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MEDIA BACKGROUNDER - August 2004
Babies were born to be Breastfed
- In a small town in Iowa last month, protesters pushing strollers and carrying infants formed a "nurse-in" after a local restaurant owner asked the mother of an eight-month old to use a restroom to nurse the baby or leave the eatery. Iowa statutes allow for public breastfeeding.
- The Illinois General Assembly passed the Right to Breastfeed Act this past spring [1], which means breastfeeding moms may feed children in any public place where they have a right to be. That didn't stop a Rockford, Illinois Girl Scout troop from booting a new mom from an event for trying to discretely nurse her two-month old daughter. [2]
- Maryland nurse-midwives implemented a state-wide grassroots campaign to ensure support for legislation protecting the right to breastfeed in public. By activating local breastfeeding mothers, allying themselves with advocacy groups and taking their campaign to the public via intensive media outreach, Maryland 's ACNM chapter was instrumental in seeing the legislation passed and signed into law. [3]
These incidents point to the curiously-never-ending debate about breastfeeding, despite the overwhelming scientific evidence which demonstrates how newborns, mothers and the community around them benefit from the practice. The evidence about the breastfeeding gap is ominous: A Surgeon General's 'blueprint for action' issued in 2000 reported that only 29% of all mothers are still breastfeeding at 6 months after delivery. Some of the important reasons breastfeeding remains the gold standard for babies:
- Breast milk is the most complete form of nutrition for infants. A mother's milk has just the right amount of fat, sugar, water, and protein.
- Breast milk contains antibodies, which help protect infants from illness. Breastfed babies are more able to fight off infection and disease, are sick less often, and require fewer visits to health care providers.
- Studies have shown a lower risk of breast cancer and possibly a lower risk of ovarian cancer in mothers who breastfeed.
- Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants. This is because breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations.
- Employers benefit because breastfeeding mothers do not miss as much work caring for sick babies. Employer medical costs are also lower and employee productivity is higher.
Real-world experience is not reflective of the validity of the science supporting better breastfeeding:
- In 1998, the year for which the most recent statistics are available, only 29% of all mothers breastfed at 6 months postpartum. [4]
- "The number of new mothers who start breastfeeding their infants and stick with it for six month varies widely from state to state," according to news reports following the release of new state data from the CDC. "The study shows the national average for exclusive breastfeeding for six months in 2003 was 14.2%, and only Oregon had an exclusive-breastfeeding rate of more than 25% at six months...Researchers also found that lower-income mothers and non-Hispanic black mothers had consistently lower rates of breastfeeding compared with others."
- Moreover, racial and ethnic disparities in breastfeeding rates are wide and reveal alarmingly low breastfeeding rates among African American women (19% at 6 months postpartum). [5]
- Breastfeeding is not viewed positively among African American women. Furthermore, it has been difficult for African American women to receive information and education about breastfeeding, to have breastfeeding initiated in the hospital, to continue breastfeeding early on in the home setting, and to continue breastfeeding for an extended period. [6]
- African American women are also more likely than other women to return to work earlier (8 weeks) and to be engaged in jobs that do not allow the mother to be successful at breastfeeding. [7]
At the same time, it is important to understand the role that modern-day marketing of breast milk substitutes is playing in decreasing breastfeeding rates. A Surgeon General's report from 2000 said: "The marketing of infant formula negatively affects breastfeeding." [8]
- "Aggressive marketing practices [9] and the use of products associated with shorter duration of breastfeeding [10] , [11] , [12] promote the use of human milk substitutes. Prenatal exposure to human milk substitute advertising significantly increases early termination of breastfeeding in the first 2 weeks and shortens overall duration among women with uncertain breastfeeding goals or goals of 12 weeks of less. [13] Marketing or providing these products in discharge packages promotes maternal-infant separation, undermines maternal confidence, and contributes to early mixed feedings that interfere and sometimes interrupt establishing an adequate milk supply." [14] [15] , [16]
- Use of commercial literature and samples has been demonstrated to decrease breastfeeding rates and increase premature weaning. [17]
- Provision of formula through [public assistance programs such as WIC] may make bottle-feeding an attractive alternative, despite concordant attempts to encourage breastfeeding. [18]
- Certain populations are potentially more vulnerable to the effects of aggressive infant formula marketing practices. [19]
Breastfeeding & Public Policy:
- More than half of the states have enacted some form of breastfeeding legislation, mostly clarifying that mothers have a right to breastfeed where they go with their baby. Other issues include exempting breastfeeding mothers from jury duty and protecting breastfeeding mothers when they return to work.
- Maryland became the first state to provide an exemption from the sales tax laws for breastfeeding accessories, such as pumps, shields, and other items that are used by breastfeeding mothers. [20]
- Some of the laws provide mothers with legal recourse if they are told to stop breastfeeding, such as New York , which has the strongest law in the nation, where a right to breastfeed as one of a person's civil rights was created. [21]
Financial benefits for families and states are evident as well:
- If 75% of mothers breastfeed at discharge and 50% at 6 months, the state of Wisconsin could save $30,984,432/year. [22]
- Breastfeeding saves families greater than $1,000 per year on formula and supplies. [23]
How Midwives Are Optimally Prepared Breastfeeding Advocates:
To celebrate World Breastfeeding Week and to continue the organization's deep commitment to breastfeeding advocacy, the American College of Nurse-Midwives (ACNM) has updated its innovative consumer-driven online resource titled www.GotMom.org.
