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Shrivastava SR, Shrivastava PS, Ramasamy J. Exclusive breastfeeding and stakeholders: Only together we can make it work. Ann Trop Med Public Health 2016;9:127-9
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Shrivastava SR, Shrivastava PS, Ramasamy J. Exclusive breastfeeding and stakeholders: Only together we can make it work. Ann Trop Med Public Health [serial online] 2016 [cited 2017 Nov 14];9:127-9. Available from: https://www.atmph.org/text.asp?2016/9/2/127/177386
Worldwide, breastfeeding has been regarded as one of the most cost-effective approaches to ensure optimal child health standards.  The World Health Organization (WHO) strongly advocates exclusive breastfeeding (EBF) till a child is 6 months old and continue the same till 2 years or beyond in combination with other nutritious complementary food items.  In fact, it has been estimated that the lives of 0.8 million infants can be saved worldwide every year, provided the recommendations of WHO are strictly implemented in all the settings and for each child.  However, the current estimates suggest that only 38% of infants are exclusively breastfed for the first 6 months and there is a definitive scope for massive improvement. 
Time and again, it has been proven that babies who are fed nothing but breast milk from birth through their first 6 months of life get the best start.  This has been indirectly attributed to the perfect nutrition (rich source of fat-soluble and water-soluble vitamins) required for healthy growth and brain development, protection from respiratory infections, diarrheal diseases and other life-threatening illnesses, and imparted protection against obesity and some of the noncommunicable diseases like diabetes/asthma. ,, Acknowledging the importance of breastfeeding in the lives of both the mother and child, the WHO and the United Nations Children’s Fund (UNICEF) has set a goal to increase the rate of EBF in the first 6 months to at least 50% by the year 2025. ,
The findings of different epidemiological studies have identified multiple determinants like lower levels of maternal education,  poor knowledge about breastfeeding,  lack of counseling of mothers/family members both during pregnancy and after the birth of the baby,  exposure to less than five baby-friendly practices during hospital stay,  traumatic delivery,  cesarean delivery,  low level of confidence among mothers regarding their ability to breastfeed,  no assistance from the spouse/family members for infant care,  depression among mothers in the postnatal period,  early resumption of work,  etc., all of which have interfered either with the initiation or with the continuation of EBF in the first 6 months of life.
As the success of EBF for the first 6 months of life is dependent on multiple factors, if we actually want to improve its percentage among women, there is an indispensable need for implementing a comprehensive strategy involving all the stakeholders [Figure 1]. ,, However, the primary strategy is to ensure optimal participation of the policymakers so that not only the breastfeeding-related services are strengthened within the different levels of healthcare but also employers are targeted to initiate a breastfeeding support program and provide enough space within the premises to encourage EBF. ,, In addition, it is very essential to realize that most women are able to breastfeed with the right support, provided they/family members prepare themselves well before the baby is born (by consulting with health professionals about the feeding plan of the baby, understand the benefits of breast milk, and try again and again even if the previous child had not been breastfed), practice cosleeping (skin-to-skin contact) with the baby to understand the signs when the baby needs to be fed and how to position them (under health workers’ guidance during hospital stay postdelivery), and understanding the fact that even though breastfeeding is natural, it can take time to learn, and timely support from health workers/family members can make breastfeeding a positive experience. ,,
|Figure 1: Role of stakeholders to ensure successful breastfeeding
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Subsequently, other measures such as strengthening nutrition counseling during antenatal and postnatal sessions,  building confidence among mothers to continue EBF during both hospital stay and at home (through family members or at times of hospital visit),  giving more attention to women who delivered by a cesarean section,  addressing the psychosocial and sociodemographic determinants,  and conducting epidemiological studies to further explore the barriers to breastfeeding  can significantly improve the prevalence of EBF.
To conclude, owing to the numerous advantages associated with EBF for both the mother and the child, it is the responsibility of each and every stakeholder to encourage all new mothers for breastfeeding as “only together we can make it work.”
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Conflicts of interest
There are no conflicts of interest.
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Source of Support: None, Conflict of Interest: None