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.

The first day of the Summit began at 8:45 am with a welcome from Dr. Ruth Lawrence, the Summit Chair, and like a marathon, did not end, or even break, until the reception on the roof at 7:00 pm.  Doth the lady exaggerate???  No—there was not one break, one stretch.  The closest we came to a breather was the walk down and then back up the stairs to and from the (delicious) buffet lunch, during which we heard another (wonderful) address.  If there can be any criticism, it would be that humans cannot sit that long and continue to think!  And although we were encouraged to leave for bathroom breaks, or to get coffee, tea or water at the back of the room, most of us were 1) too afraid to miss something important to move; and 2)  did not want to seem disrespectful to the speaker to be moving about during their presentations.  It is easy to see why this was so—there were so many great speakers, and topics, and needed discussion, and as the old adage goes, “…so little time.”  But one suggestion for the 4^th Summit—PLEASE build in some breaks!!!

I might also add here that I was left with a list of questions and comments scribbled down the side of my page of notes that I wanted to bring up in specific sessions, but we ran out of time and comment periods did not happen.  I especially wanted to bring up with the insurers the issue of how best to go about facilitating qualified lactation consultants (IBCLC’s) obtaining insurance reimbursement, so that a big piece of post-discharge care can be provided.  I did take information and questions to the moderator of that session separately, but open discussion using all the minds in the room would have been a good thing.

Now that I got that out of the way, let’s get to the meat of the matter—content.  In a word—fantastic.  With one caveat—if you are looking at breastfeeding in the United States.  We will get back to this point later.

The first section was on “Federal Government—Washington Leadership and Progress”.  A number of perspectives were presented from the White House Council on Women and Girls, the NIH on the Surgeon General’s Call to Action, the amazing progress the Indian Health Services has made (and the work still to go), and the Office of Women’s Health take on promoting the Affordable  Care Act (ACA) in terms of lactation support in the workplace.  Several speakers in this section independently made the same remark: “We should look to Europe for how this is done.”  Interesting observation.  One of the most intriguing presentations was from the CDC entitled “The Troves of National Data” detailing all the national databases that include breastfeeding data that are available to researchers who want to work with the data.

The next section was “Best Practice: Front Line Reports”.  We heard great reports on the fabulous work being done with low income populations in the big city of New York, and in the small city of Asheville, North Carolina.  Very different in terms of size, but similar in terms of issues, both making progress in supporting low income families, modeling behavior for other cities.

The afternoon was all about economics.  “Payors as Players” was a marathon looking at WIC, the health insurance industry, hospital leadership, breastfeeding in population health, the economics of breastfeeding, and the Affordable Care Act.  There was a lot of discussion about WIC carrying the stigmata as the “formula people” now working hard to be “the breastfeeding people”.    Despite that hard work, over 60% of all formula moving through the US is through the WIC program.  There are many reasons for this, not the least of which is that their clients are the marginalized women who are the least likely to breastfeed or breastfeed
exclusively.  Yet, the good news is that with the individual WIC programs that are really supportive, like some of those in NYC, their breastfeeding rates are high (and thus formula consumption is low). 

Another interesting point made by several speakers is that when trying to get specific lactation services or equipment covered by insurance companies, it is important to remember that the employers pick the specific benefits offered to their employees—so when working toward better coverage, we need to be speaking to employers as well.  And as important, it is the employers who pay the insurance bills—not the insurance companies.  The insurance company is paid a fee to administer the benefit.  So the cost savings will accrue to the company—important to remember when negotiating for these benefits.

There was also interesting focus on whether or not breastfeeding is “free”.   Free for whom?  For the family who buys extra food for the mom to make her milk?   For the mom who spends her time feeding the baby; and thus not working for a wage that she otherwise might have been working for contributing to the finances of her family?  Is a mother’s time “free”?  When she stays out of the workforce to have and nurture her baby/child, does she enter back in at the same wage she would have had she never left?  Does she catch up if not?  Lots of interesting data presented on the economic worth of a mother as per her society.

The discussions of the ACA and workplace law were fascinating as well.   Does state workplace law increase the duration of breastfeeding, or is it a proxy for conditions and interests in a state that foster a more supportive environment?  The federal statutes in the ACA have been written in such a way as to encourage an environment where the greatest number of employers can comply and support the greatest number of nursing employees—not an easy task given the multitude of factors and variables involved.  Also important to know—if state laws offer more benefit/protection to the lactating mother than the Federal law, the state laws take precedent.  It was announced that the HRSA Business Case for Breastfeeding,  which has been out of print but still available on their website for download for a while now, is adding a fifth section, Worksite Lactation Legislation and Initiatives for Advocates, and will go into its second printing as a whole set sometime next month.

