Breastfeeding: A Key Strategy for Improving Public Health

As a healthcare provider, you undoubtedly know that breast milk is the optimal food for all babies. But did you know that in addition to the impressive medical benefits it confers to children, there are also health advantages for mothers who breastfeed? And that breastfeeding can have economic, environmental and societal advantages as well?
Breast milk is, indeed, liquid gold. Unfortunately, despite all the good that it does, there are still many women who opt not to breastfeed their babies, or who begin breastfeeding and then stop early on. While we’re making gains there is still a long way to go.

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Breastfeeding: A Key Strategy for Improving
Public Health

August 17, 2021

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As a healthcare provider, you undoubtedly know that breast milk is the optimal food for all babies. But did you know that in addition to the impressive medical benefits it confers to children, there are also health advantages for mothers who breastfeed? And that breastfeeding can have economic, environmental and societal advantages as well?1


Breast milk is, indeed, liquid gold. Unfortunately, despite all the good that it does, there are still many women who opt not to breastfeed their babies, or who begin breastfeeding and then stop early on. While we’re making gains there is still a long way to go.

Let’s take a look at the state of breastfeeding in the United States: where we’re doing well, where we could use some improvement, and how you as a healthcare provider might be able to help. First, how about a refresher on all the good that breastfeeding does?

The Benefits of Breastfeeding

Brimming with antibodies, cells and hormones that help protect against illness, breast milk offers an abundance of health benefits to babies, the Office on Women’s Health at the U.S. Department of Health & Human Services (HHS) reports.2 This includes a lower risk of numerous medical conditions in infancy as well as childhood, including:

  Asthma
  Childhood leukemia
  Childhood obesity
  Diarrhea and vomiting
  Ear infections
  Eczema

  Lower respiratory infections
•  Necrotizing enterocolitis
•  Sudden infant death syndrome
•  Type 2 diabetes

 

Babies aren’t the only ones who benefit from breastfeeding; so do their moms, both after delivery and over the long term. According to the Cleveland Clinic, women who breastfeed experience fewer urinary tract infections in the postpartum period; they also have a reduced risk of anemia and postpartum depression. In addition, they experience less postpartum bleeding due to increased contraction of the uterus post-delivery thanks to the oxytocin release triggered by suckling.3

Mother breastfeeding her baby

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Women also enjoy lifetime benefits, including:3

    • A reduced risk of breast and ovarian cancer
    • A reduced risk of rheumatoid arthritis and lupus
    • Less diabetes
    • Less endometriosis
    • Less hypertension and cardiovascular disease
    • Less osteoporosis

 

And don’t forget the less-tangible yet still-important benefits, including reduced stress due to the oxytocin and prolactin release that happens during breastfeeding, the confidence boost that comes from being able to provide all the nutrition a baby needs to grow and thrive, and increased physical and emotional bonding between mother and child.3

 

That’s not all. Breastfeeding also offers perks to the economy, society and Mother Earth.

 

Economic perks: According to a 2019 report from the United States Department of Agriculture, a hypothetical increase in breastfeeding rates among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) would lead to significant healthcare savings. The report found that if breastfeeding rates increased from 2016 levels to currently recommended levels (90 percent of infants exclusively breastfed until 6 months of age, with breastfeeding continued until the age of 1 as complementary foods — but not infant formula — are added), total health-related costs would drop by $9.1 billion.4

 

And don’t forget the cost savings to mothers who breastfeed: Not having to buy formula can save an average of $1,200–$1,500 in the first year alone, the Office of the Surgeon General at HHS reported in 2011.5 Factor in inflation and that cost saving is likely even higher now.

A miniature earth surrounded by butterflies held within the palm of a hand

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Environmental perks: Breast milk is naturally renewable and produces zero carbon emissions, the World Health Organization reports.6 It also requires no packaging, shipping, or disposal, practices that are all environmentally unfriendly.7

 

On the other hand, formula derived from milk impacts the environment in numerous ways, including through land clearing, pollution, water use, and methane gas produced through dairy farming. It also requires significant amounts of energy and produces water waste during manufacturing and distribution, a 2019 commentary in the International Breastfeeding Journal reported.8

 

Furthermore, writing that “support for breastfeeding is an environmental imperative,” the authors of a 2019 report in BMJ state that supporting mothers in their breastfeeding efforts would equate to a carbon emissions savings equal to taking 50,000 to 77,500 cars off the road each year in the UK alone.9

 

Societal perks: According to the Office on Women’s Health, breastfeeding leads to numerous benefits for society, including:2

    • Lives saved. If 90 percent of women breastfed exclusively for six months, as recommended, almost 1,000 infant deaths could be prevented each year.
    • Lower medical costs. As mentioned, fully breastfed babies are often healthier than their formula-fed counterparts, which typically translates to fewer doctor’s visits, prescriptions and hospitalizations.
    • A more productive workforce. Since breastfed babies tend to be healthier than those who are formula-fed, mothers of breastfed babies often need to take less time off work to care for a sick child.
A baby supported by his mother being inspected by a doctor

The State of Breastfeeding in the U.S.

