Abstract
Washington leadership has gone a long way to facilitate the progress being made. Washington and its agencies have provided directions, funding, and the credibility and the impetus to increase breastfeeding by tracking the numbers meticulously. The formation of the work group has been led by the Centers for Disease Control and Prevention, which has been a long-standing recommendation. The National Prevention Council is charged with implementing, across federal agencies, evidence-based health interventions such as breastfeeding. Breastfeeding advocates have a great opportunity to provide guidance to this Council, according to Jeffrey Levi of the White House Advisory Group.
The payers have come to the table to listen and design a plan to improve the duration of breastfeeding, promote total breastfeeding, and avoid supplementation affordably. The Women, Infants, and Children Program has taken an active role in managing the most challenging group of new mothers who have not been breastfeeding.
The hospitals and healthcare facilities have major responsibility for promoting breastfeeding and assuring its success with good healthcare practices. Senator Harkin has promised to hold hearings about food additives and distribution of formula in hospitals. He shall be reminded of this promise.
In addition to those who pay for health care are those who pay in the workplace, where women need accommodations in time and space to continue breastfeeding while returning to work. It was pointed out that it costs a mother to breastfed because it costs in lost wages and increased out-of-pocket expenses, especially for a breast pump. Disturbing news about how individuals judge the competency of mothers who breastfeed in the workplace was proclaimed. The culture in which mothers breastfeed remains an uncharted area of concern in need of further exploration.
Vigilant monitoring of the birthplace, the workplace, and the community must be sustained systematically. The Joint Commission has the responsibility of maintaining hospital quality of care. The Commission should require all hospitals that provide prenatal care to meet the UNICEF/World Health Organization Ten Steps (Senator Harkin promised to monitor this). Our laws can provide the mandates for the work place.
Selling it is the challenge. To walk the line between zealots and disbelievers is a talent being learned. The evidence is overwhelming that supports breastfeeding as critical to good health in the mother and baby. The discussion is over, but the promotion is timid and weak.
The economics of breastfeeding is still being explored. Dr. Phelps spells out the questions. He asks what the payoffs are month by month that accrue from extending breastfeeding. He asks how much does exclusivity matter? Furthermore, he asks what interventions would provide the greatest increases in breastfeeding success for mothers of different socioeconomic backgrounds? He suggests a randomized controlled trial that would include a large cohort of mothers and babies. This would require the cooperation of health insurers, government agencies, and/or foundations, the medical and healthcare community, and skilled researchers to do it.
So what are the immediate next steps? For hospital care it is urgent that the Joint Commission accept its responsibility for perinatal care that meets the Ten Steps. Where Baby-Friendly Hospital Initiatives can be involved, although costly, they will increase hospital awareness. The business case for breastfeeding endeavor is doing well and needs to persevere, one company at a time, until the legal mandates can be established.
We have not involved the education system yet; although New York State developed a K–12 curriculum on breastfeeding in the 1980s, it has been smoldering. Our children need to grow up knowing breastfeeding is the norm.
The third-party payers need to see their role and design their own methods to reimburse for breastfeeding services that will yield for them the monetary benefits of a healthy population.
Summit III made progress. There is more progress to be made. New players have to be added from the field of healthcare economics and from primary public school education and professional education. There must be a Fourth Summit, and there may surely be a Fifth.