FLRF writes guest article for "Clic"

Breastfeeding requires more than good intentions – it requires supportive conditions.

We are delighted and proud to be featured in the latest issue of Clic, the online magazine of the Swiss Professional Association for Early Childhood Counselling, with an article by Family Larsson-Rosenquist Foundation Managing Director, Dr. Katharina Lichtner: Stillen braucht mehr als guten Willen | Clic

Find an English translation of the article below.

In “Breastfeeding Takes More Than Good Intentions”, she explores the conditions that need to be in place to ensure that women who wish to breastfeed receive the support they need. The article highlights that promoting breastfeeding is not solely an individual's responsibility; it requires supportive structures within the healthcare system, the workplace and society as a whole.

The article also draws on findings from the ZHAW study “Becoming Breastfeeding Friendly Switzerland”, funded by FLRF. These findings show where favorable conditions are already in place and where further action is still needed.

This is precisely where our work at FLRF comes in. Our aim is to translate scientific knowledge on breastfeeding, breastmilk and women’s health into practical solutions. For us, fostering exchange between research, professional expertise and practice is essential.

We are therefore especially pleased to have the opportunity to share our perspective with a broad professional audience through this publication.

Breastfeeding requires more than good intentions – it requires supportive conditions.

Almost all mothers in Switzerland initiate breastfeeding after giving birth. However, many stop breastfeeding earlier than they had originally intended. The study “Becoming Breastfeeding Friendly Switzerland” provides the first systematic assessment of where Switzerland offers supportive conditions for breastfeeding and where structural barriers make it more difficult.

In Switzerland, 97% of mothers begin breastfeeding after giving birth. At first glance, this suggests a positive starting point. However, a closer look at breastfeeding duration paints a more differentiated picture: in 2024, children were exclusively breastfed for a median of 17.4 weeks. Frequently cited reasons for stopping breastfeeding earlier than planned include a perceived insufficient milk supply, exhaustion and difficulties combining breastfeeding with employment.

These figures draw attention to a question that goes beyond an individual mother’s decision: How supportive are the conditions in Switzerland for women who want to breastfeed?

Assessing breastfeeding-friendliness systematically

This is where “Becoming Breastfeeding Friendly,” or BBF, comes in. The evidence-based initiative was developed by Professor Rafael Pérez-Escamilla and his team at the Yale School of Public Health, with support from the Family Larsson-Rosenquist Foundation. Rather than viewing breastfeeding promotion as the sole responsibility of individual professionals or institutions, BBF uses a framework to assess how well a country’s political, social and healthcare environments support breastfeeding.

In Switzerland, BBF was implemented for the first time under the scientific leadership of the Zurich University of Applied Sciences (ZHAW), led by Professor Susanne Grylka. The project was funded and administratively supported by the FLRF.

The  study assessed 54 defined criteria across eight areas of action. The evidence base included literature and documents as well as 20 interviews with experts from healthcare, politics, the federal administration, research and other relevant fields. An expert group subsequently assessed the individual areas and developed concrete recommendations based on the findings.

Where Switzerland stands today

The results are mixed. With a BBF Index score of 1.1 out of a maximum of 3 points, Switzerland is classified as moderately breastfeeding-friendly. Legislation, education and breastfeeding counseling, as well as research and evaluation, received mid-range ratings. By contrast, political will, funding and public communication on breastfeeding were rated weakly. At the same time, the analysis showed that structures are already in place that can serve as a foundation for further progress.

Twelve recommendations for Switzerland

The assessment resulted in 12 recommendations. The overarching recommendation is to develop a national breastfeeding strategy. It should bring together objectives, responsibilities, funding, communication and implementation.

Other recommendations include increasing the social visibility of breastfeeding, integrating breastfeeding knowledge into the training of relevant healthcare professionals, developing a national communication strategy, improving research and data collection, strengthening breastfeeding and lactation counseling, and developing and implementing breastfeeding guidelines.

The analysis also identifies a need for action regarding the legal framework. The report considers the current 14-week maternity leave period too short and recommends extending it to at least six months. In addition, the international WHO Code on the Marketing of Breast-milk Substitutes has so far only been partially incorporated into Swiss law. The report recommends full implementation, government monitoring and clearly defined sanctions for violations.

The recommendations highlight one key point: breastfeeding promotion cannot be reduced to counseling individual mothers. Whether breastfeeding is successful and how long a woman is able to breastfeed are also influenced by the information she receives, how well different professional groups collaborate, whether appropriate support services are available, and the conditions she encounters when returning to work.

This perspective is particularly relevant for professionals working in early childhood services. They support families during a period in which many of these factors come together. Questions about milk supply, pain, exhaustion or uncertainty rarely exist in isolation. They may also be connected to postnatal care, conflicting information, a lack of follow-up services or an upcoming return to work.

One of the BBF recommendations therefore explicitly addresses the role of breastfeeding and lactation consultants. Among other things, it proposes stronger interdisciplinary collaboration, regular case discussions, quality assurance, and better structural, financial and societal recognition of breastfeeding counseling. At the same time, breastfeeding expertise should be integrated more systematically into the education and continuing professional development of all relevant healthcare professionals.

From analysis to implementation

The real value of BBF therefore lies not solely in its assessment of Switzerland. The score of 1.1 is neither an end in itself nor a judgement on the work of individual professionals. Rather, it highlights areas where change could have a particularly meaningful impact.

This also requires a shift in perspective. Women do not need to be persuaded more strongly that breastfeeding is beneficial – both for their newborns and for themselves. What is needed are conditions in which women who want to breastfeed receive reliable and sustained support. The high breastfeeding initiation rate shows that the willingness is there. The task now is to narrow the gap between this intention and the realities of everyday life.

This is precisely the interface at which we work at FLRF. As an independent, non-profit Swiss foundation, we work to translate scientific evidence on breastfeeding, human milk and women’s health into practical solutions for healthcare, professional practice and society.

BBF provides an important foundation for this work in Switzerland. The next step should therefore be implementation. One area of focus, among others, is breastfeeding in the workplace. Together with relevant stakeholders, we aim to examine the barriers women face in different working environments and identify practical ways in which employers can provide support. In healthcare, too, the goal is to translate existing knowledge and proven approaches more effectively into practice.

The 12 BBF recommendations therefore mark not so much an endpoint as a starting point: for a Switzerland in which the desire to breastfeed does not have to be carried by individual women alone, but is supported by appropriate conditions across healthcare, society and the workplace.

Author

Dr. Katharina Lichtner holds a PhD in immunology and has many years of experience in the private sector. Since its establishment, she has served as Managing Director of the Family Larsson-Rosenquist Foundation, where she is responsible for its strategic development and international orientation.