INTERVIEW. Breastfeeding, a practice on the rise but “with significant room for improvement” in France, says an epidemiologist

According to the WHO and many scientists, breastfeeding has many theoretical benefits for the health of babies. The latest Epifane study shows progress in France, despite a certain delay compared to our European neighbors.

Breastfeeding is gaining ground in France. This is what emerges from the latest Epifane study, published Tuesday, July 23 by the Public Health France agency. “This work, carried out in 2021, highlights in particular that more and more children are breastfed in maternity wards and that the duration of breastfeeding is increasing”summarizes Public Health France. Julie Boudet-Berquier, epidemiologist at Santé Publique France within the nutritional surveillance and epidemiology team, answers questions from franceinfo.

franceinfo: What are the main lessons of this study?

Julie Boudet-Berquier: We have had results and developments that have been really favorable for 10 years in terms of infant feeding. Epifane is a study that was first conducted in 2012-2013 and was repeated in 2021-2022. In 2021, what we observed was that 77% of children were breastfed in the maternity ward, whereas this was the case for 74% of children in 2012. The median duration of breastfeeding increased by more than five weeks between 2012 and 2021 since in 2012, its median duration was 15 weeks and in 2001, it increased to 20 weeks.

Another point, in 2021, 6 months after giving birth, more than a third of children were still breastfed, whereas this was the case for less than a quarter of them in 2012.

How can we explain this progression?

For several years, with the implementation of the National Nutrition Health Program (PNNS), actions have been taken to promote and increase support for breastfeeding for women who want it. So there have really been efforts made, but there is still a long way to go. Because first of all, and this is essential, breastfeeding is women’s freedom. They have every right to choose the feeding method that suits them best and therefore, in order for them to make an informed choice, it is necessary to create environments that allow this choice.

“Breastfeeding cannot be the sole responsibility of women and families. It is also a real responsibility of society, with changes in society to enable women who wish to do so to be able to breastfeed over time.”

Julie Boudet-Berquier, epidemiologist

to franceinfo

In practice, in concrete terms, what actions have helped to advance breastfeeding?

In particular, there was the establishment and deployment of the Baby-Friendly Hospitals initiative. This is a program that aims to encourage, support and protect breastfeeding in maternity wards. The goal is to promote a culture that is very favorable to breastfeeding, which helps increase the initiation rate. Then, on the continuation of breastfeeding, when women return home, that’s where there is still a long way to go. In Epifane, women were asked what led them either to stop breastfeeding completely or to decide to introduce infant formula.

Between zero and two months, they answered that it was either the pain or the perceived insufficiency of milk. And that really requires that they be supported by professionals who have enough time, a much simpler, much easier recourse for everyone. With, for example, a lactation consultant to be able to help them with breastfeeding and to be able to assess with them this perceived insufficiency.

Then, when we move a little further away from the due date, for example at six months, what women cite as reasons is really the return to work. There, we need to create environments that allow women to reconcile returning to work and breastfeeding because it is still very difficult, in particular with training and information for employers. And also measures that allow, in certain jobs, to facilitate breastfeeding for women who work.

Despite these positive results, we are still well below the levels of certain European countries…

Most countries are at the level of 80% breastfeeding at birth, with heterogeneity, we have very high results in the Scandinavian countries for example. In the countries which are behind France, we find Ireland with less than one woman in two who breastfeeds at the maternity ward, or Cyprus and Malta.

“What we observe is that in countries where breastfeeding is particularly good, there is really the creation of a very favorable environment for breastfeeding at the societal level.”

Julie Boudet-Berquier, epidemiologist

to franceinfo

That is to say, in terms of the provisions that exist in terms of remuneration, maternity leave, sharing of tasks between men and women, in terms of promoting the image of breastfeeding women. And then also in terms of promoting the work that is done by health professionals to support breastfeeding.

There are places that are much easier to access to allow women to breastfeed, without having to stay at home all the time. This is really work that must also be done at the level of society, for example on this image of the breastfeeding woman in a public place, in restaurants or in the workplace.

So France still has room for improvement?

This year, we exceeded the objective of the National Nutrition Health Program (PNNS) 2019-2023 which was 75% of children breastfed in maternity wards. The PNNS will be reviewed and perhaps with these favorable results the objectives for initiating breastfeeding will be reviewed. But what is really important is to be able to support women who want to breastfeed. And that is where I think there is significant room for improvement. Once again, without blaming women who have made a different choice.