Advancing breastfeeding research in Afghanistan: opportunities for policy and practice.

Background: Context-specific breastfeeding research has significantly improved infant health outcomes in many low-resource settings. Afghanistan, which has one of the world's highest under-five mortality rates, similarly stands to gain from evidence-based infant and young child feeding (IYCF) interventions. Optimal breastfeeding practices - early initiation, exclusive breastfeeding, and continued breastfeeding - are proven to reduce child mortality and improve child health. Yet Afghanistan lacks robust data on breastfeeding behaviors and determinants; decades of conflict and limited research capacity have left critical evidence gaps, hindering the development of effective, tailored IYCF policies and programs.

Breastfeeding research gaps and priorities in afghanistan: To address these gaps, this commentary presents a theory of change framework that links identified research needs to feasible studies, trackable indicators, and policy impact. The theory of change outlines key assumptions and risk mitigation strategies to guide a sequenced, policy-relevant research program. Based on the identified gaps, six priority research areas are highlighted: (1) assessing mothers' IYCF knowledge and communication channels to inform education campaigns; (2) exploring cultural and religious influences on feeding practices (e.g., rationales for prelacteal feeding); (3) evaluating and adapting proven breastfeeding support interventions (peer support groups, mobile health) for the Afghan context; (4) investigating emerging challenges to optimal breastfeeding (formula marketing, bottle-feeding trends, workplace barriers); (5) strengthening health system and community support for breastfeeding (enhancing healthcare provider training, counseling services, and enforcement of maternity protection policies); and (6) piloting the feasibility of donor human milk banking in select provinces. Collectively, these studies should aim to generate actionable evidence and measurable outcomes to drive improvements in breastfeeding policy and practice.

Conclusion: Achieving this research agenda will require investment in local research capacity and strong political commitment. Key recommendations include establishing a multi-stakeholder Breastfeeding Research Working Group under the Ministry of Public Health (MoPH), securing dedicated funding for breastfeeding research in national health programs, and fostering cross-sector partnerships to ensure that new evidence is translated into policy and practice. By aligning research efforts with national priorities, Afghanistan can harness breastfeeding's lifesaving benefits to improve child survival and well-being.