Activities and policies to promote health through breastfeeding
Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.
The World Health Organization (WHO) recommends infants should be exclusively breastfed for the first six months of life to achieve optimal health and development, followed by complementary foods while continuing breastfeeding for up to two years or beyond. However, currently fewer than 40% of infants under six months of age are exclusively breastfed worldwide.
Public health awareness events such as World Breastfeeding Week, as well as training of health professionals and planning, aim to increase this number.
Significance of breastfeeding promotion in the United States.
Breastfeeding promotion is a movement that came about in the twentieth century in response to high rates of bottle-feeding among mothers, and in recognition of the many health benefits to both mothers and children that breastfeeding offers. While infant formula had been introduced in developed countries in the 1920s as a healthy way to feed one's children, the emergence of research on health benefits of breastfeeding precipitated the beginning of the breastfeeding promotion movement in the United States. In the 1950s, La Leche League meetings began. The United States began incorporating benefits specific to breastfeeding promotion into its Women, Infants, and Children program in 1972. In 1989, WIC state agencies began being required to spend funds targeted at breastfeeding support and promotion, including the provision of education materials in different languages and the purchase of breast pumps and other supplies. In 1998, WIC state agencies were authorized to use funds earmarked for food to purchase breast pumps.
Each year, the Centers for Disease Control and Prevention release a Breastfeeding Report Card, detailing breastfeeding rates and promotion programs nationally and in all fifty states. In 2013, 76.5% of US women had ever breastfed their children; 16.4% exclusively breastfed up to six months of age. The Healthy People 2020 target for exclusive breastfeeding at six months is 25.5%. The proportion of infants who were breastfed exclusively or non-exclusively at six months was 35% in 2000 and increased to 49% by 2010.
Promotion techniques.
Effective support techniques for breastfeeding include support given by nurses, physicians, and midwives during and after pregnancy, regular scheduled visits, and support that is directed towards specific groups of people. Support has been shown to be effective when offered by both professional or peers, or a combination. Providing face-to-face support has been shown to be more likely to be successful for women who are breastfeeding exclusively. The evidence for 'breast feeding plus' (programs that include overall maternal and child health) was less certain. It is essential that healthcare providers receive high-quality training in clinical lactation to provide skilled and timely support to breastfeeding families.
Prenatal care.
The discussion of breastfeeding during early prenatal care can positively effect a woman's likelihood to breastfeed her child. During regular checkups, a woman's physician, midwife or other healthcare provider can initiate a conversation about the benefits of breastfeeding, which can influence a woman to breastfeed her child for a longer period of time than she might have otherwise. In addition, the involvement of lactation consultants in the prenatal visits of low-income women increases the likelihood that they will breastfeed.
Peer support and counseling.
Peer support techniques can be used before, during, and after pregnancy to encourage exclusive breastfeeding, particularly among groups with low breastfeeding rates. Breastfeeding peer counselors, who are ideally women who have breastfed who can provide information, support, and troubleshooting to mothers, have had a positive effect on the breastfeeding rate in American Indian populations. Peer counseling has also been effective at increasing breastfeeding initiation rates and breastfeeding rates up to three months after birth in Hispanic populations in the United States. In addition, peer counseling can be effective in encouraging not only exclusive breastfeeding, but also breastfeeding rates in combination with formula, or "any breastfeeding".
Peer counseling has had a strong effect on breastfeeding initiation and duration in developing countries such as Bangladesh and in areas where home births are more prevalent than hospital births. When combined with nutrition support, particularly the WIC program in the United States, the presence of peer counselors can have a significant effect on incidence of breastfeeding among low-income women.
Support during and immediately after childbirth can also help women initiate and continue breastfeeding while working through common concerns related to breastfeeding. This support can be non-medical, as doula care is. Culturally sensitive care (for example, care from a peer of a similar ethnic background) may be most effective at encouraging high-risk women to breastfeed.
Lactation consultants.
Lactation consultants are health care professionals whose primary goal is to promote breastfeeding and assist mothers with breastfeeding on an individualized or group basis. They work in a variety of health care settings, including hospitals, private doctor's offices, and public health clinics. Lactation consultants are board-certified by the International Board of Lactation Consultant Examiners. The majority of lactation consultants hold a certification in another healthcare profession, often as a nurse, midwife, dietician or physician. However, there is no specific post-secondary education required to become a lactation consultant.
In low-income contexts, interventions by breastfeeding consultants can be effective in promoting breastfeeding among high-risk populations. In one study, while exclusive breastfeeding rates were low in both control and intervention groups, black and Latina low-income women who had prenatal and postnatal support from a lactation consultant were more likely to breastfeed at 20 weeks than women who had not accessed this support. ;ref name="Bonuck/Trombley 2005" ; ;/ref ; In general, lactation consultants give a greater proportion of positive feedback to mothers regarding breastfeeding than either physicians or nurses do; the amount of positive advice that a first-time mother receives regarding breastfeeding from any health care provider can influence her likelihood to continue breastfeeding for a longer period of time.
Social marketing and media.
Social marketing has been shown to influence women's decision to breastfeed their children. One study found that in years when Parents magazine ran formula advertisements at a higher frequency, the proportion of women who breastfed often decreased in the following year. Conversely, women who are exposed to marketing that promotes breastfeeding are likely to breastfeed at higher rates.
