Table 3 Suggested actions for improving breastfeeding practices in South Africa

Community level actions

· Implement a national media and communication campaign for health workers and the general public promoting breastfeeding as a key intervention to reduce child mortality

· Communicate the importance of early initiation of breastfeeding [39]

· Communicate the benefits of exclusive breastfeeding for the first 6 months in HIV-positive and HIV-negative women [40][15]

Health service level actions

· Train all health workers in the benefits of exclusive breastfeeding, including doctors, nurses, dieticians and community health workers during initial training and reinforce during in-service training

· Rapidly increase the proportion of hospitals with Baby Friendly status [41]

· Employ breastfeeding counsellors in health facilities and at community level

· Train existing community health workers to support breastfeeding and establish a system of home visits to women postpartum for lactation support

· Avoid using formula milk in health facilities

· No advertising of formula in health facilities

Policy level actions

· Restrict advertising/promotion of formula, including at professional conferences.

· Review the current policy of provision of free formula milk to HIV-positive women [43]

· Legally enforce the Code of Marketing of Breastmilk Substitutes [42]