- GotMom.org serves as a concise clearinghouse for news, research and information concerning breastfeeding awareness and advocacy.
Online Resources:
[1] Illinois General Assembly bill SB3211 was sent to the state's governor for signature on June 23, 2004 . Click Here to learn more. Accessed July 27, 2004 .
[2] Emerson, Judy. "Public nursing puts damper on Scout event." Rockford Register Star. May 28, 2004 . Click Here. Accessed July 27, 2004 .
[3] http://www.marylandmidwives.org/pressreleaseapril3_03.htm (accessed August 2, 2004 )
[4] U.S. Department of Health and Human Services. Healthy People 2010: Conference Edition - Volumes I and II. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, January 2000, pp. 2, 47-48.
[5] See #3
[6] Caulfield LE, Gross SM, Bentley ME, et al. WIC based interventions to promote breastfeeding among African-American women in Baltimore: Effects on breastfeeding initiation and continuation. J Hum Lact 1998;14(1):15-22.
[7] Bronner YL, Bentley M, Caulfield L, et al. Influence of work or school on breastfeeding among urban WIC participants. Abstracts of the 124th Annual Meeting of the American Public Health Association. New York , NY : American Public Health Association, 1996.
[8] Dermer A. Overcoming medical and social barriers to breastfeeding. American Family Physician 1995;51:755-763; Howard C, Howard F, Lawrence R, et al. Office prenatal formula advertising and its effect on breast-feeding patterns. Obstet Gyneco 2000;95(2):296-303.; Bergevin Y, Doughtry C, Kramer MS. Do infant formula samples shorten the duration of breastfeeding? Lancet, 1983;1(8334):1148-1151; Powers NG, Naylor AJ, Wester RA. Hospital policies crucial to breastfeeding success. Seminars in Perinatology 1994;18(6):517-524. World Health Organization. International Code of Marketing of Breast-milk Substitutes. Geneva : World Health Organization, 1981, pp. 5-7, 316-350.
[9] Dungy CI, Christensen-Szalanski J, Losch M, Russell D. Effect of discharge samples on duration of breastfeeding. Pediatrics. 1992;90:233-237.
[10] Barros FC, Victora CG, Semer TC, Filho ST, Tomasi E, Weiderpass E. Use of pacifiers is associated with decreased breastfeeding duration. Pediatrics.1995;95:497-499.
[11] Howard CR, Howard FM, Lanphear B, DeBlieck EA, Eberly S, Lawrence RA. The effects of early pacifier use on breastfeeding duration. Pediatrics. 1999;103(3):e33.
[12] Aarts C, Hörnell A, Kylberg E, Hofvander Y, Gebre-Medhin M. Breastfeeding patterns in relation to thumb sucking and pacifier use. Pediatrics. 1999;104(4):e50.
[13] Howard CM, Howard F, Lawrence R, Andresen E, DeBlieck E, Weitzman M. Office prenatal formula advertising and its effect on breast-feeding patterns .Obstet Gynecol. 2000;95:296-303.
[14] Dungy CI, Christensen-Szalanski J, Losch M, Russell D. Effect of discharge samples on duration of breastfeeding. Pediatrics. 1992;90:233-237.
[15] Novotny R, Hla MM, Kieffer EC, Park CB, Mor J, Thiele M. Breastfeeding duration in a multiethnic population in Hawaii. Birth. 2000;27(2):91-96.
[16] Position of the American Dietetic Association: Breaking the barriers to breastfeeding - Download. Accessed July 27, 2004 .
[17] Whitelaw A. Kangaroo baby care: just a nice experience or an important advance for preterm infants? Pediatrics 1990;85(4):604-605.
[18] American Academy of Family Physicians position paper on breastfeeding: Download. Accessed July 27, 2004 .
[19] Dungy CI, Losch ME, Russell D, et al. Hospital infant formula discharge packages. Do they affect the duration of breastfeeding? Arch Pediatr Adolesc Med 1997;151(7):724-729.
[20] http://www.lalecheleague.org/Law/Bills21.html (Accessed August 2, 2004 )
[21] Public policy citations - Click here (accessed August 2, 2004 )
[22] Wisconsin State Breastfeeding Coalition - Download. Accessed July 27, 2004 .
[23] Sharon Perkins, RN, Carol Vannais, RN. Breastfeeding for Dummies. Publisher: For Dummies. March 2004. Page 27.
[24] Smith JW, Tully MR. Midwifery management of breastfeeding: using the evidence. J Midwifery Womens Health. 2001 Nov-Dec;46(6):423-38.
[25] Raisler J. Against the odds: breastfeeding experiences of low income mothers. J Midwif Women's Health. 2000;45:253-263.
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