Investing in the first 1.000 days of life, from pregnancy to a child’s second birthday, is important for immediate and long-term health. Therefore, the World Health Organization (WHO) stresses the importance of the protection, promotion, and support of breastfeeding, identified as one of the WHO’s Best buys –most cost-effective interventions– to tackle non-communicable diseases (NCDs).
In women, breastfeeding reduces the risk of breast cancer, ovarian cancer, and type II diabetes.. In children, breastfeeding supports healthy growth, optimal brain development and protection against overweight. Beyond health benefits, breastfeeding also has also been proven to reduce social inequalities, which is a key focal area of JA PreventNCD.
Although breastfeeding is crucial for achieving a healthy population, breastfeeding rates in Europe remain lower than in any other continent. While nearly all women are biologically capable of breastfeeding, low breastfeeding rates demonstrate how breastfeeding practices are affected by environmental factors. Health determinants at multiple levels affect breastfeeding practices, but competent support from the health services plays a crucial role. Workplace conditions, social norms or marketing pressures influence whether families can start and continue breastfeeding, but, critically, competent support from the health services plays a crucial role.
The Baby-Friendly Community Health Services strategy
A Baby-Friendly Community Health Service (BFCHS) is a primary health service model grounded in the WHO and UNICEF Baby-Friendly standards, that systematically protects, promotes and supports breastfeeding through competent health professionals, coherent infant feeding policies, compliance with the International Code of Marketing of Breast-milk Substitutes and coordinated community action, with the aim of improving maternal and child health, reducing health inequalities and preventing both infections and non-communicable diseases.
In Norway, BFCHS was developed as an extension of the WHO/UNICEF Baby-Friendly framework into primary and community health care settings. The Norwegian model was formally evaluated and recognised as an EU Best Practice for NCDs prevention in 2022, demonstrating effectiveness in increasing the duration of exclusive breastfeeding.
Within JA PreventNCD, this Best Practice is being transferred and adapted across multiple European countries, confirming its relevance, scalability and policy value at European level.
Flowchart for Baby-Friendly Community Health Services Best Practice of Norwegian Direcotorate of Health
A European Journey in Community Breastfeeding Support, One Step at a Time
Across Europe, countries are advancing along a shared pathway to strengthen breastfeeding support within communities, adapting a common model to diverse social, geographic and health system contexts. This journey begins in the far north of Norway and gradually moves south, ending in the beautiful region of Castelló, Spain. Along the way, we explore how different regions in Europe are working to strengthen breastfeeding support and support health equity through the JA PreventNCD project.
In Norway’s northernmost region lies Finnmark, an arctic county of striking contrasts in nature –from vast tundra to rugged coastlines– under the midnight sun and the northern lights. The population of Finnmark has one of Norway’s lowest life expectancies, making health inequality a key concern. Of the county’s 18 municipalities, only two are currently designated as BFCHS.
As part of upscaling the BFCHS in the region 14 municipalities are now implementing the Best Practice within the JA Prevent NCD, supported by The Norwegian Directorate of Health. Local health professionals show strong commitment and enthusiasm, even as some of the municipalities face challenges such as long distances and depopulation, which affect both staffing and care delivery.
Most municipalities are completing the first stage of the process –self-assessment of the current situation– and are on their way to the stage 2 (see flowchart) on staff training and the development of infant feeding policies. A strong policy provides a shared direction and ensures consistency in the protection, promotion and support of breastfeeding, laying the groundwork for consistent and high-quality breastfeeding support across the region.
Snapshot of norweggian BFCHS location in Google Maps. Circle indicates the Finnmark’s region
From northern Norway, the implementation pathway extends south-east to Lithuania, a Baltic country with a long tradition of public health action. Here the goal is simple: to ensure that every family receives the best possible support on breastfeeding and infant nutrition issues. All 60 municipalities are strengthening the knowledge and skills of healthcare professionals who support mothers during this important period. Experts are updating counselling guidelines for breastfeeding mothers and ensuring compliance with International Code of Marketing of Breast-milk Substitutes.
Further to the east, in Ukraine, the implementation of BFCHS is taking place in the context of an ongoing full-scale war, which continues to challenge the whole healthcare system. Three primary health care facilities in the Kyiv region were selected as pilot sites, where facility teams engaged in a one-month infant feeding registration, which not only enabled data collection but also supported a shared understanding of breastfeeding practices at community level.
During the self-assessment process, health workers demonstrated a high level of motivation, when two of the facilities have completed the self-assessment process and the third one, despite a temporary pause, has confirmed its commitment to continue. UNICEF-recommended breastfeeding support training for health professionals and specialized webinars for both health workers and the communities have been delivered, strengthening knowledge, confidence and continuity of breastfeeding support even in times of uncertainty.
