Publication date: 
July 22, 2019

Estimates indicate that more than 800,000 child deaths could be averted annually with optimal breastfeeding practices, according to World Health Organization


Detailed interactive maps illustrate where countries are advancing and falling behind


SEATTLE – Only three African countries are expected to meet the global target for exclusive breastfeeding, “an unparalleled source of nutrition for newborns and infants, no matter where they are born,” according to a global health expert.

The three nations, Guinea-Bissau, Rwanda, and São Tomé and Príncipe, are singled out in a new study from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine. The study, published today in Nature Medicine in advance of World Breastfeeding Week Aug 1-7, finds areas of persistent low prevalence in countries that have made progress overall. Detailed maps accompanying the analysis reveal vulnerable populations, especially those living in rural areas and in extreme poverty.  

However, researchers note that that several nations, including Burundi, Rwanda, and parts of Ethiopia, Uganda, and Zambia were among the highest rates of exclusive breastfeeding levels in 2000 and 2017. Sudan had some of the “highest and most consistent rates of increase” toward the exclusive breastfeeding goal of the World Health Organization (WHO) – prevalence by 2025 of at least 50% nationwide. The Global Burden of Disease, the annual comprehensive health study, attributed 169,000 child deaths to lack of breastfeeding in 2017, more than half of them in sub-Saharan Africa. Moreover, according to the WHO, increasing breastfeeding to near-universal levels could save more than 800,000 lives every year, the majority being children under 6 months.

The paper examines breastfeeding prevalence down to the level of individual districts and municipalities and compares progress among 49 African nations. The paper is accompanied by an interactive visualization tool that allows users to compare prevalence of exclusive breastfeeding within and across countries, look at the rate of change over time, and see the probability of meeting WHO’s goal by 2025.

The value of exclusive breastfeeding of children cannot be over-emphasized. 

“Breastfeeding is an unparalleled source of nutrition for newborns and infants, no matter where they are born. If we are serious about ensuring that every infant is offered a healthy start in life, we need to know who isn’t being reached with the support they need to breastfeed,” said Dr. Ellen Piwoz of the Bill & Melinda Gates Foundation. “By illustrating where exclusive breastfeeding rates are falling behind, these maps are a powerful tool to help policymakers and practitioners examine and act on disparities within their countries.”

In 2017, at least a two-fold difference in exclusive breastfeeding prevalence existed across districts in 53% of countries, a three-fold difference in 14% of countries, and a more than six-fold difference in Niger and Nigeria.

Exclusive breastfeeding refers to mothers using only breast milk to feed their children for the first six months, with medications, oral rehydration salts, and vitamins as needed. The practice provides essential nutrition and can prevent infection and disease, particularly in areas without access to clean water.

The study is available at IHME’s website at; data visualizations are available at

The study’s detailed maps reveal vulnerable populations left behind. Senegal, Angola, Ethiopia, and Tanzania had areas with a less than 5% probability of meeting the WHO target and, simultaneously, communities with a greater than 95% probability of meeting the target.

“Our maps allow us to see patterns and trends that aren’t visible at the national level. They serve as an invaluable resource to ministries of health and others making decisions to advance child well-being,” said lead author Dr. Natalia Bhattacharjee, Research Scientist at IHME.

The WHO and other organizations celebrate World Breastfeeding Week to encourage breastfeeding and improve the health of babies globally. They advocate for “family-friendly policies to enable breastfeeding and help parents nurture and bond with their children in early life, when it matters most,” according to the WHO website. This includes enacting paid maternity and paternity leave.

The paper is part of the Local Burden of Disease project (LBD) at IHME, led by Dr. Simon I. Hay, Director of Geospatial Science at IHME and Professor of Health Metrics Sciences at the University of Washington’s School of Medicine. It was funded by the Gates Foundation.

“Our collaboration with the Gates Foundation, as well as other researchers, academics, and clinicians throughout the world, enables us to develop the best tools possible for reaching populations where health care support can make the biggest difference,” said Hay.  

This study is the latest in a series of IHME papers as part of the institute’s LBD project, which produces estimates of health outcomes and related measures covering entire continents at a fine resolution. Project leaders are seeking additional collaborators, including academics, researchers, and others, to contribute data and to evaluate draft papers. For more information, please contact the LBD Engagement Team at [email protected].

All estimates produced from this research are publicly available at the Global Health Data Exchange:


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About the Institute for Health Metrics and Evaluation

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington School of Medicine that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME is committed to transparency and makes this information widely available so that policymakers have the evidence they need to make informed decisions on allocating resources to improve population health.


About the Local Burden of Disease project

The Local Burden of Disease (LBD) project at IHME aims to produce estimates of health outcomes and related measures that cover entire continents, but to do so at a very fine, local resolution. Such estimates allow decision-makers to target resources and health interventions precisely, so that health policy decisions can be tailored for local areas rather than entire countries. Combining local detail with broad coverage – producing estimates for different administrative subdivisions across entire continents, give health officials tools to make locally informed decisions. The LBD project is led by Dr. Simon I. Hay, Professor of Health Metrics Sciences at the University of Washington School of Medicine and Director of Geospatial Science at IHME.