Abstract
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That the problem is not solely one of the medical condition of the maternal–infant dyad or lack of family support or a reflection of different sociocultural variables was emphasized in a recent (2014) Centers for Disease Control and Prevention report entitled “Racial disparities in access to maternity care practices that support breastfeeding—United States, 2011.” 2 The investigators linked data from the ongoing Maternity Practices in Infant Nutrition and Care survey with U.S. Census data on percentage of blacks in different zip code areas. The linkage documented an inverse relationship that wherein the percentage of blacks was higher than the national average, there was a lower availability of facilities that would allow for meeting recommended maternity practices that support breastfeeding. In particular, what was striking was the reduced availability in these geographic areas of facilities that provided rooming-in or hospital practices that facilitated early initiation of breastfeeding or minimizing of routine formula supplementation. Simply put, there were blatant racial disparities of access to maternity care practices that have been documented to support breastfeeding, a situation that highlights the inherent deficiencies and biases of the system, clearly a problem beyond any individual mother's failings.
Somewhat in contrast is another study published in this issue of Breastfeeding Medicine entitled “Relationship of maternal perceptions of workplace breastfeeding support and job satisfaction” by Waite and Christakis. 3 The authors compared the degree of support and job satisfaction at two major corporations that adjusted their work schedules to comply with the newly mandated regulations of the U.S. Affordable Care Act. This Act mandates that employers provide reasonable break time for mothers who chose to pump (or nurse) during their regular work time. Not surprisingly, there was a direct correlation of the degree of support and job satisfaction with benefits to both the employer and employee. What was most interesting, however, was the difference between the two corporations in what was the key element that defined “support.” In one, it was support from coworkers and managers, and in the other it was the flexibility of time and schedule. These differences reflected the nature of employees' status. In the corporation where the mothers were shift workers, who were paid an hourly wage, worked fewer than 40 hours per week, and had little control over their daily schedules (i.e., more likely lower paid at lower skilled jobs), the goodwill and support of coworkers were critical. In contrast, for the women at the large corporation, where the mothers were salaried full-time professional employees, the degree of flexibility in their day-to-day schedules was critical. These differences clearly reflect the socioeconomic realities of mothers working in different settings and the unique problems of breastfeeding support of minority, less educated, less skilled mothers in the workforce.
Thus, once again Breastfeeding Medicine highlights the complexity of developing a comprehensive support system for breastfeeding success. These two articles, along with the other reports in this month's issue, which focus more on the interrelationship of maternal hormonal, neuroendocrine, or dietary status on the biochemical constituents of breastmilk and their ultimate impact on breastfeeding outcome, are testimony to the variety, quality, and practicality of information that is being presented to the readers of Breastfeeding Medicine.