Improving the world, one breastfeeding dyad at a time

This fall, I had the honour to represent the Academy of Breastfeeding Medicine (ABM) at the 64th annual conference of the UNO DPI/NGO in Bonn (Germany). The theme of this conference was “Sustainable Societies, Responsive Citizens”. This theme was discussed in plenary discussions, panel discussions, Round Tables and workshops. Emphasis was also placed on youth participation. They partly had their own program but also joined in the regular discussions. There was a large NGO exhibition, and between the discussions and through an official invitation for a reception by the city of Bonn, there was much time to meet with persons of organisations from around the world.

What a difference five years makes

Breastfeeding advocacy has come a long way in the past five years. In 2006, then MA-Governor Mitt Romney shut down efforts to stop hospitals from marketing formula to new mothers, arguing that a ban on marketing of branded formula took choices away from parents. Five years later, news that fewer hospitals are distributing the bags was largely embraced in the press as progress for mothers and babies.

The shift reflects a powerful change in the way public health advocates have approached breastfeeding over the past decade. We’ve moved away from goading mothers to “try harder” to addressing the barriers that prevent mothers from achieving their own infant feeding goals. For example, consider the language around breastfeeding in the Healthy People 2010 goals, published in 2000. Commenting on progress from 1990 to 2000, the authors write:

…evidence is encouraging about increases in women’s use of health practices that can help their own health and that of their infants… The percentage of mothers who breastfeed their newborns also went up 18.5 percent between 1988 and 1998, with greater gains among African American and Hispanic women.

By framing the discussion as “women’s use of a health practice,” the implication was that women needed to try harder to breastfeed. Healthy People 2010 set goals to increase breastfeeding iniation and continuation at 6 and 12 months to 75%, 50% and 25%. Notably, none of the HP2010 goals addressed barriers that might influence whether mothers were able to meet those targets.

The difference in the Healthy People 2020 goals is striking. Again, there are goals for breastfeeding rates — but HP2020 also targets workplace lactation programs, unindicated formula supplementation in the hospital, and the Baby Friendly Hospital Initiative. We’re not telling mothers to try harder — we’re telling hospitals and workplaces to make it easier for mothers to succeed.

That difference in focus is making an impact in myriad ways. This summer, during world breastfeeding week, the CDC issued a report linking poor maternity care practices around breastfeeding to the childhood obesity epidemic. The tag line? “Hospital Support for Breastfeeding: Preventing obesity begins in hospitals.”

Last week, California Governor Jerry Brown signed legislation to require all maternity centers in California to adopt an infant feeding policy modeled on the Baby Friendly Hospital Initiative. Echoing the CDC’s approach, the legislation notes, “A growing body of evidence indicates that early infant-feeding practices can affect later growth and development, particularly with regard to obesity.”

This legislation shifts the onus for obesity prevention away from individual moms to the hospitals that set mothers and babies up to succeed — or fail.

It’s a breakthrough change, brought about by the thoughtful arguments of public health leaders working on the Surgeon General’s Call to Action to Support Breastfeeding and by bloggers that have made “booby traps” a trademarked phrase. We’ve got plenty of work left to do, but look how far we’ve come.

Alison Stuebe is an ABM member and a maternal-fetal medicine physician at the University of North Carolina in Chapel Hill.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Highlights from Third Annual Summit on Breastfeeding: First Food–The Essential Role of Breastfeeding

Riding home on the train from Washington DC Thursday night, I was utterly physically exhausted as my mind tumbled over everything I had heard during the past two days.  I was returning from the Third Annual Summit on Breastfeeding.  For those of you who aren’t familiar with this Summit, I am going to unapologetically copy from the announcement of this Summit, as they said it better than I can!

“The First Annual Summit, held in June 2009, marked the 25th anniversary of the Surgeon General’s Workshop on Breastfeeding and Human Lactation, a milestone event led by C. Everett Koop, MD in 1984. Dr. Koop also delivered opening remarks at this 21st century follow-up.

