In April, 2008, the National Center for Health Statistics (NCHS), a department of the Center for Disease Control and Prevention (CDC) issued a report entitled Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Survey, 1999-2006. What did they find?
* The percentage of infants who were ever breastfed increased from 60% among infants who were born in 1993-1994 to 77% among infants who were born in 2005-2006.
* Breastfeeding rates increased among non-Hispanic black women from 36% to 65%
* Breastfeeding rates were significantly higher among those with higher income (74%) compared with those who had lower income (57%)
* Breastfeeding rates among mothers 30 years and older were significantly higher than those under 30
* There was no significant change in the rate of breastfeeding at 6 months of age for infants born between 1993 and 2004
Of note: for infants born in 2005-2006, the percent ever breastfed exceeded the Healthy People 2010 target of 75%.
Breastfeeding was defined as ever having been breastfed or received breast milk.
Ever breastfed was defined by the following question: “Was (your baby) ever breastfed or fed breast milk?”
My comment: It is very encouraging to learn that 77% of babies born in the United States between 2005 and 2006 were ever breastfed. However, we continue to fall short of the 50% goal of exclusive breastfeeding at 6 months. Why does this continue to be an issue?
Throughout most of history, breastfeeding was the norm, with only a small number of infants not breastfed for a variety of reasons. In the distant past, wealthy women had access to wet nurses, but with the industrial revolution this practice declined as wet nurses found higher-paying jobs. By the late 19th century, infant mortality from unsafe artificial feeding became an acknowledged public health problem. Public health nurses addressed this by promoting breastfeeding and home pasteurization of cows' milk.
After the turn of the century, commercial formula companies found a market for artificial baby milks as safer alternatives to cows' milk. During this same period, infant feeding recommendations became the purview of the newly organized medical profession. Partially due to the support of physicians and a vision of "scientific" infant care, the widespread use of formula as a breast milk substitute for healthy mothers and babies emerged in the first half of the 20th century.
Throughout the middle part of the 20th century, most physicians did not advocate breastfeeding, and most women did not choose to breastfeed. Therefore, an entire generation of women-and physicians-grew up not viewing breastfeeding as the normal way to feed babies. Despite the resurgence of breastfeeding in the late 20th century in the United States, breastfeeding and formula feeding continued to be seen as virtually equivalent, representing merely a lifestyle choice parents may make without significant health problems.
Currently, the World Health Organization (WHO) recommends that children breastfeed for at least two years. (1) The American Academy of Pediatrics recommends that all babies, with rare exceptions, be exclusively breastfed for about six months. (2) The United States Public Health Service's "Healthy People 2010" set national goals of 75% of babies breastfeeding at birth, 50% at six months, and 25% at one year. (3) Are these goals realistic? If so, how can we reach them?
One important question to ask is: Why do women stop breastfeeding? As in other published research, Ahluwalia, et al (4) found that the most common reasons for cessation included sore nipples, inadequate milk supply, infant having difficulties and the perception that the infant was still hungry after feeding. Something not explored in this article is the lack of support offered to women who do breastfeed whether amongst their communities, places of employment or the health care providers from whom they seek advice.
Though surpassing the goal of 75% of all babies ever breastfed is wonderful, it is vital we move on to the more difficult goal of still breastfeeding at 6 months.
References:
1. World Health Organization, United Nations Children's Fund, US Agency for International Development, Swedish International Development Agency. Innocent declaration on the protection, promotion and support of breastfeeding. New York: UNICEF, 1990.
2. American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100(6):1035-1039.
3. United States Department of Health and Human Services. Healthy People 2010. US Stock number 017-001-0547-9. Washington, DC: DHHS, 2000.
4. Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the pregnancy risk assessment and monitoring system. Pediatrics 2005;116(6):1408-12
Posts
