Dear members of the Editorial Team,
It was with a mixture of amazement and delight that I read issue 2/2026 on the new AWMF S3 guideline on breastfeeding duration (Germany Ends Its Separate Course).
I’ve been waiting for this for a long time.
I worked for many years in the English clinical and outpatient healthcare system (the National Health Service, or NHS) in London, and after returning to Berlin, I could never understand the different approach in Germany. I share the confusion felt by mothers and colleagues about the separate course that Germany pursued until now, and I am surprised by the dominance of allergists’ views on breastfeeding duration – views which, unfortunately, are also shared by many paediatricians.
In the UK, the WHO’s recommendation applies to everyone working in the healthcare sector, and there are no alternative guidelines issued by other professional bodies.
Interdisciplinary collaboration between medical and non-medical staff takes place there with mutual respect and on a more equal footing.
UNICEF UK plays a very prominent role in the Baby-Friendly Initiative’s annual multidisciplinary conference. The conference is aimed at healthcare professionals and other interested parties within the healthcare system, including participants from across Europe.
There are many non-profit breastfeeding charities such as La Leche League and the National Childbirth Trust (NCT), most of which offer free breastfeeding counselling and support. The NHS publishes regular information leaflets on breastfeeding in line with the best-practice standards set by NICE (the National Institute for Health and Care Excellence). Postnatal midwifery services are not as well developed as in Germany; instead, more and more parents are consulting IBCLCs or other lactation consultants, who must be paid for privately. There are also breastfeeding groups run by non-profit organisations and local peer support schemes.
Sandra Deissmann’s article describes the process of drawing up the guideline very well and in clear terms.
Prof. Längler and Vera Hesels speak in clear, long-overdue, evidence-based terms to put an end to this confusion surrounding breastfeeding.
I believe the focus on public health recommendations is, by definition, very important: the goal is not to optimise individual cases, but to achieve the greatest possible health benefits at a population level.
Unfortunately, thinking in terms of public health categories is not very common in Germany, as we have a federal system and healthcare is the responsibility of the federal states. In my experience, centralised healthcare systems such as those in the UK and other countries have many advantages and are more effective than the highly fragmented German system, as has also been demonstrated by numerous studies.
The S3 Guideline on breastfeeding duration and interventions to promote breastfeeding published in February 2026 may be a first step in this direction.
There have been repeated efforts and discussions aimed at improving the public health service as part of a national public health strategy, particularly in the context of the coronavirus/Covid-19 pandemic. However, there is little evidence of any progress—given the current political climate and the financial need for reforms.
A 2019 article by Professor Rafael Pérez-Escamilla from the Yale School of Public Health in the USA entitled: “Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months?”, outlines the evidence behind the recommendations of the WHO and UNICEF and concerns about food allergies, iron deficiency and the baby’s readiness to start eating solid foods. The report concludes that there is no basis for changing the WHO and UNICEF recommendations.
It was also Professor Pérez-Escamilla who, in June 2019, presented the international research project “Becoming Breastfeeding Friendly” and the “Breastfeeding Gear Model” – developed by the Yale School of Public Health – at a highly regarded conference organised by the “Netzwerk Gesund ins Leben” in Berlin.
Regrettably, and without providing any evidence, the “Netzwerk Gesund ins Leben” has consistently adopted the German Allergy and Asthma Association’s (Deutscher Allergie- und Asthmabund, DAAB) stance on allergy prevention, which is at odds with the WHO and UNICEF recommendations followed by many midwives and lactation consultants.
I hope and sincerely wish that this guideline will finally provide clarity for mothers and healthcare professionals.
Many thanks!
Best regards,
Annette E. Sawatzki, IBCLC