Breastfeeding as a Public Health - and Family – Issue

On the surface, it may seem surprising that breastfeeding should be the contentious issue it often is. It benefits infants' health in so many ways. But for the new mothers who decide they cannot manage it or who are unsuccessful in their efforts, breastfeeding can be a source of feelings of failure and frustration.

Two recent studies, taken together, offer a more balanced picture of an area of motherhood that too-often resembles a battleground. The American Academy of Pediatrics has just issued an updated statement on the value of breastfeeding and the use of human milk.

At almost the same time, a British study provides a clear-eyed look at the reasons why women decide not to breastfeed and finds it is time for breastfeeding recommendations to acknowledge the realities that may lead mothers to decide against the practice.

Citing numerous short and long-term health benefits to children and mothers, the American Academy of Pediatrics (AAP) urges that breastfeeding be viewed as “ a public health issue and not only a life style choice” and recommend “exclusive breastfeeding for about six months followed by continued breastfeeding as complementary foods are introduced a with continuation of breastfeeding for one year or longer as mutually desired by mother and infant.”

The evidence for the health benefits of breastfeeding to infant and mother is abundant and compelling.

The AAP has have taken such a strong position because the evidence for the health benefits of breastfeeding to infant and mother is abundant and compelling. Citing data from the Agency for Health Care Research and Quality, the Academy offers a long list of the ways breast milk can improve or safeguard infants' health:

• The risk of being hospitalized for a lower respiratory track infection (pneumonia, bronchitis) is reduced by 72% in infants who are breastfed exclusively for more than four months.
• The risk of ear infections is decreased by 50% in infants who breastfeed for more than three months, and by 63% in infants who breastfed exclusively for six months.
• Breastfeeding reduced the incidence of gastrointestinal infections by 64 %, with the protection lasting for two months after breastfeeding is discontinued.
• Breastfeeding confers a 38% reduction in the risk of sudden infant death syndrome (SIDS) that is independent of the sleeping position of the infant.
• When infants are breastfed exclusively for 3-4 months, they have a 27% decrease in the development of asthma, atopic dermatitis and eczema. This protection increases to 42% decrease in infants with a positive family history for these allergic conditions.
• If infants are being breastfed at the time of their first exposure to gluten, there is a 52% reduction in the risk of developing celiac disease.
• There is a 31% reduction in the development of inflammatory bowel disease in breastfed children.
• When breastfeeding of any duration had occurred, there was a 15-30% decrease in adolescent and adult obesity, the longer the breastfeeding, the more the reduction in overweight.
• Infants who were exclusively breastfed for at least three months with no exposure to cows milk protein had up to a 30% decrease in type one diabetes and a reduction of 40% in the incidence of type 2 diabetes.
• A reduction of 20 % in the risk of acute lymphocytic leukemia and 15% in the risk of acute myeloid leukemia has been seen in infants breastfed for six months or longer.

Breastfeeding has also been shown to improve neurodevelopmental outcomes and IQ scores, Higher IQ scores and higher teacher ratings are seen in infants who were exclusively breastfed for three months or longer.

Higher IQ scores and higher teacher ratings are seen in infants who were exclusively breastfed for three months or longer.

The AAP policy statement outlines safe practices for storage and use of human milk in the Neonatal ICU. Preterm infants fed breast milk have lower incidences of necrotizing enterocolitis, a serious inflammation of the gastrointestinal tract, and sepsis, widespread infection. IQ tests and brain imaging studies support the positive neurodevelopmental impact of breast milk on the developing premature central nervous system.