According to the Centers for Disease Control and Prevention (CDC), breastfeeding is a key strategy for improving public health.10 As such, many organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), state that women should be strongly encouraged to breastfeed.1, 11


Similar to government recommendations, ACOG and the AAP both recommend exclusive breastfeeding (meaning no formula) for approximately the first six months of life. Breastfeeding should be continued when complementary foods are introduced and through at least age 1, or as long as the woman and her child prefer, the organizations say. 1, 11


According to the CDC’s latest Breastfeeding Report Card, released in 2020, 841 percent of U.S. babies who were born in 2017 were breastfed initially, yet only 58.3 percent were still breastfeeding at 6 months of age.10 This falls short of the FDA’s goal of 90 percent of infants being exclusively breastfed for the first six months, followed by continued breastfeeding for another six months.4


Other findings from the report include:10

  Among babies born in 2017, 19.2 percent received supplemental formula before 2 days of age. This is an increase from 16.9 percent among babies born in 2016.

  Among babies born in 2017, 46.9 percent were exclusively breastfed through 3 months of age.

  Just 25.6 percent of babies born in 2017 were exclusively breastfed until 6 months of age.

  Only 35.3 percent of babies born in 2017 were still breastfeeding at 12 months of age.

 

So while most babies are receiving some breast milk — and experts agree that any amount is beneficial12 — the majority are not exclusively breastfed or continuing to breastfeed as long as experts recommend.10

 

How You Can Help

ACOG and numerous other experts say that the advice and encouragement of healthcare providers are critical in helping women make an informed decision about whether to breastfeed. That said, while women should be encouraged to breastfeed, they should not be pressured or unduly influenced when making infant feeding decisions, ACOG states.1


Following are steps you can take when helping women decide whether to breastfeed — and, if they decide to, to help them succeed.

  1. If a patient decides to breastfeed, encourage her to take a breastfeeding class while pregnant and to join a breastfeeding support group after she delivers. If she has difficulties with nursing, suggest that she consult with an international board-certified lactation consultant.
  2. Don’t minimize or dismiss patients’ concerns. Listen openly and without judgment. In a previous article, we covered some tips to improve patient communication.
  3. Discuss the downsides to not breastfeeding: a higher risk of breast and ovarian cancer, diabetes, heart disease, and hypertension for the mother; an increased risk of infectious disease, metabolic disease, and sudden infant death syndrome for the baby.1
  4. Encourage patients to deliver at a designated Baby-Friendly hospital if possible. Delivering at such facilities has been shown to increase breastfeeding initiation and exclusivity rates.13
  5. Institute, where possible, the World Health Organization’s 10 Steps to Successful Breastfeeding.
  6. Don’t distribute formula samples or marketing materials to pregnant patients. According to ACOG, distribution of such materials reduces breastfeeding initiation and duration rates and should not occur in healthcare settings.1
  7. If a woman chooses to breastfeed, discuss early strategies for success, including early skin-to-skin contact, rooming-in and feeding on demand.14, 15
  8. Help set reasonable expectations. In the early days, women may experience engorgement and sore nipples, which is common. Also remind patients that newborns need to nurse often to help establish a robust supply. This doesn’t mean the baby isn’t getting enough milk.16
  9. Remind women that even if they were to experience difficulties with breastfeeding, such as a difficult latch or persistently sore nipples, that doesn’t mean they can’t still feed their baby mother’s milk. Expressing breast milk by hand or via a breast pump and then feeding the milk through a bottle can bring the same health benefits.

