Most mothers know that breastfeeding and providing expressed mothers milk is best for babies and is the normal standard for infant feeding and nutrition. According to the American Academy of Pediatrics (AAP) Breastfeeding and the Use of Human Milk Policy Statement, the committee states that “breastfeeding should be considered a public health issue and not only a lifestyle choice” (AAP 2012). The reason for this statement is the documented short- and long-term health and cognitive positive outcomes of breastfeeding. The AAP recommends exclusive breastfeeding for about 6 months and then continued breastfeeding once complementary foods are introduced for 1 year or longer (2012).
The Healthy People 2020 Breastfeeding Objectives mirror this recommendation and believe that breastfeeding and/or providing expressed mothers milk is a key public health strategy. One reason for this increase is the awareness of the impact of hospital practices and routines that support initiation and duration of breastfeeding. The Ten Steps to Successful Breastfeeding developed by WHO and UNICEF when implemented by hospitals has been shown improve breastfeeding rates. Breastfeeding rates are increasing nationally but still fail to reach any of the Healthy People 2020 Breastfeeding objectives.
Mothers’ milk provides more than the perfect nutrition at the right times in a newborn and infants life. It also provides non-nutritional benefits beginning with colostrum and continues for as long as the infant/child received mothers’ milk including after cessation of breastfeeding into adulthood. There are over 200 compounds found in mothers’ milk all working together to provide the necessary nutrition and immunologic protection while the infant’s immune system is maturing. Mothers milk has many roles; it transports nutrients, affects biochemical systems, enhances immunity and destroys pathogens. This is why benefits are seen with any breastfeeding and the longer the breastfeeding duration the more significant health risks are reduced producing (see table 1).
The health benefits and outcomes listed in table 1 are just the beginning. Breastfeeding and receiving mothers’ milk has been associated with a positive risk reduction of non-communicable diseases (NCD) into adulthood. Kelishadi and Farajian (2014) reported the reduction and prevention of the NCD’s as a public health issue as 63% of all-cause mortality are related to NCD’s. Kelishadi and Farajian (2014) report evidence is growing to support the role of breastfeeding in infancy to reduce risk and prevalence of hypertension, obesity, type 2 diabetes mellitus, hypercholesterolemia, and cardiovascular disease. Duration of breastfeeding is also associated with more protection later in life. The authors conclude the need for more longitudinal studies in these areas as some studies are conflicting with confounding factors and do not show a clear association. Despite this need for more research on NCD’s, the authors stress clear short- and long-term health benefits and reduction in risk with breastfeeding.
The health benefits associated with breastfeeding are significant. Recommendations are to exclusively breastfeed for 6 months and continue as mutually desired for at least one year. There are a few medical reasons a mother is not able to breastfeed her baby including a metabolic disorder and a few specific maternal infections. All mothers are encouraged to speak up and discuss concerns they have with an International Board Certified Lactation Consultant (IBCLC).
Recent studies have published the impact of suboptimal breastfeeding. Bartick et al. (2017) studied the costs associated with suboptimal breastfeeding. They report excess deaths in infants associated with suboptimal breastfeeding mostly due to Sudden Infant Death Syndrome (SIDS) with 492 deaths annually and with 92 deaths annually from necrotizing enterocolitis in the United States. Bartick et al. also reported 0.8 women need to breastfeed to prevent infant gastrointestinal infection, 3 women to breastfeed to prevent acute otitis media, and 95 to prevent hospitalization for lower respiratory infection. The authors conclude that “for every 597 women who breastfeed, one maternal or child death is prevented” (Bartick et al. 2017). Bartick and Reinhold in 2010 reported a cost savings of 13 billion dollars in the United States and 911 deaths prevented if 90% of mothers could breastfeed exclusively for 6 months. They also reported a cost savings of 10.5 billion and 741 lives saved if there was 80% compliance with the AAP and Healthy People breastfeeding recommendations.
Utah is one of only 10 states meeting all five Healthy People 2020 objectives in the 2016 CDC Breastfeeding report card (see Table 2). According to the CDC Breastfeeding Report Card, Utah has the highest initiation of breastfeeding in the country and the highest breastfeeding rates of breastfeeding at 6 months. Costs of suboptimal breastfeeding are much lower in Utah because of increased compliance with the AAP and Healthy People Guidelines.
Despite the high initiation and duration rates in Utah, work still needs to be done to improve exclusive breastfeeding rates at 3 and 6 months. According to the 2016 CDC Breastfeeding report card, 73% of infants in the state of Utah are not being exclusively breastfed at 6 months despite initiation of 94.4%. Providing education to mothers and families on these benefits has a significant impact on initiation and duration. Wallenborn, Perera and Masho (2017) report mothers who had knowledge of breastfeeding benefits were 5.6 times more likely to have longer duration of breastfeeding compared to women who did not have a greater knowledge of these benefits. Ongoing efforts are needed to continue to provide education and ongoing support for breastfeeding mothers.
- American Academy of Pediatrics (2012). Committee on Nutrition, Section on Breastfeeding Policy Statement. Breastfeeding and the Use of Human Milk. Pediatrics, 129(5), e827-841, doi:10.1542/peds.2011-3552.
- Bartick, M. and Reinhold, A. (2010). The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics, 125:e1048-e1056.
- Bartick, M. C. et al. (2017). Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr, 13(1). doi:10.1111/mcn.12366.
- Centers for Disease Control (2016) Breastfeeding Report Card. Retrieved from https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf accessed 6/29/2017.
- Healthy People 2020. About Healthy People (2014). Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People accessed 6/20/2017.
- Kelishadi, R. and Farajian, S. (2014). The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence. Adv Biomed Res, 2014 3(3). Doi:10.4103/2277-9175.124629.
- Wallenborn, J. T., Perera, R. A., and Masho, S. W. (2017). Breastfeeding after Gestational Diabetes: Does Perceived Benefits Mediate the Relationship? J of Pregnancy, Article ID 9581796, 6 pages. Doi: 10.1155/2017/9581796
Lechtenberg E. (2019). Breastfeeding and Mothers Own Milk is Best for Babies. Utah Women’s Health Review. doi: 10.26054/0KD9B5MYQG.