The Second Summit in June 2010 addressed the unmet health needs of underserved mothers and their vulnerable children associated with low rates of breastfeeding, working proactively toward reducing barriers to breastfeeding. The goal was to bring high-level visibility in order to generate timely and judicious policy recommendations for a national breastfeeding agenda under the new health reform plan.

The Third Annual Summit on Breastfeeding was just held June 29-30, 2011 to make sure that we continue our best efforts to guarantee support for First Food: The Essential Role of Breastfeeding.  The Summit again took place in Washington to ensure maximum visibility in the public policy arena.

With continued support from the Kellogg Foundation, key leaders in health and public policy, including high-level representatives from key federal agencies as well as hands-on grass roots administrators from important programs throughout the country and leaders from academic institutions, industry, nonprofits, and public agencies were invited.”

The significant accomplishments of the First Summit and the Second Summit are documented in special supplements of Breastfeeding Medicine.  The Third Summit will be published in detail in an upcoming issue of Breastfeeding Medicine—so be on the look-out for Volume 6 Issue 5 in October.

WIC Peer Counseling Program essential for public health

A proposed amendment to the Agriculture Appropriations Bill would eliminate funding for the WIC Peer Counseling Program, an important source of breastfeeding support in communities throughout this country.

“The science clearly shows that peer counselors increase breastfeeding success and this is a key tool in addressing current disparities,” says Jerry Calnen, president of the Academy of Breastfeeding Medicine.

The amendment, proposed by Virginia Foxx, (R-NC), would remove existing funding for the WIC Peer Counseling Program established under former President George W. Bush.

The WIC Program serves families with incomes less than $27,214 for a family of two. WIC serves over four million children, with two-thirds below the poverty line. These families are less likely to initiate breastfeeding, and less likely to continue breastfeeding. By now it is well-documented that peer counseling does make a difference.

Not breastfeeding is associated with substantial health risks for both mother and child. Infants who are not breastfed face increased risks of ear infections, diarrhea, pneumonia, obesity, diabetes, childhood leukemia and sudden infant death syndrome. Among mothers, not breastfeeding is associated with increased risks of type 2 diabetes, breast and ovarian cancer, high blood pressure, and heart attacks.

A recent study found that suboptimal breastfeeding rates incur $13 billion in excess health costs each year.

“Disparities in breastfeeding lead to lifelong disease burdens for mothers and children,” Calnen said. “Peer counseling programs to reduce these disparities are essential.”

Announcing our Newest Protocol: ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation) (First Revision June 2011)

I am pleased to announce our newest protocol has been published in Breastfeeding Medicine: ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation) (First Revision June 2011).  This is a revision of the previously entitled ABM Clinical Protocol #10: ‘‘Breastfeeding the Near-Term Infant (35 to 37 Weeks Gestation)”.  As this protocol starts out explaining:

“At the time this protocol was first written ‘‘near-term’’ infant was commonly used to describe infants born in the few weeks before the 37th week of gestation. In July 2005 a panel of experts assembled by National Institute of Child Health and Human Development designated infants born between 34 0/7 to 36 6/7 weeks of gestation as late preterm to emphasize the fact they are really ‘‘preterm’’ and not ‘‘almost term’’ and establish a uniform designation for this group of infants.  This definition, however, includes infants born 1 week more premature (34 0/7–34 6/7 weeks) than the previous Academy of Breastfeeding Medicine protocol for the ‘‘near term infant’’ that encompassed infants born at 35 0/7 weeks to 36 6/7 weeks. In addition, infants born at 37 0/7–37 6/7 weeks may be at risk for breastfeeding problems and associated risks, and, therefore, the following guidelines may be applicable to these infants as well”.   Breastfeeding Medicine 2001; 6(3):151-156.