The growth of the Internet's influence has also influenced women's choices in infant feeding. The Internet has served as both a vector for formula advertisement and a means by which women can connect with other mothers to gain support and share experiences from breastfeeding. In addition, social media is a category of advertising that did not exist when the International Code of Marketing of Breast-milk Substitutes was published; thus, while some advertising practices undertaken by formula companies on the Internet violated the Code, they did so in ways that could not have been anticipated.
One social medium used to promote breastfeeding is video. These videos are often independently filmed and produced by lactation consultants who seek a new way to reach clients. While the efficacy of these videos has not been formally studied, they are a relatively new medium of conveying messages about breastfeeding to women.
Cultural and social factors.
Ethnicity and breastfeeding promotion.
Breastfeeding initiation and duration varies significantly by race and ethnicity. The National Immunization Survey in the United States found that while 73.4% of all women in the United States initiated breastfeeding upon the birth of their child, only 54.4% of black, non-Hispanic women and 69.8% of Native American and Alaska Native women did. White non-Hispanic women initiated breastfeeding 74.3% of the time and Hispanic women had an initiation rate of 80.4%. However, one study found that in a low-income environment, foreign-born black women had a similar breastfeeding rate to Hispanic women; both of these rates were higher than that of non-Hispanic white women. In addition, native-born black women had a somewhat higher rate of breastfeeding than white women.
Immigrant status in the United States is a predictor for breastfeeding adherence. In particular, the Hispanic paradox plays a role in the high breastfeeding rates observed among Hispanic/Latina women in the United States. Breastfeeding initiation rates among this population are higher for less acculturated immigrants; Hispanic women who have been in the United States for longer are less likely to breastfeed. This disparity does not depend on age, income level, or education level; more acculturated Hispanics are likely to cite the same reasons for bottle-feeding as native-born white women do. In many cases, the connection that Hispanic women feel to their culture and its values can strongly influence their decision regarding breastfeeding.
Access to prenatal care, socioeconomic status, cultural influence, and postpartum breastfeeding support all influence the differing rates of breastfeeding in different ethnic groups. In the United States, black women are more likely than white women to report that they "prefer bottle-feeding" to breastfeeding, and they are also more likely to be low-income and unmarried and to have lower levels of education. The decision to bottle-feed rather than breastfeed is of similar importance to low birth weight in predicting infant mortality, particularly in regards to the black-white infant mortality gap. Thus, breastfeeding promotion initiatives focused on black women should emphasize education and encourage black women to prefer breastfeeding to bottle-feeding.
Experts attribute high mortality rates and under nutrition amongst infants to the decreasing number of woman who breastfeed. This delay in breastfeeding initiation increases the risk of neonatal mortality. Experts suggest breastfeeding within the first day of birth until the infant is 6-months old. Promotion of breastfeeding during this period could potentially reduce the mortality rates by 16% if infant was breast fed since day one and 22% if the infant was breastfed within the first hour. Rates of breastfeeding initiation vary with ethnicity and socioeconomic situations. Studies suggest that college educated women over their 30 are more likely to initiate breastfeeding in comparison to other women who have different levels of educational attainment.
Ethnicity, age, education, employment, marital status, and location are reported factors of delayed breastfeeding and infant under nutrition. Low- income mothers are specifically at risk for under nutrition and high mortality rates amongst their infants because they replace breast milk with formula. They do so because they lack a supportive environment, embarrassment of nursing, or the need to return to school or work. About 16.5% of low-income mothers breastfed for the recommended time. Studies suggest that scarce financial and social resources are consistent with the high mortality rates amongst the infants of low-income mothers.
An example of neonatal and infant mortality that is directly correlated with delayed initiation of breastfeeding is seen is sub-Saharan, Africa. Mortality rates are highest in this region of the world and have had the slowest progress to achieving reductions to the overall child mortality. Even if low-income mothers exclusively breast fed their infants for the 6 month – 1-year period, their infant is still at risk because most women commonly delay first day initiation of breast-feeding. Most women aren't aware that absence in breast milk put their infant at risk for serious health problems in the future. The Centers for Disease Control and Prevention (CDC) implements programs that promote and support breastfeeding and the benefits for infants and children. They compile many types of data so states can monitor progress and to educate expecting parents on the subject . But for other countries these programs aren't so common.
Socioeconomic influence.
Socioeconomic status of mothers likely has a larger influence on breastfeeding adherence than race or ethnicity, as many women who are members of groups with low breastfeeding rates also have a low socioeconomic status. Among women born in the United States, women who are wealthier are more likely to breastfeed. In addition, employment can influence the decision to breastfeed. When either parent was unemployed or held a lower-status occupation (such as labor or sales), their children were more likely to never have been breastfed. In addition, women with public insurance or with no health insurance are more likely to never have breastfed their children, as are women who receive WIC.
The time commitment of exclusive breastfeeding is also an economic constraint. The time required per week to breastfeed rather than bottle-feed or feed solids to children can be a significant burden for women without other childcare or who need to spend this time doing paid work. However, some evidence suggests that the long-term benefits of exclusive breastfeeding outweigh the short-term costs. In the United States, workplace policy surrounding breastfeeding and parental leave often does not reflect these benefits. In addition, women are often unable to risk the