Breastfeeding is the cornerstone of child survival and development, particularly in resource-constrained settings [1]. Globally, an estimated 16% of deaths in children under two are attributable to suboptimal breastfeeding practices [2]. Robust evidence demonstrates that early initiation of breastfeeding, exclusive breastfeeding for six months, and continued breastfeeding alongside appropriate complementary feeding for up to two years or beyond reduce infant mortality, support optimal growth and neurodevelopment, strengthen maternal-infant bonding, and enhance immune function [3, 4]. In 2023, the World Health Organization (WHO) updated its guideline on Infant and Young Child Feeding (IYCF) to reaffirm these three core practices as global public health priorities, alongside new recommendations for protecting breastfeeding from commercial influence, ensuring maternity protection, and enabling workplace lactation support [2, 5]. These indicators serve as benchmarks for tracking progress and guiding national strategies, including Afghanistan’s commitments under the National Nutrition Strategy, which incorporates WHO-aligned targets for early initiation of breastfeeding, Exclusive Breastfeeding (EBF), and continued breastfeeding.

Over the past two decades, breastfeeding research has matured into a translational field informing both global policy and local interventions. Context‑specific studies in low‑resource environments have identified cultural norms, health‑system barriers, and community drivers of breastfeeding behaviors, leading to tailored IYCF programs and improved outcomes [3, 6]. In Afghanistan, existing plans, such as the National Nutrition Strategy and the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) framework, explicitly reference the WHO’s IYCF recommendations [7, 8]. Over the years, media platforms have supported the Afghan government in disseminating knowledge about appropriate IYCF practices in the community [9, 10]. Moreover, promoting appropriate IYCF practices is a central component of antenatal care (ANC) and postnatal care (PNC) services [11, 12]. However, gaps remain in generating local evidence to monitor these indicators and address persistent barriers. Strengthening the health research infrastructure and embedding WHO-aligned IYCF monitoring within program evaluation are essential for sustaining high-quality, policy-relevant studies in underserved settings [13]. Nonetheless, financing and budget allocation for breastfeeding research remain an obstacle in Afghanistan [13], confirming similar findings in other low-resource settings [14]. For example, currently, there is no budget for breastfeeding research in the Afghan Ministry of Public Health's yearly budget [13].

Afghanistan’s prolonged conflict, spanning the Soviet invasion, the U.S.‑led intervention and withdrawal, and ongoing political instability, has eroded health‑system capacity and exacerbated poverty, contributing to some of the highest rates of under‑five mortality and malnutrition globally [15, 16]. Despite the pivotal role of appropriate IYCF practices in reducing infant mortality [17], published data on breastfeeding patterns, determinants, and program impact in Afghanistan remain scarce. To address this gap, our commentary reviews the current landscape of breastfeeding research in Afghanistan and proposes strategic directions to strengthen the evidence base and inform country‑led policy and practice.

In this commentary, we developed a theory of change to link Afghanistan’s breastfeeding research gaps to feasible study designs, near-term outputs, measurable outcomes, and ultimate impact on IYCF practices. The theory of change specifies key assumptions, risks, and mitigation measures and is intended to guide a sequenced program of policy-relevant studies rather than a single project. Table 1 summarizes the research gaps, exemplar methods, indicators, and risk-management strategies; Fig. 1 presents the same logic as a schematic causal pathway. Together, these elements operationalize the agenda outlined in the “Future directions” section.

A schematic causal pathway and outcome measures for advancing breastfeeding research in Afghanistan