Approaching the Mediterranean coasts, BFCHS is being implemented in Patras with the support of the Institute of Child Health of Greece. The implementation lies on inspiring health professionals to promote breastfeeding within a supportive network connecting maternity hospitals and health centers.
Two primary healthcare centers have been chosen as implementation sites where experienced personnel promote breastfeeding through antenatal breastfeeding classes and personalized postnatal mother-baby care. Key achievements include the development of a common breastfeeding policy for all health sectors and the creation of a comprehensive database of public health services to strengthen referral pathways and continuity of care. Questionnaires and reflection notes have been adapted to the Greek health system's reality.
At the enclosure between the Alps and the Adriatic Sea, the National Institute of Public Health of Slovenia, collaborates with the National Committee for the Promotion of Breastfeeding (NOSD), operating under UNICEF Slovenia, to expand the network of Breastfeeding-Friendly Cities in the Koroška region, which includes 12 municipalities.
Each city commits to meeting 10 steps, including having breastfeeding-friendly health services, support groups and lactation counselors, as well as encouraging breastfeeding-friendly practices in local businesses. Outside the health sector, breastfeeding corners are available in pharmacies, kindergartens, parks, the central library, the intergenerational center, and the social work center. In the Municipality of Ravne na Koroškem, the local health center follows the 7 Stages to Successful BFCHS and the International Code of Marketing of Breast-milk Substitutes.
BFCHS training event in Calabria (Italy)
Beyond the Alps, the Italian implementation site lies in southern Italy`s Calabria region. A total of 17 municipalities within the Ionio Nord Health District have been recruited. The implementation involves over 40 community stakeholders including municipalities, associations, peer groups, health services and the general population.
According to the Italian Surveillance System data on children 0-2 years, exclusive breastfeeding rates at 4–5 months are among the lowest in the country, at just 21.6%, and health inequalities are high, especially related to education. Despite these challenges, motivated health teams and active peer support networks provide a strong foundation for expanding BFCHS.
The self-assessment form has been completed by the health centers and infant feeding policy have been elaborated. Knowledge update activities for healthcare staff and community (workshops and peer training) have been conducted and will continue as part of future activities.
Presentation meeting of the BFCHS implementation in Province of Castelló (Spain)
The Province of Castelló in the Valencian Community of Spain acts as the last scenario for BFCHS implementation. The implementation site comprises a health department serving nearly 240,000 inhabitants. It brings together 16 primary healthcare centers as pilot sites impacting in 21 municipalities in both urban and rural settings. The initiative mobilizes actions that will impact families and support municipalities and local stakeholders in creating baby- and breastfeeding-friendly environments.
In Spain, BFCHS implementation is coordinated by IHAN-Spain, a WHO/UNICEF-promoted non-profit organization. A distinctive feature of the Castelló experience is the use of IHAN’s joint designation modality, in which several centers progress together in the accreditation process. All 16 pilot centers participate in this model and are organized into two joint designation pathways: one cluster of 10 centers has reached an advanced stage and is currently undergoing documentary evaluation, while a second cluster of 6 centers is consolidating its infant feeding policy, action planning, and professional training activities.
From Arctic landscapes to Mediterranean cities, the BFCHS demonstrates that protecting and supporting breastfeeding is achievable across very diverse contexts when communities, health services and institutions work together. By sharing knowledge, adapting proven practices and strengthening cross-country collaboration, JA PreventNCD and partners such as Fisabio are helping shape a common European response to one of the most effective early-life prevention strategies.
Investing in BFCHS means investing in prevention where it matters most: at the very beginning of life. Strengthening breastfeeding support within communities not only improves health outcomes today, but also contributes to fairer, more resilient societies in the long term. Through JA PreventNCD and the sustained commitment of partners like Fisabio, this shared European journey continues—so that every family, everywhere, receives the support it needs and every child is given the best possible start in life.
JA PreventNCD team on Baby Friendly Communities and Health Services
Anne Bærug, Ann-Magrit Lona, Hanne Christine Mosand Bliksås, Gry Hay
Norwegian Directorate of Health, Norway
Angela Giusti, Francesca Zambri, Vincenza Di Stefano, Annachiara Di Nolfi, Flavia Splendore
Italian National Institute of Health, Italy
Marta Garcia Sierra
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Spain
Ieva Gudanavičienė
Ministry of Health of the Republic of Lithuania, Lithuania
Tjasa Bonca,
National Institute of Public Health of the Republic of Slovenia, Slovenia
Venetia Vraila, Chryssa Ekizoglou
Institute of Child Health, Greece
Yuliia Kotykovych
Public Health Center of the Ministry Of Health of Ukraine, Ukraine
Healthy Living Environments Communication Officer
Lluís Pascual
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Spain.