 

Resources for Patients
For information on how to get a good latch:
https://wicbreastfeeding.fns.usda.gov/steps-and-signs-good-latch

 

For information on the importance of skin-to-skin contact:
https://my.clevelandclinic.org/health/articles/15276-skin-to-skin-contact-for-you--baby


For information on laid-back breastfeeding, a position that many experts advocate for use in the hospital and at home:
https://lllusa.org/lie-back-and-relax-a-look-at-laid-back-breastfeeding/


To get help for sore nipples:
https://www.mottchildren.org/health-library/hw103462


For questions about milk supply:
https://www.lowmilksupply.org


For information about pumping:
https://www.pumpstation.com/blogs/articles/video-how-to-use-a-breast-pump https://www.marchofdimes.org/baby/using-a-breast-pump.aspx


How to find a Baby-Friendly hospital:
https://www.babyfriendlyusa.org/for-parents/find-a-baby-friendly-facility/


How to find an international board-certified lactation consultant:
https://uslca.org/resources/find-an-ibclc/


Breast milk is one of the best gifts a woman can give her baby, yet due to various factors, many pregnant patients are making the decision not to breastfeed. Let’s all work together to help change that.

Footnotes:
1 American College of Obstetricians and Gynecologists. “Optimizing Support for Breastfeeding as Part of Obstetric Practice.” https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice. Accessed July 2021.
2 Office on Women’s Health. “Making the Decision to Breastfeed.” https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed. Accessed July 2021.
3 Cleveland Clinic. “The Benefits of Breastfeeding for Baby & for Mom.” https://my.clevelandclinic.org/health/articles/15274-the-benefits-of-breastfeeding-for-baby--for-mom. Accessed July 2021.
4 Oliveira, V, et al. “The Economic Impacts of Breastfeeding: A Focus on USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).” United States Department of Agriculture, February 2019. https://www.ers.usda.gov/webdocs/publications/91273/err-261.pdf?v=2226.3. Accessed July 2021.
5 Office of the Surgeon General. “Breastfeeding: Surgeon General’s Call to Action Fact Sheet.” HHS.Gov, 19 Jan. 2011, https://www.hhs.gov/surgeongeneral/reports-and-publications/breastfeeding/factsheet/index.html. Accessed July 2021.
6 UNICEF/WHO Baby-Friendly Hospital Initiative (BFHI) Benefits of Breastfeeding for the Environment and Society. “Ten Steps to Successful Breastfeeding.” http://www.tensteps.org/benefits-of-breastfeeding-for-the-environment-society.shtml. Accessed July 2021.
7 Shenker, N, et al. “Breastfeeding Can Help Tackle Climate Crisis but It’s on Governments, Not Mums to Save the World.” https://phys.org/news/2019-10-breastfeeding-tackle-climate-crisis-mums.html. Accessed July 2021.
8 Smith, JP. “A Commentary on the Carbon Footprint of Milk Formula: Harms to Planetary Health and Policy Implications.” International Breastfeeding Journal, vol. 14, no. 1, Nov. 2019, p. 49. BioMed Central, doi:10.1186/s13006-019-0243-8.
9 “Environmental Cost of Formula Milk Should Be a Matter of Global Concern.” BMJ. https://www.bmj.com/company/newsroom/environmental-cost-of-formula-milk-should-be-a-matter-of-global-concern/. Accessed July 2021.
10 Centers for Disease Control and Prevention. “2020 Breastfeeding Report Card.” 17 Sept. 2020, https://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed July 2021.
11 Section on Breastfeeding. “Breastfeeding and the Use of Human Milk.” Pediatrics, vol. 129, no. 3, Mar. 2012, pp. e827–41. pediatrics.aappublications.org, doi:10.1542/peds.2011-3552.
12 March of Dimes. “Breastfeeding Your Baby.” https://www.marchofdimes.org/baby/breastfeeding-your-baby.aspx. Accessed July 2021.
13 Merewood, A, et al. “Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey.” Pediatrics, vol. 116, no. 3, Sept. 2005, pp. 628–34. pediatrics.aappublications.org, doi:10.1542/peds.2004-1636.
14 Chiou, S-T, et al. “Early Skin-to-Skin Contact, Rooming-in, and Breastfeeding: A Comparison of the 2004 and 2011 National Surveys in Taiwan.” vol. 41, no. 1, Mar. 2014, pp. 33–38. PubMed, doi:10.1111/birt.12090.
15 UNICEF/WHO Baby-Friendly Hospital Initiative (BFHI) Benefits of Breastfeeding for the Environment and Society. “Ten Steps to Successful Breastfeeding: Step 8: Encourage Breastfeeding on Demand.” http://www.tensteps.org/step-8-successful-breastfeeding.shtml. Accessed July 2021.
16 Lauwers J, Swisher A. Counseling the Nursing Mother: A Lactation Consultant’s Guide. Jones & Bartlett Learning, 2011.

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