outlined in the UNICEF /Global Breastfeeding Collective submission.The current target indicators are not only insufficient to capture the SDG goal to end all forms of malnutrition, but without the addition of breastfeeding, can lead to a distortion of the care provided.  Breastfeeding is extraordinarily resilient and provides food, care and protection against all forms of malnutrition. Its importance is too often forgotten as commercial replacements are increasingly pushed. Very few countries have adequate controls in place to prevent commercial misinformation. Parents, carers and health care workers need to be protected against  all forms of commercial influence, including from digital marketing. The SDGs could play an important role in highlighting the critical importance of breastfeeding and encouraging governments to regulate marketing in line with World Health Assembly recommendations. It will also be  essential for all governments and global institutions to adopt and implement  effective conflict of interest safeguards

The formation of SDGs wasinfluenced by the Private Sector and those advocating a multi-stakeholder approach to governance. As a consequence SDG 17  in particular (17.H) Encourage Effective Partnerships  is frequently  misinterpreted and misused to promote inappropriate multi-stakeholder partnerships (that promote commercial agendas) rather than strengthening partnership between governments. This has led to an undermining of breastfeeding, and nutritious, minimally processed and bio-diverse family foods.  This needs to be urgently addressed.