Breastfeeding as a Public Health - and Family – Issue

Longer-term benefits include a decreased risk of type two diabetes, rheumatoid arthritis, adult cardiovascular disease, and breast and ovarian cancer. Generally, longer duration of breastfeeding confers more protection. For example, breastfeeding longer than 12 months is associated with a 28% decreased risk in breast cancer and each additional year of breastfeeding results in an additional 4.3 % reduction.

There are relatively few medical reasons not to breastfeed, and the Academy’s statement contains recommendations for the management of specific medical conditions that may require short-term changes in breastfeeding routines. Similarly, there are some maternal medications that do not preclude breastfeeding completely although they may require special management.

Because breastfeeding rates in the US fall far short of the Academy’s goals, the policy statement reviews the barriers to breastfeeding and describes the policies that have been developed for U.S. hospitals to address them.

The AAP especially recommends that hospitals develop policies and programs to encourage breastfeeding. Five early breastfeeding practices have proven to increase breastfeeding success and duration:

1. Newborns should be breastfed in the first hour after birth.
2. Newborns should be breastfed exclusively.
3. Hospitals should promote rooming in to make breastfeeding easier.
4. Pacifiers should be avoided.
5. New mothers should be given a telephone number to call for breastfeeding help and support after discharge from the hospital.

The goal of the AAP's updated statement is to make new parents and parents-to-be aware of the compelling evidence for the extensive and diverse health benefits of breastfeeding to children and mothers. They would like the public and the medical community to view giving new mothers breastfeeding support as a critical public health issue that can decrease the individual and societal burden of acute and chronic illness.

In light of the benefits of breastfeeding, it is also valuable to know why people decide not to do it, both to provide assistance that might make it possible and to offer more support to those women who opt not to breastfeed.

Not everyone is willing to commit to six months of exclusive breastfeeding. There are maternal, family, social, economic, and environmental factors that may all make breastfeeding more difficult.  

There is a striking contrast between the idealism of the breastfeeding... and the realities of the demands of infant feeding within family systems and complex lives. 

British researchers conducted 220 interviews with women and their partners or other caregivers every month during their infants’ first six months of life.

The researchers were interested in the challenges the women and their families faced and what influenced their decision not to breastfeed or to give it up. They found a striking contrast between the idealism of breastfeeding recommendations, which are based on the desire to optimize the health of women and infants, and the realities of the demands of infant feeding within family systems and complex lives. 

Women and their partners reported a need to factor in the immediate well-being of their families before the "theoretical longer term health benefits.”  Mothers who need to tend to other young children, for example, may find it easier to hand their infants over to fathers or family to feed, making formula feeding more attractive.

The authors of the study are supportive of breastfeeding and emphasize that breastfeeding need not be an all-or-nothing proposition. In addition to setting incremental goals for breastfeeding and introducing it in the context of a family-centered approach to feeding, they urge that efforts to promote breastfeeding take into account the "... diverse values, meanings and emotions around infant feeding within families.”