Breastfeeding: Population-Based Perspectives

doi:10.1016/j.pcl.2012.09.011

Pediatric Clinics of North America

Volume 60, Issue 1, February 2013, Pages 11-30

https://doi.org/10.1016/j.pcl.2012.09.011 Get rights and content

Section snippets

Key points

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Breastfeeding initiation has increased over the last 2 decades in the United States; increases in optimal breastfeeding lag.
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The number of published research studies has increased significantly, despite little dedicated federal funding for breastfeeding translational and programmatic research.
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Sociocultural factors, such as migration, ethnic belief systems, subtle discrimination, and social and other media, as well as political factors, such as laws and regulations, also create barriers to

Progress

In the United States, the Healthy People 2010 goals for breastfeeding were to have 75% of mothers breastfeed in the early postpartum, continued breastfeeding by 50% at 6 months and 25% at 1 year, with exclusive breastfeeding by 40% at 3 months and 17% at 6 months.¹³ Public health goals for breastfeeding are set to stimulate action both in clinical practices and in public health programming. Because of progress in breastfeeding rates, new US public health goals are now:

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Initiation of any

Perceptions

The pediatrician’s role in support of breastfeeding is more important than ever. Increasingly, women are initiating breastfeeding; however, rates are far from optimal and barriers to successful breastfeeding persist. These barriers fall in 3 categories: (1) health system, (2) sociocultural and (3) economic/political barriers. The following sections consider how these barriers affect breastfeeding.

Public health

Public health approaches may help in the achievement of population-based health behavior change.⁴⁴ Some consider that policy development is a necessary prelude to program intervention. Globally, the major policy approach is the Millennium Development Goals (MDGs) for improving maternal and child health, including gender equity and reproductive justice as underlying needs. The MDGs include 8 goals, all which have implications for breastfeeding. This issue was examined at a global nutrition

Summary

Clinical support for breastfeeding is essential, but such support has greater impact if it is coupled with public health interventions as well. Clinicians have a vital role to play in ensuring their own skills and knowledge base and that of future clinicians, and they also have a vital role in advocating for comprehensive programming to ensure population-level normalization of optimal breastfeeding for all.

Acknowledgments

The author wishes to thank the anonymous North Carolina family for supporting the creation of the Carolina Global Breastfeeding Professorship and Institute in the Department of Maternal and Child Health at the University of North Carolina, allowing her to pursue in-depth study of breastfeeding practices and support.

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Cited by (18)

