The recent attempt by U.S. representatives to the World Health Assembly to reduce support for global infant nutrition guidelines represents a new low in promoting global public health. World Breastfeeding Week gives us reason to review hard facts and real news about how and why to support nursing mothers and their infants.
First, the good news: the importance of breastfeeding for infant survival and health continues to be appreciated. This includes early initiation (starting breastfeeding within one hour of birth) and exclusive breastfeeding (feeding only breast milk for the first six months of life). Recent data from Tanzania confirm that compared with early initiation, delayed breastfeeding initiation is associated with a 48 percent higher risk of difficulty breathing during the first six months of a child’s life, an important finding in countries where pneumonia is a common cause of death.
Infant feeding is a personal parental decision and society has a responsibility to assure that each family has the information and social support to make this informed personal choice.
Second, in many countries, breastfeeding rates are rising. According to the CDC, U.S. breastfeeding initiation has risen from 73 percent in 2004 to 83 percent in 2014, over half of infants are breastfeeding at six months, and almost one third are breastfeeding at 12 months. This means that more infants and young children are receiving nutritional, immunologic, growth and emotional factors that are their biological norm. Studies now show that these benefits extend into adulthood, and are mediated by important changes in infant metabolism, immune function and the microbiome (the large population of commensal microbes residing in the human gastrointestinal tract).
Next some hard facts about why we need to do even better. Globally, practices lead to 823,000 child deaths each year; of these, an estimated 721 child deaths and 2619 maternal deaths occur in the U.S. alone. Annual morbidity from suboptimal breastfeeding in the U.S. includes 600,000 ear infections, 2.6 million gastrointestinal illnesses, 5,000 cases of breast cancer and more than 900 maternal heart attacks. Personal and family losses, additional health care costs, compromised economic productivity from lost work days for parent and child illnesses are staggering. In the U.S. alone, suboptimal breastfeeding costs $13 billion per year for preventable infant and maternal illnesses.
Health disparities permeate US health care and culture and they begin with pregnancy and the first food — human milk. Compared with their white counterparts, African American mothers are 57 percent more likely to receive inadequate (late or no) prenatal care, almost twice as likely to deliver prematurely, and 23 percent less likely to breastfeed. Safety net hospitals, those that treat high proportions of Medicaid and uninsured patients, are more likely to treat mothers with high risk pregnancies and premature babies, but are less likely to provide donor human milk. Use of donor milk results in better short and long term health outcomes for babies and in more mothers breastfeeding in hospital and on discharge.
Support for newborns and their parents must reach beyond the walls of hospitals, health clinics and medical offices. For example, the U.S. is the only high-income country that does not have national paid parental leave. As a result, almost a quarter of employed women return to the workplace within 10 days of birth. The lack of a clear social policy to support women’s ability to heal from birth and nurture their children, however they feed them, is known to undermine breastfeeding. Several states and some companies already have various paid parental leave policies in place, with no detrimental effect on business or the economy. Finally, peer support groups, Baby-friendly Hospitals (that promote optimal infant nutrition practices), lactation consultants, health provider education, appropriate use of donor milk and other steps are all important ways to support breastfeeding mothers.
Infant feeding is a personal parental decision and society has a responsibility to assure that each family has the information and social support to make this informed personal choice. Whatever each family decides, as a society, we must normalize breastfeeding wherever mothers and their babies are for as long as they choose to nurse — work places, playgrounds, airplanes, schools, places of worship and physical activity.
We and others believe that women (and their families and societies) should not be denied access to support for successful, early and exclusive breastfeeding.
About the authors: Naomi Bar-Yam, Ph.D., is executive director of Mothers’ Milk Bank Northeast and president of the Human Milk Banking Association of North America. Christopher P. Duggan, MD, MPH, is director of the Center for Nutrition at Boston Children’s Hospital, professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard TH Chan School of Public Health.