Be Our Voice Blog

Thursday, April 5th, 2012

The Importance of Advocating for Supportive Breastfeeding Policies

Posted by: Kristi Fossum Jones, MPH

Historically, the decision to breastfeed has primarily been between mothers, infants, and—sometimes—doctors. But increasing evidence suggests that, even if a mother wishes to breastfeed her infant, the current healthcare system does not always provide the resources, policies, and knowledge to support her. According to a 2011 Vital Signs report published by the CDC, “less than 4 percent of U.S. hospitals provide the full range of support mothers need to be able to breastfeed.”1

And this issue isn’t isolated to primary care providers. In its most recent policy statement, the American Academy of Pediatrics (AAP) wrote that “Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.”2 Breastfeeding has been shown to have a wide array of health benefits for both baby and mom, from lowering the infant’s risk of developing diabetes and ear infections to lowering the mother’s risk of developing breast and ovarian cancers.1 But while most infants start off breastfeeding in the US, within the first week half have already been given formula; and by 9 months, only 31% of babies are breastfeeding at all.1 And low rates of breastfeeding add $2.2 billion a year to medical costs.1

Breastfeeding targets were included in the Healthy People 2010 goals set forth by the US Department of Health and Human Services. But despite this effort to promote the importance of breastfeeding as both a public health and personal health issue, the 2010 targets for breastfeeding duration and exclusivity were not reached. Breastfeeding was again added as part of the Healthy People 2020 goals, but without changes to the current healthcare system we might not achieve those targets, either.

That’s why organizations such as the Baby-Friendly Hospital Initiative and NICHQ offer programs designed not just to reach individual mothers, but to make health systems more supportive of breastfeeding. 

What does this have to do with childhood obesity and policy advocacy? Some research indicates that breastfeeding reduces the risk of childhood (and adult) obesity. In 2007, the US Agency for Healthcare Research and Quality (AHRQ) did a meta-analysis of studies on the health benefits of breastfeeding—including studies on breastfeeding and obesity.3 AHRQ’s analysis demonstrated that breastfed infants showed reduced risks of obesity and type 2 diabetes later in their lives, and that duration of breastfeeding is inversely related to the risk of developing obesity. The array of health benefits for mom and baby both is what makes supporting breastfeeding policies  a worthwhile focus for healthcare professional advocates.

Breastfeeding policy advocacy can happen on many levels, as outlined in the AAP’s Obesity Policy Opportunities Matrix:

  • In the maternity, delivery, and post-partum areas, healthcare providers can encourage and support new mothers as they learn to breastfeed. 
  • If implemented at the institutional level, Hospital Breastfeeding Policies can help ensure that all healthcare providers and staff follow the same breastfeeding protocols and distribute consistent, accurate information about breastfeeding.
  • Systems-level change can include supporting and implementing the10 Steps to Successful Breastfeeding across a hospital. For instance, NICHQ’s Best Fed Beginnings initiative will facilitate hospital participation in a learning collaborative to make institutional changes with the ultimate goal of becoming a designated Baby-Friendly hospital through Baby-Friendly USA.
  • In OB and pediatric offices, healthcare providers seeing pregnant mothers and newborns can provide individual encouragement as well as more tangible support like lactation areas for nursing mothers. And instead of handing out formula samples and coupons to expecting or new mothers, healthcare providers could distribute information about breastfeeding support groups and resources in the community.
  • Outside of healthcare settings, healthcare professional advocates can use tools like The Business Case for Breastfeeding to educate employers on the economic benefits of supporting lactating mothers in workplaces to increase employee retention after childbirth.
  • State-level advocacy provides opportunities to focus on state laws and policies related to breastfeeding, i.e. lactation areas in public places. 
  • At the federal level, the Affordable Care Act requires employers to provide space and reasonable break time for working women to express breast milk, which may open new doors for successful breastfeeding policy advocacy.  

Healthcare professional advocates working on childhood obesity have a plethora of possible focus areas. Breastfeeding is a crucial one because it offers so many health benefits to mothers and babies alike, and it is something that most mothers—regardless of race or socioeconomic status—can do for their infant with support. Healthcare professionals are positioned to provide that support as well as advocate that it be provided in workplaces and in the community. They can be credible and effective breastfeeding advocates because they work with mothers and infants from birth onwards; they have the relationships with patients and families to provide individual support; and they possess the knowledge and the resources to advocate for broader policies to support breastfeeding.

>> For more information about NICHQ's breastfeeding projects, go here.

>> For more information about NICHQ's Best Fed Beginnings initiative, go here.

References
1. CDC Vital Signs. “Hospital Support for Breastfeeding.” August 2011. http://www.cdc.gov/vitalsigns/Breastfeeding/index.html
2. AAP Policy Statement. “Breastfeeding and the Use of Human Milk.” Pediatrics Vol. 129 No. 3 March 1, 2012 pp. e827 -e841. http://pediatrics.aappublications.org/content/129/3/e827.full
3. Lau, Joseph et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2007. http://www.ncbi.nlm.nih.gov/books/NBK38337/

General Childhood Obesity 



Comments

From mothers milk
Posted Wednesday, December 31st, 1969 - 7:00 pm EST

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From Jonathan Goldfinger
Posted Wednesday, December 31st, 1969 - 7:00 pm EST

First off, great piece! Kudos for your strong arguments. As a pediatrician and breasteeding advocate I applaud your work. Regarding the following "In OB and pediatric offices, healthcare providers seeing pregnant mothers and newborns can provide individual encouragement as well as more tangible support", I think you need to consider how difficult it is for pediatricians and obstetricians to provide this service. Prior to the Affordable Care Act, reimbursement for lactation services or counseling was rarely. I have yet to find exact rates that can be anticipated based on this act, if we were to provide this service and it were to be upheld. It's essentially an hour's-worth of time that we can't see other patients and so would lose money. Where is the advocacy to support our efforts? In my opinion advocates focused heavily on the Baby Friendly Hospital movement have unfortunately neglected the idea that clinical practices in the outpatient setting can be Baby Friendly as well. NICHQ and breastfeeding advocates should be advocating for reimbursement of pediatrician and obstetrician counseling in the clinic, which has been proven to increase breastfeeding duration. I welcome any thoughts or response. Sincerely, Jonathan Goldfinger, MD, MPH jonathan.goldfinger@gmail.com


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