Contextualizing online human milk sharing: Structural factors and lactation disparity among middle income women in the U.S.
2014, Social Science and Medicine
Citation Excerpt :
Women with higher income and education may have greater knowledge of the benefits of breastfeeding and better access to a wider range of social support required to overcome breastfeeding barriers (Jones et al., 2011). Political economic and sociocultural dimensions of breastfeeding are closely linked in the U.S. (Labbok, 2013). The absence of a supportive family breastfeeding culture and negative social attitudes are major barriers to breastfeeding (Smith et al., 2012) and are more pronounced in lower income communities (Baranowski et al., 1983; Guttman and Zimmerman, 2000).
Women in the U.S. face significant structural constraints in attempting to breastfeed as recommended in the first six months of their child's life. Internet-facilitated human milk sharing is an emergent response to breastfeeding challenges. Little is known about the demographic characteristics of milk sharing donors and recipients and the ways structural factors circumscribe the biocultural context of lactation in milk sharing practices. Data regarding demographic characteristics, reproductive history, lactation history, and levels of social support and health care provider support for breastfeeding were collected via an online survey September 2013–March 2014. Statistical tests were executed to ascertain whether significant differences exist between donors and recipients. A total of 867 respondents (661 donors, 206 recipients) met the eligibility criteria for the study. Respondents were U.S. residents and primarily White, middle-class, well educated, and employed women. Both donors and recipients reported higher than the national average for household income, maternal educational attainment, breastfeeding exclusivity 0–6 months, and breastfeeding duration. Differences in lactation sufficiency and breastfeeding outcomes between donors and recipients were associated with both structural and biocultural factors. Donors reported significantly higher income, education, and support for breastfeeding from spouse/partner, other family, employers, and pediatricians. Donors also reported significantly higher rates of full term birth for child of most recent lactation. This study provides a foundation for understanding how milk sharing reflects a broader political economy of breastfeeding in the U.S.
Immigration and factors associated with breastfeeding. CALINA study
2014, Anales de Pediatria
Identificar las características socioculturales, obstétricas y perinatales asociadas con la lactancia materna completa (LMC) durante 4 meses, en dependencia del origen materno.
Estudio de una cohorte representativa de la población de lactantes aragoneses (n = 1.452). Se han evaluado las variables socioculturales, obstétricas y perinatológicas asociadas a la modalidad de lactancia materna, en dependencia del origen de la madre.
La prevalencia de LMC en nuestro medio es más alta en las madres inmigrantes que en las de origen español. El 37,2% de las de origen español mantienen la LMC a los 4 meses frente al 43% de las inmigrantes (p = 0,039) (RR españolas/inmigrantes = 0,76; IC del 95%, 0,58-0,99); a los 6 meses, esto ocurre en un 13,9% vs. 23,8%, respectivamente (p < 0,001) (RR españolas/inmigrantes = 0,52; IC del 95%, 0,37-0,72). Los factores que se asocian a la LMC a los 4 meses son diferentes entre ambos grupos. Las madres de origen español tienen más edad (p = 0,002), nivel educativo (p = 0,001), paridad (p = 0,003) y mayor probabilidad de parto vaginal (p = 0,005), y sus hijos presentan mayores valores antropométricos al nacimiento. Sin embargo, en las madres inmigrantes, el mantenimiento de LMC se asocia a un mayor índice de masa corporal materno y a no trabajar fuera del domicilio. En ambos grupos, la LMC se mantiene con más frecuencia en aquellas madres que no fuman (p = 0,001).
La prevalencia de LMC durante los primeros meses de edad es más alta en las madres inmigrantes que en las madres de origen español y los factores socioculturales, obstétricos y perinatales que se asocian a la misma son distintos en función del origen materno.
To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin.
Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452).
The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants = 0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants = 0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001).
The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin.
Lactation Telehealth in Primary Care: A Systematic Review
2022, Breastfeeding Medicine
Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice
2021, Journal of the American Association of Nurse Practitioners
Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding
2019, BMC Pregnancy and Childbirth
Breastfeeding self efficacy among pregnant women in Saudi Arabia
2018, Saudi Medical Journal

View all citing articles on Scopus

: Disclosures: No disclosures.

View full text

Breastfeeding: Population-Based Perspectives

Section snippets

Key points

Progress

Perceptions

Public health

Summary

Acknowledgments

First page preview

Lancet

Lancet

Womens Health Issues

J Health Econ

Aust N Z J Public Health

AAP policy statement: breastfeeding and the use of human milk

Pediatrics

Global strategy for infant and young child feeding

Delayed breastfeeding initiation increases risk of neonatal mortality

Pediatrics

Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment No. 153

Evidence on the long-term effects of breastfeeding systematic reviews and meta-analyses

1990–2005: Celebrating the Innocenti Declaration on the protection, promotion and support of breastfeeding

Child mortality estimation: accelerated progress in reducing global child mortality, 1990-2010

PLoS Med

Making room for breastfeeding on the worldwide agenda!

Breastfeed Med

The quiet revolution: breastfeeding transformed with the use of breast pumps

Am J Public Health

Prevalence of breast milk expression and associated factors

Pediatrics

Risk of bottle-feeding for rapid weight gain during the first year of life

Arch Pediatr Adolesc Med

Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants?

Pediatrics