Breastfeeding in Germany – promotion in maternity hospitals and breastfeeding rates during the first year of life

Abstract

Human breastmilk is the gold standard for infant feeding. Breastfeeding offers multiple benefits to the breastfed infant, the lactating mother, and the society. Therefore, professional societies in Europe recommend exclusive or full breastfeeding for at least 4 months after birth, followed by age-appropriate complementary feeding introduced no later than the beginning of the 7th month along with partial breastfeeding for as long as mother and infant desire. However, many mothers do not achieve this recommendation, because various determinants hinder them to breastfeed successfully. In order to improve breastfeeding practices numerous international initiatives have been launched. In this context, breastfeeding monitoring is envisaged for the regular collection and evaluation of breastfeeding data, e.g., to enable targeted breastfeeding promotion at the national level. In Germany, the two SuSe studies (SuSe I 1997–1998; SuSe II 2017–2019) provided data within the framework of breastfeeding monitoring. In the present thesis, data from the two SuSe studies were compared and associations for breastfeeding success were examined. The analyses showed that both, maternal breastfeeding behavior and breastfeeding promotion in maternity hospitals were more in line with the recommendations in SuSe II than in SuSe I. Seven of the 10 Steps were implemented to a greater extent in SuSe II hospitals than in SuSe I hospitals and more mothers exclusively breastfed for 4 months (57% vs. 33%) and continued partial breastfeeding until 12 months pp (41% vs. 13%). In SuSe II, a high level of breast-feeding promotion in the hospital favored exclusive breastfeeding in the hospital setting, while maternal factors such as no early use of a pacifier and preexisting breastfeeding experience were stronger predictors of longer-term exclusive breastfeeding success. Although these findings cannot be generalized to all mothers and maternity hospitals in Germany and do not allow causal conclusions to be drawn about the effectiveness of individual interventions, they nevertheless provide important insights for breastfeeding promotion in Germany and point to targeted promotion needs in order to further increase breastfeeding rates.