Abstract
Several articles in this issue1–5 address the global problem of the short duration of breastfeeding, even though initiation of breastfeeding has increased to approximately 75% of mother–baby dyads—the World Health Organization's standard and the Healthy People 2020 goals. In Volume 6, Number 5, the report of the Third Summit on Breastfeeding, 6 held in Washington, DC, in June 2011, also focused on the deplorable duration in spite of improvement in initiation. At the Summit, the role of the Joint Commission was described. It was thought that the Joint Commission should be responsible for requiring all hospitals delivering perinatal care to meet the Ten Steps. 6 Each article in this group describes a mechanism to improve breastfeeding duration with interventions during pregnancy and especially after delivery and discharge home. The key issues are identified as education of the healthcare providers and the patients and a support system in the early weeks postpartum. The overarching theme is the need for involvement of the public health system and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which currently provides services for over 50% of all newborns.
Wallis et al. 5 point out that initiation of breastfeeding is dropping throughout Europe, especially in Romania, where resources have centered on hospital care. They provide evidence that a community-based public health program would be effective. The value of a prenatal education program in promoting extended duration is reported by Steube and Bonuck. 4
The important role of WIC in providing education and support to mothers, especially in the first few weeks at home, is confirmed in the evaluations and conclusions provided by Evans et al. 1 and Gross et al. 2 Both articles describe the impact of a well-designed and staffed program provided for WIC clients by 2 weeks postpartum.
One would conclude that further progress toward exclusive breastfeeding for the first 6 months will come from public health and WIC efforts in the community, not the hospital. If the Joint Commission takes the responsibility for assuring that all hospitals that deliver perinatal care meet the Ten Steps originally designed by UNICEF and the World Health Organization, then the money being poured into hospital-based programs can be redirected toward these urgent out-of-hospital efforts that are being shown to make a difference in duration and ultimately a large impact on health outcomes for a greater percentage of infants.
Although WIC is a United States–based program, there are similar programs elsewhere. The work from Romania describes similar problems and solutions. 5
The utilization of the internet for educational programs as described by O'Connor et al. 3 may well also address these out-of-hospital issues. It is hoped other investigators will test this hypothesis so resources can be directed at effective programs.
These studies1–5 suggest that we must rethink the global approach that focuses only on the first two days in the hospital. We must produce strong community resources that promote continued breastfeeding and support for mother and child at home, the original mission of WIC and backbone of public health efforts.