New report calls for national breastfeeding strategy

A new report by the National Academies of Science, Engineering, and Medicine (NASEM) calls for an evidence-based national strategy to increase breastfeeding rates in the United States. The report aligns with the September 9 recommendations of the U.S. Department of Health and Human Services (HHS) Make America Healthy Again Commission, which identified a need to increase U.S. breastfeeding rates as one of 120 initiatives the government should pursue to reduce childhood chronic diseases.

The HHS’ Healthy People 2030 initiative has set a goal of at least 42% of infants being exclusively breastfed through their first six months, and at least 54% breastfeeding in conjunction with other foods and liquids through 12 months. Currently, 27% of U.S. babies are exclusively breastfed through their first six months, and less than 40% are still receiving breast milk by 12 months of age.

Yale School of Public Health (YSPH) Professor Rafael Pérez-Escamilla, an international expert on breastfeeding, co-authored the NASEM report. Dr. Pérez-Escamilla, PhD, is a professor of public health (social and behavioral sciences) and director of the YSPH Global Health Concentration and the YSPH Maternal and Child Health Promotion Track.

The NASEM report acknowledges that individual infant feeding goals may differ from national recommendations, and that not all mothers choose to, or are able to, breastfeed exclusively or for an extended period. National guidelines are intended to improve health outcomes over time, not to impose a singular standard of behavior.

Dr. Pérez-Escamilla discussed the NASEM report with Colin Poitras.

(Editor’s note: This article uses the terms women and breastfeeding throughout for brevity and because most people who breastfeed identify as women; we recognize that not all people who breastfeed or chestfeed identify as women.)

Dr. Rafel Pérez-Escamilla: First, the U.S. economy is losing billions of dollars every year because of a lack of adequate investments to protect, promote, and support breastfeeding. Research has shown that breastfeeding strengthens an infant’s immune system and is key for the healthy growth and development of children. It also benefits maternal health by reducing the risk of cardiovascular diseases, type 2 diabetes, and breast and ovarian cancer. Second, the great majority of women in the U.S. (close to 85%) are choosing to breastfeed but less than half end up breastfeeding for as long as they would like. We know that poorer women are less likely to meet their breastfeeding goals, resulting in health inequities. This is mainly driven by social, economic, employment, and health care system barriers and massive and aggressive marketing by the infant formula industry. Third, the U.S. needs to invest in translating the extensive knowledge that we already have in place to make breastfeeding work for women in the U.S. regardless of their socio-economic status. This is going to require supporting implementation studies and adopting dynamic management information systems as many complex systems need to engage for the coverage and quality of breastfeeding care for women to be improved throughout their entire breastfeeding experience—from the prenatal and perinatal stages through the postnatal and postpartum periods.

RPE: The report acknowledges that breastfeeding is the responsibility of society as a whole and not only the responsibility of women. It provides the U.S. government with a roadmap for strengthening the implementation of multisectoral and multi-level (national, state and local levels) programs following a well-designed evidence-based national breastfeeding strategy with strong input from diverse communities. It recommends investments to improve breastfeeding training for health care professionals. It also calls for increasing the coverage and quality of the Baby Friendly Hospital Initiative (based on 10 steps that maternity services should implement to support breastfeeding from the prenatal period onward), offering universal access to breastfeeding counseling at the community level through the Supplemental Nutrition Program for Infants, Women and Children (WIC), and strengthening the human milk banks network infrastructure. The need for adequate reimbursements from Medicare and private insurance plans for breastfeeding services and supplies is emphasized. The report also calls for a federal mandate for paid maternity leave of adequate duration and for women to have reasonable accommodations at work and school to help them meet their breastfeeding goals. It recommends implementing non-judgmental social and behavioral change communication campaigns combined with implementation and enforcement of the International Code of Breastmilk Substitutes to protect consumers against the unregulated marketing of infant formula products. Strengthening support for breastfeeding during humanitarian emergencies is strongly recommended given the negative infant feeding experiences families in the U.S. have had with climate change-related and other events. Finally, the report calls for funding effective breastfeeding monitoring and evaluation systems to ensure the quality and impact of the breastfeeding strategies.

RPE: The report strongly recommends engaging mothers, families, and community organizations in the co-design of a national breastfeeding strategy, including the provision of breastfeeding services across settings throughout the breastfeeding journey. It acknowledges the very strong contributions that community-engaged approaches, such as peer counseling, have had at improving breastfeeding outcomes across communities in the U.S. and globally. This is not surprising because peer counselors are well-trained, have often breastfed themselves, and have a strong understanding of the social, economic, and cultural contexts in which their clients live. Effective breastfeeding peer counseling programs include training and supportive supervision from certified lactation consultants working in maternity facilities, community agencies, and programs such as WIC. For this reason, the report emphasizes the need to follow a systems-level approach that includes community assets to ensure effective coordination of breastfeeding care across the breastfeeding experience. This will allow the great majority of women in the U.S. who choose to breastfeed to have a better chance of being able to do so for as long as they want and for the country to benefit from the huge return of investment that such an approach would have.