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.