Impact of COVID-19 on maternal and child healthThe study by Timothy Roberton and colleagues (July, 2020), 1 which modelled the indirect effects of COVID-19 on maternal and child mortality in low-income and middle-income countries (LMICs), highlights potential consequences of disruptions to routine health care and decreased access to food. While the total projected impact is shocking, the analysis omitted modelling disruptions in breastfeeding practices because the authors "assumed only a marginal reduction in these activities." 1 The COVID-19 pandemic is already indirectly threatening breastfeeding practices (early initiation and exclusive and continued breastfeeding). Universal breastfeeding could prevent 823 000 child deaths per year, 2 yet additional examination as part of COVID-19 impact modelling is needed.During the COVID-19 pandemic, reductions in breastfeeding prevalence will plausibly occur due to limitations in the provision and use of health services and disruptions to the enabling environment. Limitations in the availability of skilled health workers and increased reluctance by women to use the health system could lead to lower coverage of antenatal care, postnatal care, and facility and communitybased lactation support and counselling. Anecdotal evidence suggests that some health facilities are inappropriately separating newborn babies from mothers and discouraging breastfeeding because of unfounded fears of transmission of COVID-19 through breastmilk. These situations might result in a decline in early initiation of breastfeeding after birth-missing the child's first natural vaccine (colostrum)-and, in turn, exclusive breastfeeding.The enabling household environment for breastfeeding can be
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