The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier.

In the studies on ‘breast-feeding and infant nutrition in Germany’ named ‘SuSe’, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother–infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF.

Two nationwide surveys SuSe I (1997–1998) and SuSe II (2017–2019).

In SuSe I, 177 hospitals and 1717 mother–infant pairs and in SuSe II 109 hospitals and 962 mother–infant pairs were included.

In SuSe II, hospitals implemented seven of the WHO ‘Ten Steps to Successful Breastfeeding’ to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding.

In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.