Executive Summary The Surgeon General's Call to Action to Support Breastfeeding

Mothers and Their Families

Encouraging women to discuss their desire and plans to breastfeed with their clinicians, family and friends, employers, and child care providers is key. When a woman has decided she wants to breastfeed, discussing her plans with her clinician during prenatal care and again when she is in the hospital or birth center will enable her clinician to give her the type of information and assistance she needs to be successful. Family members—including spouses, partners, and the baby's grandmothers—can play critical support roles, both with regard to assisting in decision-making about how the baby is fed and in providing support for breastfeeding after the baby is born.

Communities

A mother's ability to begin and to continue breastfeeding can be influenced by a host of community factors. The communities where we live, work, and play—urban, rural, neighborhoods, and apartment buildings—are where we feel most comfortable. Mothers can learn about breastfeeding in prenatal classes and by discussing their interest in breastfeeding with a variety of people. In addition, women can turn to other mothers in their community, whether they are family, friends, or women they have met through mother-to-mother support groups, as well as women who are knowledgeable and have previous experience with breastfeeding. Community-based groups should include family members such as fathers and grandmothers in education and support programs for breastfeeding. Community-based support groups such as La Leche League and programs such as the U.S. Department of Agriculture's WIC program can expand the support that women ideally have received in the hospital and help extend the duration of breastfeeding.

Marketing of infant formula within communities is another influence on breastfeeding. Research indicates that advertising infant formula can deter exclusive breastfeeding and the effect may be stronger among women who do not have well-defined goals for breastfeeding.

Health Care

Nearly all births in the United States occur in hospital settings, but hospital practices and policies in maternity settings can create barriers to supporting a mother's decision to breastfeed.

National data from the Centers for Disease Control and Prevention's (CDC) ongoing survey of Maternity Practices in Infant Nutrition and Care (mPINC) indicate that hospitals have opportunities to implement practices in labor, delivery, and postpartum care, as well as in hospital discharge planning, that support mothers who want to breastfeed.

Once home from the hospital, mothers need support to continue breastfeeding. Support from health care professionals is particularly important at this time; however, many health professionals need more breastfeeding education and training themselves and often have time constraints that can present barriers. One way this issue is addressed is through coordinated health care systems that partner with community networks to provide breastfeeding support so mothers have access to breastfeeding assistance after they return home. New mothers need access to trained individuals with established relationships in the health care community who are flexible enough to meet mothers' needs outside of traditional work hours and locations, and provide consistent information.

International Board Certified Lactation Consultants (IBCLCs) are an excellent source of assistance for breastfeeding mothers. IBCLCs are health care professionals certified in lactation management. They work with mothers to solve breastfeeding problems and educate families and health care professionals about the benefits of breastfeeding. Research shows that rates of exclusive breastfeeding and of any breastfeeding are higher among women who have had babies in hospitals with IBCLCs on staff than in those without these professionals.

Employment

Employment is now the norm for U.S. women of childbearing age (20–44 years). In 2009, half of all mothers with children younger than 12 months were employed, and more than two-thirds of those employed worked full-time (35 or more hours per week).

Employed women have been less likely to initiate breastfeeding, and they tend to breastfeed for a shorter length of time than women who are not employed. Most employed mothers who are lactating have to pump milk at work for their children and need to be provided with accommodations to do so.

In 2010, the Affordable Care Act (ACA) included a provision for employers to provide workplace accommodations that enable employees who are breastfeeding to express their milk. Specifically, the ACA amends the Fair Labor Standards Act of 1938 by having employers provide reasonable, though unpaid, break time for a mother to express milk and a place, other than a restroom, that is private and clean where she can express her milk.

Given that 26 percent of mothers employed full-time in 2003 were breastfeeding when their infant was aged six months, it is clear that a substantial percentage of U.S. mothers manage to combine breastfeeding and paid work. However, U.S. mothers overall have less support for continuing to breastfeed after returning to work than is recommended by the International Labor Organization. In 2009, 15 U.S. states required that employers support breastfeeding employees when they return to work.

Research and Surveillance

Although there is a body of research on breastfeeding, significant knowledge gaps are evident. These gaps must be filled to ensure that accurate, evidence-based information is available to parents, clinicians, public health programs, and policymakers. For example, more research is needed on the barriers to breastfeeding among populations with low rates of breastfeeding. Economic research is also needed on how breastfeeding affects mothers and employers, as is research on best practices for management and support of lactation and breastfeeding. Building capacity for research on breastfeeding should be a priority by strengthening surveillance at state and local levels.

Public Health Infrastructure

An effective national public health program requires the basic coordination and monitoring of services. Within the federal government, numerous agencies have developed programs on breastfeeding, and others have programs that affect breastfeeding indirectly. Although the work of each of these agencies is valuable, the creation of a federal interagency work group on breastfeeding could enhance coordination and collaboration across agencies to improve support for breastfeeding.

Through the technical assistance of the U.S. Breastfeeding Committee (USBC), all 50 states have now formed breastfeeding coalitions, and there are many local, tribal, and territorial coalitions as well. These coalitions mobilize local and state efforts to promote and support breastfeeding. The USBC supports state coalitions with technical assistance, web-based communications, and a biannual conference. However, most of these coalitions are small and unfunded. Additionally, except within the WIC program, most state health departments do not have staff responsible for breastfeeding activities, making it a challenge to carry out new breastfeeding programs at the state level.

Key Barriers to Breastfeeding