An astonishing piece of data given by immediate past-president Dr. Caroline Chantry in her presentation “Supporting the 75%” was that from a very average population she studied only 8% of women reported no problems with breastfeeding in the first two weeks postpartum.  Looked at in another way, a whopping 92% of women had at least one significantly self-reportable problem with lactation.  Didn’t Rep. Virginia Foxx (R-N.C.) introduce an amendment to a House spending bill recently that would zero out funding for a peer counseling and support program for low-income women on WIC because “women have been doing this for millions of years and shouldn’t need any help”?  Thankfully, Rep. Foxx’s Breastfeeding Peer Counseling Amendment was defeated with a bipartisan vote of 119 to 306.  Mull that one over and look for Dr. Chantry to report her findings.  Pretty thought-provoking stuff.

The second day was opened with an address from The Honorable Thomas Harkin, US Senator from Iowa and long-standing friend to breastfeeding and mothers and families.  He had much of importance to say to us, but the one line that stuck in my head (paraphrased I fear):  “Health should be the default status of our bodies, and society sabotages our ability to accomplish that.”  Chew on that for a few moments…  He also stated support for the Code in the US—let’s hope that goes somewhere.

The Reverend Greenaway, President and CEO of the National WIC Association addressed us again this year.  WIC was like a ping pong ball at the Summit—it got batted back and forth probably more over the course of the 2 days than any other individual topic.   Depending on who was speaking and from what perspective, they went from the bad guys dolling out formula to the good guys supporting breastfeeding with awesome peer counselor programs to the bad guys getting 1/5^th of their budget from formula rebates  to the good guys as constantly promoting breastfeeding.  One point was very clear—the government is trying to balance the budget on the backs of its poorest citizens, and as Rev. Greenaway stated, “Leave the safety-net programs alone”.

There was also overlapping discussion that we can no longer solve our biggest health problems by biomedical solutions, with disease by disease intervention.  The key now is to think prevention, and what better way to have cross-cutting prevention strategy (those which affect multiple outcomes, like exercise…or breastfeeding) than by breastfeeding from the start of life???  The focus should be on policies that support making healthy choices and undercut structural and institutional impediments to them, and not on specific programs.  One such new strategy is the National Prevention Council, chaired by the Surgeon General, whose goal is to change the focus from sickness/disease to health/wellness.

The one truly international presentation came from David Clark, a lawyer and Nutrition Specialist from UNICEF.  He quoted James P. Grant, UNICEF’s third Executive Director 1980-1995, saying “Breastfeeding is the only natural safety net against being born into poverty.”  It is the single largest factor that can affect infant mortality, with early initiation leading to a 19% reduction.   Breastfeeding is at the core of UNICEF’s equity focused approach to childhood survival.  And he stresses that Code implementation is key to stopping the commercial undermining of breastfeeding.

The next presentation by a representative of The Joint Commission was very interesting for two reasons—the first, she came right out and said they are an International organization—we need to explore that at ABM more!  And second, they are launching a new segment to their public “Speak Up” campaign on August 1^st to coincide with World Breastfeeding Week, “Speak Up on Breastfeeding”.  So stay tuned!!  It will be available in both English and Spanish.

There is so much more detail that will come out in the October issue of Breastfeeding Medicine covering the proceedings of the Third Annual Summit.  I promise it will be a good read; a stimulating, thought-provoking read, even for those of us who were there and could not take it all in.  I urge you to look for it, and read it when it comes out.  What did I come away with?  That breastfeeding is undeniably a biological process, which we must acknowledge to ourselves, to our families, and we must get it across in our messaging to families, workplaces, legislators, payors, and society.   That it cannot be broken into pieces, and must remain as a whole for the health not only of our children but of our society long-term.  That there is much we know, but so much more we do not yet know, which reinforces my belief that we need good, well-designed, top grade studies to try and get at some of these questions and determine the best answers with which to then apply to our policies.  And that we need to keep coming together like  this to think things through, together and out loud, with some likely and some not so likely colleagues, to get at the roots and work through the branches to get at some of that “low hanging fruit” (and the harder to reach fruit) we talked about at the Summit that is out there to help these families.

Now I promised to come back to one thing—the issue of global applicability.   As a member of the Board of ABM, who has personally pledged to keep this mission always in the fore, I must bring this up.  The Summit has been a sticking point with our non-US colleagues (and some US colleagues) for the past 3 years, because we, ABM, are an international/global organization, and the Summit is seen as very US-centric.  I must say this year there were cracks in that evident.   I heard over and over speakers bringing up European models of paid maternity leave, lactation support in and out of the hospital, societal support for breastfeeding in the newborn period, into toddlerhood, in public, in the workplace—all the issues we struggle with that they have in many countries successfully dealt with.  And we had an official from UNICEF and from The Joint Commission talking about international programs.  So a crack has occurred. I urge our planners for the 4^th Annual Summit to widen that crack, so that we may learn from each other, and what works across the ocean or in another hemisphere can be very instructional to us here in the US.   Communication is a wonderful thing.

Thanks for this year’s Summit.  We will all be chewing on it for some time to come, and hopefully working toward some of those answers we all so desperately need.

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.