This protocol is the perfect example of what we as the Protocol Committee hope can happen as we update and revise our Clinical Protocols on a 5 year basis.  Unless the evidence has changed dramatically, the plan is to attempt to update the references and the data in such a way as to follow the general outline of the original protocol.  The reasoning is that those of you who are used to using a particular protocol will think everything is changed if you see a completely differenct document, when maybe only one or two things have actually been changed.  If the format remains generally the same, you will be able to easily see what has been updated and what has changed since the last version, and easily be able to update your own practice.  Sometimes this is not possible if either practice really has changed extensively, or author styles and interpretation of the data are so different that there is just no way around it.  But this protocol is an excellent example of how some of the evidence has changed, starting with the basic definition of the population, and there are many more references available ( 13 cited in 2004 versus 52 in 2011) but the basic outline has been followed, enhanced, and expanded to make an even better protocol than the original was.

As the ABM Protocol Chair, I speak for my Committee and for the ABM Board of Directors when I say we are very proud of these Clinical Protocols and our Statements, all of which can be found on our website.  The Clinical Protocols are also accepted and published by the National Guidelines Clearinghouse, sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health & Human Services, which has very stringent requirements for acceptance to their website.

So please check out this newest protocol, and keep your eye open for our next one, the brand new Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Emotional (!) responses to breastfeeding promotion and formula marketing

Is anyone besides me endlessly fascinated by how emotional we all become about infant feeding?  It’s such a big part of mothering, & I would submit that we get emotional about our kids because they are so precious to us.  (As my 10-year-old would say, well, duh.)

In response to my rant about the formula company putting my name on their advertising rag last week,  a friend I hadn’t heard from in years sent me a lovely private message saying that the “tangle over breastfeeding” left adoptive moms feeling ignored and left out.  “(W)hen (my kids) were babies, I often felt badgered and belittled by the insistence that breast milk was best… We were, after all, feeding our kids.”

I tried to apologize for leaving adoptive moms out of the discussion.

I tried to sum up the public health perspective:  that human babies do best with human milk, and that, in the US at least, we feel we are still working to overcome  decades of cultural “belittling” of breastfeeding –  summed up by Jayne’s comment that  “(t)he only reason breastfeeding is seen as so much harder is because our culture and often our medical professionals totally undermine it.”.

And (rhetorically, perhaps) I asked whether there is a way for the public health community to avoid hurting feelings while still counteracting the cultural forces of formula marketing, back-to-work pressures, and just plain undervaluing women in general.

Perhaps there is some explanation, if not an actual answer, in the State of the World’s Mothers 2011 report.  (For those who haven’t already heard, the US comes in at #31 among 43 developed countries surveyed.)

And I think the US Surgeon General’s Call to Action to Support Breastfeeding (full statement here)  is an important start toward improving our situation in this country, beyond the simple repetitive  “breast is best” message that seems to have so hurt and angered my friend.

Happy Mother’s Day to all of us!   Love your kids, nurture them … feed them.  It’s what we do.

Kimberly Lee is a neonatologist and member of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Breastfeeding in the Face of Natural Disaster and Nuclear Reactor Core Damage

It has been well over a week now that we the citizens of the world have been watching the seemingly unending horror unfold in Japan.  First they endured an earthquake of historic proportions, followed rapidly by a tsunami of untold destruction.   These unexpected natural disasters are frightening, devastating, and so very poignant and sad to comprehend. One cannot live in this age of instantaneous video reporting and see those images of death and destruction and not be affected at some deeply primal and emotional level.  Initially, the concerns for after effects in other nations around the Pacific were also frightening, but came nowhere near the complete devastation in Japan.  Totally coincidentally, I have been working on the United States Breastfeeding Committee Position Statement on Infant/Young Child Feeding in Emergencies. The images on the television brought the horrors of Hurricanes Katrina and Rita here in the US vividly back to my mind, and the words I have been typing into my computer drafting the Position Statement seem so inadequate in the face of the reality I see on the television screen.   It leaves me feeling impotent to really help, armed only with a computer and words.

