In the UK, the women most likely to use formula milk are young, white and from low socioeconomic backgrounds, and this has created a major public health and inequalities challenge, write Professor Mary Renfrew from the University of York and Professor David Hall from the University of Sheffield.
It is well known that breast feeding improves infant health, and it has been shown to be the single most important preventive approach to saving children's lives.
In spite of national and international policy initiatives, 40% of women in the UK who start to breast feed discontinue by the time their baby is 6 weeks old, and only 20% of infants are exclusively breast fed at six weeks.
Yet evidence has shown that the main reasons cited for discontinuing breastfeeding could be easily remedied. For example, problems getting the baby to feed, or women reporting that breast feeding is painful.
In addition, recent data show that health professionals, especially doctors, are not adequately trained in giving advice on breast feeding, and often do not know how to position the baby so that feeding is effective and pain free.
The authors call for real and sustained changes in policy, practice and the education of health professionals, particularly doctors, to increase the rates of initiation and duration of exclusive breast feeding.
Key to this will be increasing the number of NHS trusts in England who are accredited by the World Health Organisation/United Nations Children's Fund Baby Friendly Initiative as recommended by the National Institute of Clinical Excellence, say the authors. The initiative encourages and facilitates breast feeding in hospitals and community settings by addressing the core problems such as staff training, supporting mothers and mainstreaming improved practice.
But, they conclude, changes in the provision of health services are unlikely to succeed without changes in societal attitudes to breast feeding in public, support for women in the workplace, and greater protection from misleading formula milk advertising.