Abstract
The Academy of Breastfeeding Medicine (ABM) will be holding its annual international conference in the United Kingdom this year. A common admonition for rail travelers in the United Kingdom is to “Mind the Gap.” This common caution warns us to be careful of the gap between the train door and the rail platform. Not paying attention to the gap could result in harm or serious injury. As ABM members and physicians worldwide, we need to continue to be mindful of the significant gaps and barriers that exist to achieving optimal breastfeeding across the globe.
Chronic disease management and preventative medicine are regularly faced with gap analysis and the need to close gaps in our care. Some of that information is used by insurance companies, governments, and worldwide agencies to monitor the health of our populations. Gap analysis helps us identify where resources and initiatives are necessary to promote healthy interventions and that same analysis continues to be important for breastfeeding.
The most obvious gaps in breastfeeding occur in initiation and continuation rates of breastfeeding. Indeed only 41% of infants 0–5 months of age are exclusively breastfed worldwide. 1 Although we have made slow progress in improving breastfeeding rates, much more can be done. My hope is that with the presence of ABM, our initiatives and educational mission have made an impact on the medical community that is helping to close these gaps.
Lower socioeconomic status (SES), including less income, lower education, and unemployment, accounts for a significant reduction in breastfeeding initiation and continuation.
Reducing the gaps in breastfeeding rates that are affected by lower SES is a monumental task. Physicians can play a vital role in reducing this gap by advocating for our patients in these areas. Advocating for and supporting social programs that provide for adequate food, skills training, and policies that support paid maternity leave can be part of our contribution. Supporting baby friendly hospital initiatives, and staff training in our hospitals, offices, and communities will help to reduce the educational gaps that are barriers to providing consistent knowledgeable health care services related to breastfeeding.
Although several countries have given priority to breastfeeding support, we continue to have gaps in administrative, payor, and governmental policy support for breastfeeding. We all know the emphasis placed on closing gaps in other chronic disease management and prevention care. Both governmental and private insurance payors push us to close and admonish us for not filling gaps in care. However, we see little emphasis placed on breastfeeding and lactation in the same circles. Breastfeeding and the provision of human milk should be considered the ultimate primary prevention measure with its own gap analysis. Maybe “lack of breastfeeding” should be considered chronic disease management with an emphasis placed on providing breastfeeding and human milk to close that gap to improve care.
Gaps in breastfeeding education for our patients and communities occur at multiple levels. The best education occurs at home but, unfortunately, we have generations of children that have never witnessed breastfeeding and only know the feeding of a baby by a bottle. Elementary and high schools generally provide little if any education on breastfeeding as proper infant nutrition. Only in selected special courses would we see breastfeeding in any college curriculum. As physicians, we can identify gaps in our communities and advocate or become involved in offering our educational expertise to help close these gaps.
Probably the most significant gap that we have to mind is physician knowledge. As we all know, breastfeeding education in most medical schools, dental schools, and residencies is seriously lacking. Postgraduate continuing education also has limited events and emphasis on breastfeeding and human lactation. But there is some hope for closing this wide gap. The ABM and our regional network of conferences and educators are serving our mission to promote, protect, and support breastfeeding through education, supporting research, and disseminating knowledge worldwide.
Significant gaps still exist in many areas of breastfeeding support, such as peer support, father and family education, and general community education. There are also many gaps in governmental policies and cultural and ethnic support that need to be overcome. Our ABM Clinical Protocols, many now translated into several languages, are excellent sources of written support to help close gaps in these areas. Public perception or misconceptions, fostered by advertising and negative social media about breastfeeding and such things as skin-to-skin contact, supplementation, feeding on demand, and workplace support, are also gaps that physicians must help with closing.
For those attending the ABM International Meeting in the United Kingdom this year, I hope that when you hear “Mind the Gap,” that it has new meaning and prompts us to pay attention to the gaps we must overcome to promote the health benefits of breastfeeding worldwide.