Lactation Services: Basics, Economics, and Conflicts of Interest

Lactation services are not merely “breastfeeding advice” — they constitute a public health infrastructure built on clinical practice, policy protection, and support systems. The World Health Organization and UNICEF’s Baby-Friendly Hospital Initiative established the global core standards through the Ten Steps to Successful Breastfeeding. This framework covers the complete chain from management procedures to clinical practice: health facilities must fully comply with the International Code of Marketing of Breast-milk Substitutes, have a written feeding policy, and ensure staff have the knowledge and skills to support lactation. Clinically, they must facilitate immediate skin-to-skin contact and breastfeeding initiation, support rooming-in, give no food or drink other than breast milk to breastfeeding newborns (unless medically indicated), and coordinate continued support after discharge.

The logic underlying these ten steps is that breastfeeding success rarely depends on a mother’s individual “determination” — it depends heavily on whether the health system she encounters provides the right support at critical time windows. Evidence shows that systematic implementation of the ten steps significantly increases breastfeeding rates. However, global implementation is uneven. The 2025 Global Breastfeeding Scorecard shows that while nearly half of infants under six months are exclusively breastfed — an 8 percentage point increase since 2020 — the policy environment lags far behind. Only 17% of countries have legislation substantially aligned with the Code, and only 10% meet International Labour Organization maternity leave standards. Lactation services are essentially a public health intervention requiring institutional guarantees, not an optional “lifestyle recommendation.”