Abstract
Background: Breast feeding is beneficial for mothers and children and in all countries breast feeding should be encouraged, protected and promoted. Levels of breast feeding in Europe are lower than elsewhere, but there are few recent data on breast feeding policies and progress against international standards. Design: Questionnaire survey of national European non-governmental organizations (NGOs). Materials and Methods: Questionnaires were sent to NGOs in 41 European countries. Reports were received of policy and practice for 32 countries (a 76% response rate). Comparison with an independent World Health Organization/United Nations Children's Fund (WHO/UNICEF) survey showed good result validity. Results: Only 50% of the western European countries had a national breast feeding programme, while these were reported for nearly 90% of eastern Europe. Less than 50% of the countries monitored their programme's progress, only 40% communicated official policies to staff advising mothers on breast feeding and less than 60% reported routine antenatal breast feeding education. Although employment laws supporting breast feeding are common, these may be ineffective because women work outside the formal sector, especially in eastern Europe. Not all countries reported enactment of the International Code of Marketing Breast Milk Substitutes and this had been agreed with the food industry in less than 50%. Regular breast feeding surveys were uncommon and non-standardized. Although 50% of the countries routinely collected data on breast feeding, these data were not necessarily used. The results standardized well against the WHO survey. Conclusion: National breast feeding policies and practices remain inadequate in Europe, where there are considerable weaknesses in the protection, promotion and monitoring of breast feeding. NGOs are a useful complementary source of data and should be used more widely in international surveys and monitoring.