And then, as if it could not have gotten any worse, one day later, an explosion occurred at the damaged Fukushima 1 nuclear power plant initiating a radiation leak, making this a catastrophe of unprecedented proportion.  By 6 days after the explosion, Japan’s nuclear safety agency raised the severity rating of the country’s nuclear crisis from Level 4 to Level 5 on a seven-level international scale, putting it on par with the Three Mile Island accident in Pennsylvania, USA in 1979.  For comparison, the Chernobyl accident of 1986, which killed at least 31 people with radiation sickness, raised long-term cancer rates, and spewed radiation for hundreds of kilometers, was ranked a Level 7.

So why am I writing this on a blog for ABM?  Besides the humanity that connects us all globally, and the immediate questions that arose in the medical and lactation communities concerning humanitarian efforts and safe infant and child feeding practices on the heels of the earthquake and tsunami, (on which there is much already written) the radiation leaks have led to many questions and some incorrect information related to breastfeeding that it is important to address, for now and should we ever need to deal with this again.

Down with rules!

Brisbane, Australia – It’s time to do away with breastfeeding rules.

This week, I am in Australia as a traveling speaker for the Australian Breastfeeding Association, sharing perspectives with an international team of speakers and with hundreds of dedicated breastfeeding counselors, lactation consultants, midwives and physicians.

Compared with the US, Australia seems like a breastfeeding paradise: every mother gets multiple home visits after birth from an experienced maternal-child health nurse. Each mother also enrolls in a local, health-professional led mother’s group. Baby Friendly hospitals are becoming the dominant paradigm, and 90% of mothers initiate breastfeeding. And yet, breastfeeding rates fall off in the first month, and rates of exclusive breastfeeding are hardly higher than here in the US.

The opening speaker for our traveling seminar is Lesley Barclay, a midwife and researcher who has spent her career improving systems of care for mothers and infants. She argues, in a talk grounded in careful qualitative research, that professionalization of breastfeeding and rigid implementation of rules has undermined breastfeeding mothers.

Attachment, development and the Surgeon General

It will not be denied, that a child, before it begins to write its alphabet and to gain worldly knowledge, should know what the soul is, what truth is, what love is, what powers are latent in the soul.

Mohandas Gandhi, 1927

One of the most significant statements in the recently released Surgeon General’s Call to Action is the recommendation that our society “work toward establishing paid maternity leave for all employed mothers.” ¹ The acknowledgement that the absence of paid leave is a barrier to breastfeeding is of monumental significance.   Without paid leave, it seems highly unlikely that our society will ever be able to come close to achieving the now universally accepted recommendations to breastfeed exclusively for 6 months, and to continue to breastfeed after the addition of complementary foods until the infant is at least one year of age.   Although strategies that enable mothers to express their milk while at work are certainly laudable, it is far more preferable to put the infant to breast than to offer breast milk in a bottle.   In other words, it is best to keep mothers and infants together as much as possible, for as long as possible.   This can only happen by guaranteeing employed mothers a paid maternity leave.

ABM President responds to Obama/Bachman controversy

In response to “Breastfeeding Plan Mixes Partisan Reactions” (2-17-11), it is essential to first be reminded that breastfeeding is a health issue, not a political or social one. The data are well substantiated to show the value of breastfeeding to babies, mothers, and the community as well. Breastfeeding provides the perfect nutrition as well as infection protection, immunology protection, allergy protection and obesity
protection. Formula is a solution of nutrients with no antibodies, enzymes, or other protective factors.

It’s about time we remove barriers for breastfeeding mothers. After years of exhorting mothers to “try harder”, we’ve finally started to implement policies that remove the “booby traps” that undermine success. With the WIC Program spending billions on infant formula, the now available IRS one-time deduction for breastfeeding equipment is merely a drop in the bottle!

Gerald Calnen, MD
President
Academy of Breastfeeding Medicine
New Rochelle, New York 10801
914 740-2115
http://www.bfmed.org

This letter was submitted to the editor of The New York Times