Breastfeeding and the Introduction of Solid Foods in Infants: Encouraging Results

The lack of data on young children’s diets and the recommendations of the National Nutrition and Health Program (PNNS) led Santé publique France to establish a surveillance system for the diets and nutritional status of infants and young children to:

• Describe breastfeeding and weaning practices

• Contribute to the evaluation of public health policies

• Guide initiatives to promote breastfeeding and recommendations for more appropriate nutrition for young children.

The Epifane study is part of this surveillance effort. First conducted in 2012, Santé publique France is now publishing the results of the second edition, conducted in 2021.

The main findings of this second edition are encouraging. In fact, some of the targets set in the 4th National Nutrition and Health Program (PNNS) 2019–2023 have been met:

• The rate of children breastfed at birth now exceeds the 75% target set by the 4th PNNS.

• The median duration of total breastfeeding (which includes exclusive breastfeeding and mixed feeding, i.e., supplemented with breast milk substitutes) is 20 weeks, compared to the target of 17 weeks.

Regarding breastfeeding, Epifane shows that:

• 77% of children are breastfed in the maternity ward (vs. 74% in the first edition of the study in 2012).

• The median duration of breastfeeding (exclusive + mixed) increased from 15 to 20 weeks between 2012 and 2021.

• At 6 months, more than a third of children were still being breastfed in 2021 (vs. less than a quarter in 2012).

At 2 months, finding bottle-feeding more convenient (including the desire to involve the father more) and the perceived insufficiency of breast milk production (without this being objectively confirmed by an actual decrease in the newborn’s weight) are the two main reasons for stopping breastfeeding (affecting 76% of mothers who stopped in both cases). Problems with latching (57%) and organizational issues and lack of time (54%) are also cited by more than one in two women. These results underscore the importance of support for mothers from well-trained professionals, both for initiating breastfeeding and for continuing it.

Regarding the introduction of solid foods, the study shows that recommendations for weaning are increasingly being followed; however, certain foods are introduced later than recommended:

• For 91% of children in 2021, complementary feeding began within the recommended window, between 4 and 6 months.

• Only 4% of mothers began introducing solid foods before the recommended period.

• Some foods are still introduced later than recommended by a significant proportion of the mothers surveyed (added fats, legumes, eggs).

Enhance training for healthcare professionals and provide clearer information to parents

The second edition of the Epifane study thus shows satisfactory results and a positive trend in breastfeeding and nutrition among young children since the first edition in 2012. Nevertheless, France lags far behind other European countries in terms of breastfeeding, most of which have rates exceeding 80% at birth, according to the latest available data on the ^subject1. Ireland, where fewer than one in two women breastfeed upon leaving the maternity ward, is the only European country, along with Cyprus and Malta, to report breastfeeding rates lower than those in France.

There are likely multiple reasons for France’s unfavorable situation, ranging from potentially insufficient maternity leave to inadequate training for healthcare professionals and employers in supporting women who wish to breastfeed, as well as the low social status of breastfeeding women and the contradictory information received regarding breastfeeding and infant feeding.

Overall, the results of this second edition of Epifane highlight the need to:

• Increase training for healthcare professionals who can provide support and advice to families, and inform and train employers;

• To make information on breastfeeding and infant feeding clear and consistent for parents;

• To continue initiatives to support and assist with breastfeeding, particularly for women who begin breastfeeding during their stay in the maternity ward but stop very early on, and to facilitate access to lactation consultants.

Santé publique France is involved in this effort, particularly through the publication and distribution of guides on breastfeeding and the introduction of solid foods for new parents and their families.

In addition, Santé publique France supports the work and implementation in France of the Baby-Friendly Hospital Initiative (BFHI), whose program aims, in particular, to encourage, support, and protect breastfeeding. In this context, the Agency also contributed to assessing the impact of the BFHI designation on breastfeeding rates in French maternity wards. Indeed, the BFHI is associated with improved breastfeeding outcomes in many countries, such as the United Kingdom and the United States, but its effectiveness had never before been measured in France. The study, based on data collected in 2010, 2016, and 2021, showed that the rate of exclusive breastfeeding was significantly higher among mothers giving birth in IHAB-certified maternity units. To view the full study on this topic: The impact of the Baby-Friendly Hospital Initiative on breastfeeding rates at maternity units in France.

Furthermore, Santé publique France has conducted research on breastfeeding practices among women returning to work in Europe. Indeed, countries in the WHO European Region have the lowest rate of exclusive breastfeeding at six months in the world, at 25% of infants. Improving this situation raises, among other things, the question of extending maternity leave but also of continuing breastfeeding after returning to work: How can work and breastfeeding be reconciled? What are the characteristics of jobs that support continued breastfeeding after returning to work? The answers to these questions were the subject of a literature review conducted by Santé publique France in partnership with the University of Bordeaux. This work contributes to advancing scientific knowledge in this field.

For more information:

• Characteristics of mothers’ employment as a socio-structural determinant of breastfeeding after returning to work in the European Region: a scoping review