Breastfeeding Medicine

Physicians blogging about breastfeeding

The Surgeon General’s Call to Action to Support Breastfeeding: Reflections of an Eyewitness

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Wow! I am here in Washington DC, attending the United States Breastfeeding Committee (USBC) meeting as the representative from the Academy of Breastfeeding Medicine. I was even asked to come to town early to be a part of the USBC media team for the Surgeon General’s Call to Action to Support Breastfeeding, which occurred on Thursday, January 20 at George Washington University(GWU).  It was a monumental day in my family—my dad turned 78, and I had planned to celebrate with him on my way  from CT to DC for the meeting on the 21st.  But he understood, as great dads always do, and I witnessed history at GW! It was an absolute thrill to be there, and I can attest to the electricity in the room!  For the first time, we held the previously embargoed document in our hands.  It is an amazing document, a true gift to the breastfeeding and medical communities, and to US mothers, babies and families. Containing 20 action items with implementation suggestions, it covers virtually anything one would put on their own personal wish list of support for breastfeeding, making it our national, cultural and healthful norm.

We stood outside the auditorium of GWU for what seemed an interminable time.  When the doors finally opened, we rushed inside with the anticipation of little kids on Christmas morning. Taking our seats, the auditorium filled, the excitement palpable.  We craned our necks to see when and where she would walk in—it was real star power!

As Dr. Benjamin came into the room, we spontaneously gave her a standing ovation.  She didn’t even have to say a word—we were so thrilled with the message and the bearer of that message.  Her main message?  Pure.  Simple.

Everyone can help make breastfeeding easier.

She held our rapt attention.  20 Action Items.  Six broad categories.  Not rocket science.  Common sense.

I. Mothers and their families:

 1. Give mothers the support they need to breastfeed their babies.

2. Develop programs to educate fathers and grandmothers about breastfeeding.

The onus is on us—the health care system and families—to support moms reaching their breastfeeding goals; not leaving them struggling in a void. Pretty simple concept.

II. Communities:

 3. Strengthen programs providing mother-to-mother support and peer counseling.

 4. Use community-based organizations to promote/support breastfeeding.

 5. Create a national campaign promoting breastfeeding.

 6. Ensure marketing of infant formula is conducted in a way that minimizes negative impacts on exclusive breastfeeding.

Wow—earth-shattering?  No.  Brilliantly simple?  Yes!  The community needs to rally around and support what we know is best for moms, best for babes, and best for society as a whole.  Win-win.  Before the days of highly mobile and highly separated families, this is indeed what happened.  We can make it happen within the communities in which we function today—where we live, work, play and worship. And finally—recognition from someone outside the field of lactation that marketing of infant formula directly to mothers, families can influence breastfeeding, thus harming babies.  Way to go Surgeon General (SG)!!! Touchdown on that one!!

III. Health Care:

 7. Ensure maternity care practices throughout the US are fully supportive of breastfeeding.

 8. Develop systems to guarantee continuity of skilled support for lactation between hospitals and the community.

 9. Provide education and training in breastfeeding for all health professionals caring for women and children.

 10. Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians.

 11. Ensure access to services provided by International Board Certified Lactation Consultants.

 12. Identify and address obstacles to greater availability of safe banked donor milk for fragile infants (one of my favorites!!!)

Is this any surprise??  Health care in the US has been abysmal in supporting breastfeeding.  The SG hit the nail on the head!  A woman representing a national nurses’ group stood up and demanded why nurses weren’t listed?  SG told her only the worst offenders needing the most remediation in breastfeeding education were listed—notice my field, pediatrics??  Is your field listed????  Again—SG—you go girl!  And finally—someone from on high is coming right out and stating that donor milk is important enough to be listed in the Top Twenty—are my neonatal colleagues listening???

IV. Employment:

 13. Work toward establishing paid maternity leave for all employed mothers.

 14. Ensure employers establish and maintain comprehensive, high quality lactation support programs for employees.

 15. Expand use of workplace programs allowing lactating mothers direct access to their babies.

 16. Ensure all child care providers accommodate needs of breastfeeding mothers and infants.

Some states have enacted laws to protect mother rights to express milk and even breastfeed at work (my state, CT 2001).  And these are so important,  But the standing ovation came for paid maternity leave!  Note the “toward establishing”—but it is still huge for US (and us)—Go SG Go!! 

V. Research and Surveillance:

 17. Increase funding of high-quality breastfeeding research.

 18. Strengthen existing capacity and develop future capacity for breastfeeding research.

 19. Develop national monitoring system to improve tracking of breastfeeding rates and policies and environmental factors affecting breastfeeding.

