Abstract
For this reason, HHS is developing a new Call to Action on Breastfeeding led by the Office on Women's Health, the Centers for Disease Control and Prevention, and the Office of the Surgeon General. Specific action steps for a societal approach to supporting breastfeeding mothers, infants, and families are called for. Input was sought from a wide array of partners, including testimony from medical, nursing, and breastfeeding organizations as well as private industry.
HHS also encouraged a national dialogue on breastfeeding and invited public comments through www.womenshealth.gov. Within the 6-week open-comment period, from April 15 to May 31, 2009, 2,354 respondents representing individuals and organizations submitted comments regarding policies, programs, initiatives, and activities that promote, support, and protect breastfeeding. Respondents belonged to the following representative groups: Breastfeeding Coalition Representative; Concerned Citizen; Employer; Health Professional Organization; Lactation Professional; Nonprofit Organization; Public Health Worker; Researcher; State or Local Government; Community Organizer; Healthcare Provider; and Industry Representative. Major themes and key points from respondents, based on 11 broad topic categories, are summarized below.
Access to Lactation Care and Support (288 Respondents)
Reimbursement for lactation services is a crucial link to access for mothers across all social economic levels. The lack of reimbursement has created a gap in access between women who can afford lactation services and those who cannot. Early postdischarge support is key to maintaining lactation for new mothers. Numerous geographical and cultural concerns prevail, affecting rural areas, Native American communities, and African American mothers. Bilingual lactation services are important for reaching Hispanic mothers.
Community Support for Breastfeeding in Complementary Programs (101 Respondents)
Complementary programs such as Early Head Start and Healthy Start provide an effective medium to provide support and education to breastfeeding mothers because many of the programs have extensive follow-up and home services that provide one-on-one interactions with mothers and families. Staff in these programs should be trained in providing basic breastfeeding information and education, and there should be coordination of efforts at all levels of government so that mothers are receiving accurate breastfeeding information and assistance.
Health Professional Education, Publications, and Conferences (146 Respondents)
Many physicians and other healthcare personnel are not adequately trained to manage lactation and will often provide inaccurate or conflicting information, inappropriately advise use of formula, and fail to appropriately refer to the services of a board-certified lactation consultant. Lactation management should be incorporated into the medical curriculum. Physicians and other providers who work with mothers and infants should acquire a basic knowledge of lactation principles.
Maternal and Infant Care Practices: Prenatal, Hospital, and Postdelivery Care (515 Respondents)
There should be consistent, not conflicting, breastfeeding messages and continuity of care from all disciplines interacting with the mother and infant pair. 2 Many of the current hospital policies present barriers for successful breastfeeding. Birthing hospitals should observe the principles of the Baby-Friendly Hospital Initiative. Surveys such as the Centers for Disease Control and Prevention's Maternity Practices in Infant Nutrition and Care are valuable and should continue. The midwifery model is successful and enhances breastfeeding. Hospitals that provide appropriate, evidence-based lactation management principles provide the assistance and support new mothers need to become successful in their breastfeeding efforts.
Paid Maternity Leave (302 Respondents)
Mothers often feel torn that they must decide between working to contribute to the financial needs of the family or staying home to breastfeed, bond, and nurture their baby. Breastfeeding becomes a challenge when mothers must leave their infants, often when breastfeeding is just becoming well established. Ideally, paid maternity leave would mitigate some of that financial burden and enhance opportunities for successful breastfeeding and mother–infant bonding.
Peer Support and Education of Family Members and Friends (91 Respondents)
A new mother's family and friends may have substantial influence on her decisions about breastfeeding. Therefore, they should be included in educational efforts that promote breastfeeding. Peer counselors and mother-to-mother support play a vital role in providing breastfeeding mothers with needed support and contribute to longer breastfeeding duration.
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media (176 Respondents)
The media presents such a powerful opportunity to reach a variety of audiences with the message that breastfeeding is normal infant feeding and part of our parenting culture. Women need to see other women, portrayed in the media and in everyday life, who are breastfeeding. Media images need to represent all ethnic groups and include images of family.
Support for Breastfeeding in Public Settings (217 Respondents)
Breastfeeding in public is an emotional topic. Many mothers would like to see symbols that welcome breastfeeding mothers, indicating that a clean and comfortable setting is available for nursing. Other mothers believe they should have the right to nurse their infants whenever he or she is hungry, regardless of the location. Breastfeeding laws exist that allow public nursing in most states. More educational efforts are needed so that breastfeeding becomes the cultural norm.
Worksite Lactation Support, Onsite Child Care, and Milk Expression (248 Respondents)
Returning to work poses many challenges to the working breastfeeding mother if she does not have accessibility to a clean, private place to pump or if she is not allowed adequate time for pumping during her breaks. These challenges may lead a mother to discontinue the breastfeeding relationship and not meet the recommended goal of at least 6 months of exclusive breastfeeding. On-site daycare presents an ideal scenario for mothers to access their infants during the workday for breastfeeding. However, many worksites are not capable of meeting the regulations and requirements for on-site daycare.
Use of Banked Breastmilk (114 Respondents)
In situations where the mother's own milk is not available, human milk banks provide pasteurized, screened donor milk as the next best option. Medical practitioners who provide care to sick infants should be educated about the benefits and made aware of this option. Banked milk should only be processed and dispensed according to the Guidelines of the Human Milk Banking Association of North America. 3
Research and Surveillance (57 Respondents)
Optimal breastfeeding practices must be promoted and supported through ongoing research and continued surveillance and may include: a National Institute or Consortium on Breastfeeding that would provide opportunities for researchers to collaborate with other researchers, public health professionals, and behavioral scientists; a multistate data quality improvement initiative for improving data sharing, networking, and communication between states; electronic health records to include lactation and infant feeding information for continuity of care; and additional research on the economic impact of breastfeeding in the United States.
Footnotes
Disclosure Statement
No competing financial interests exist.