The Office of Disease Prevention and Health Promotion set very specific and aggressive goals for increasing breastfeeding initiation and duration in its Healthy People 2010 report. Published in 2000, the Healthy People breastfeeding targets identified significant health threats and established goals to reduce them by 2010.
In 2006 we got a sense of how much progress we were making when the Centers for Disease Control and Prevention (CDC) released the 2006 Breastfeeding Report Card. Breastfeeding advocates and educators shuddered to see that the number of moms who attempted to nurse their babies was slim, and those who continued to breastfeed past the initiation phase quit long before health professionals recommend. Reaching the breastfeeding initiation and duration goals set for 2010 seemed unlikely.
That brings us to today. The CDC just released the 2010 Breastfeeding Report Card. It reveals breastfeeding rates at the national and state levels at the following postpartum milestones:
- Breastfeeding immediately after birth (referred to as initiation)
- Non-exclusive breastfeeding six months after birth
- Non-exclusive breastfeeding 12 months after birth
- Exclusive breastfeeding (feeding only breast milk) three months after birth
- Exclusive breastfeeding six months after birth
The CDC's attention to exclusivity rates is especially important. The American Academy of Pediatrics and other major medical organizations around the world recommend exclusive breastfeeding for the first six months of life and breastfeeding with supplemental foods for a minimum of 12 months.
Unfortunately, the only category in this report card where the U.S. gets an A is initiation. Three out of every four new mothers in the United States try breastfeeding. This statistic puts a check in the box next to the Healthy People 2010 national objective for breastfeeding initiation.
Beyond this, we haven't achieved any of the other Healthy People 2010 objectives, as shown in the chart below. Notice there have been no changes in the categories other than initiation rates in the last four years.
The news is disappointing. Ultimately, a 75 percent initiation rate means very little if duration and exclusivity rates remain low. Currently, 43 percent of moms make it to the six month mark, with 22.4 percent reaching a full year. Exclusive breastfeeding rates haven't budged either since 2006, with 33 percent of moms breastfeeding exclusively at three months, and only 13.3 percent at six months. This is despite increased awareness and research backing up the importance of exclusive breastfeeding for this length of time.
While our national rates remain largely unchanged, some states are showing progress. In Alaska, Colorado, Montana, Oregon and Vermont, the average rate of exclusive breastfeeding at six months is 22.9 percent, compared to a national average of 13.3 percent.
In several other states, breastfeeding rates remain low. Georgia, Mississippi, Louisiana and West Virginia have fallen to single digit percentages in some categories.
None of this surprises me. But it does renew my sense of urgency. Breastfeeding alone can significantly impact the health and well being of children and their mothers, and I believe that it's the lack of education and support for new moms that are primary factors driving these statistics.
However, we're making inroads. The workplace accommodations for breastfeeding mothers mandated by the Patient Protection and Affordable Care Act will make it easier for moms to continue nursing after maternity leave. Michelle Obama's focus on breastfeeding promotion as part of her Let's Move campaign to end childhood obesity will put our society's ignorance of breastfeeding benefits in the spotlight.
But we must do more. The 2010 Breastfeeding Report Card highlights a few key recommendations for increasing initiation and duration rates nationwide. They include:
- Birth facility support. Birth facility policies and practices significantly impact whether a woman chooses to start breastfeeding and how long she continues.
- Professional support. A strong statewide group of professional breastfeeding experts and International Board Certified Lactation Consultants (IBCLCs) is needed to assist the mother-infant pair, create and administer lactation programs, and educate other health professionals about breastfeeding.
- Legislation. Most states now have some type of law protecting the right to breastfeed but there are many cases in which these laws are not being upheld and/or implemented sufficiently. The laws requiring support for breastfeeding mothers in the workplace are a step in the right direction.
- Infrastructure. It's important to increase the number of state health department full-time equivalents (FTEs) responsible for breastfeeding. According to the CDC's report, there are 97 FTEs supporting breastfeeding mothers and babies in their states. This represents less than two FTEs per state. The report also suggests growing statewide breastfeeding coalitions with public websites as a way to educate women and families.
- Support in child care settings. Child care facilities play an important role in breastfeeding promotion. States that lack regulations that support breastfeeding at child care facilities are encouraged to meet best-practice national standards.
The CDC will release a new Breastfeeding Report Card in 2014, bringing breastfeeding rates again to the fore. Every day up until then I'll be doing what I can as a breastfeeding educator to improve those numbers. And I charge every mother out there who is capable of breastfeeding her child to embrace her power to shift this country's breastfeeding behaviors and attitudes.
The benefits of breastfeeding, and the health risks of not breastfeeding, are significant. We can make our children, ourselves and our nation healthier. Let's not wait to implement change and show our support for breastfeeding. Let's not be disappointed again in 2014.