No-brainer; and the SG and her staff get it.  Will the potential funders???

VI. Public Health Infrastructure:

 20. Improve national leadership on the promotion and support of breastfeeding.

Well, we have national leadership at the level of the Surgeon General!  No doubts there.  And we know we have it in a number of federal agencies who work so hard with USBC and independently on many projects in recent years—from DHHS: CDC, HRSA/MCHB, OWH, WIC, FDA, HIS, AHRQ and from the USDA FNS/WIC.  MCHB has supported ABM and protocol development for many years now.  With technical assistance of the USBC all 50 states now have state coalitions, and there are many territorial and tribal coalitions too.  But hopefully what Action #20 will do is support the creation of a federal interagency work group to improve basic coordination and monitoring of services (i.e. we all work together, better, to change the Landscape of Breastfeeding in the US.) 

Is the CTA a law?  No.  It is a framework for advocacy; a call for collaboration; a call for funding and a call for research.  There is great excitement that the WHO Code is included.  I commented that ABM is an international organization, we do support the Code, we are the Physician arm of WABA, and we could be a resource for this issue within USBC.  Collaboration.  

Tough issues—breastfeeding, working, expressing milk, breast milk feeding, paid maternity leave.  What are we supporting?  Human milk?  Or mothers being together with their babies?  Difficult discussions to come.

SGCTA is a tool—not a means to browbeat , not a government edict to breastfeed, not an induction of guilt.  If you choose to breastfeed, you should be supported.   Everyone can help support breastfeeding—the message.  And as 75% of our population IS initiating, and 87% was quoted to me as really wanting to initiate, what does that tell us?  The vast majority of our moms DO want to breastfeed—as the Surgeon General is telling us, the onus is on us to support them to be successful!!!  We do not need to convince them breastfeeding is best—we need to make it work for them and put our “money where our mouths are!”

The full document is 88 pages and can be ordered and downloaded from .  The main and over-riding message of the SGCTA is one of SUPPORT; of improving support for breastfeeding. 

Everyone can help make breastfeeding easier! 

Links to the document and executive summary:


Office of the Surgeon General:

Link to the webcast:

I was truly honored to be at the launch, to speak personally to Dr. Benjamin, and to be a small part of the changing landscape of breastfeeding in the United States.  We have entered a new era where breastfeeding support has taken on a whole new meaning and importance, and we will all be able to make these changes happen, even seeing them in our lifetime.  Our community has cause to celebrate, and to celebrate the leadership of Dr. Regina Benjamin!  Dr. Benjamin, my heartfelt thanks, from all of us who represent and are the breastfeeding families in this nation of ours!

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.

Written by kmarinellimd

January 25, 2011 at 8:39 am

6 Responses

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  1. […] This post was mentioned on Twitter by Diana Cassar, IBCLC, BF Medicine. BF Medicine said: ABM Member Kathy Marinelli blogs on the Call to Action, "a true gift to the #breastfeeding" […]

  2. Nice job, Kathy. The excitement in your article was palpable. In an ideal world, all this would be in place, but people like you can make our dream a reality. Your credentials lend so much to the cause. Thank you.

    Annie Brown, FNP, IBCLC, LLL Leader

    January 25, 2011 at 4:20 pm

  3. Thanks Kathy! For your report, for your enthusiasm and for your valuable involvement. I sincerely hope that the wonderful intent of this document from the Surgeon General is followed by action that improves the support that mothers who want to breastfeed get. I cannot agree enough with your comments about the issue not being one of desire on mothers part, but about informed, educated, accurate support from everyone around her!

    Sue Iwinski, IBCLC, LLL Leader

    January 25, 2011 at 6:34 pm

  4. Kathy, How exciting to be a part of the process. This makes what we do worth it and want to continue to work at it. Thanks for forwarding this information. I will hopefully be at the next MMBNE meeting. Talk to you then. Susan

    Susan Worden

    January 31, 2011 at 9:51 am

  5. I am so excited to read the statment I am retired as KY state BF Co. and worked many years trying to promote breastfeeding in our state by providing ed and training to health professionals as well as families. Having the Surgeon General come out with this statement will help move us forward. I hope that more attention will be placed on breastfeeding that it is more than just fluff that it does improve the lives of mom’s and babies.
    Thank you

    Becky S Derifield

    February 8, 2011 at 5:04 pm

  6. […] 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, […]

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