The HealthyPeople initiatives use science-based objectives with the aim to improve health of Americans and disease prevention through awareness and improved understanding. The CDC Breastfeeding Report Card tracks progress of the HealthyPeople 2020 breastfeeding objectives nationally and by each state (Table 1). Breastfeeding and providing the mother’s own milk is well known to protect and improve health for infants with any breastfeeding; short and long-term breastfeeding and exclusive breastfeeding duration have long-term health outcomes that last through childhood into adult life. These health benefits are dose related and correlate with the HealthyPeople breastfeeding objectives. Breastfeeding and/or providing the mother’s own breastmilk protects mothers short-term and long-term, with improved health outcomes related to duration of breastfeeding or pumping. Dermer et al. reports that these breastfeeding benefits to mothers are a well-kept secret that is often unknown or not emphasized in education. Nationally, breastfeeding initiation rates are rising, with 29 states meeting the initiation objective. Duration rates are also increasing nationally; however, only 12 states met the 6-month objective for breastfeeding at 6 months. Utah has the highest initiation of breastfeeding in the country and the highest rates of breastfeeding at 6 months. Utah is one of only 10 states meeting all five HealthyPeople 2020 objectives in the 2016 CDC Breastfeeding report card (see Table 1).
Benefits that mothers obtain when they breastfeed are often understated and underemphasized. Maternal health is negatively impacted when mothers do not breastfeed or wean prematurely. Documented health outcomes studied in the literature include reduction of risk for breast cancer, ovarian cancer, type 2 diabetes mellitus, metabolic syndrome, obesity, hypertension, cardiovascular disease and postpartum depression. Many of these diseases are chronic non-communicable diseases (NCD) in adulthood and are attributed as major causes of mortality (Kelishadi and Faraijan, 2014). According to the World Health Organization (WHO) June 2017 Fact Sheet, NCD’s are responsible for 70% of all deaths globally, amounting to 40 million people. Cardiovascular disease is responsible for the most deaths from NCD’s followed by cancers, respiratory diseases, and diabetes (WHO 2017). Risk factors include being overweight/obese, hypertension, hyperglycemia and hyperlipidemia. All of these factors are associated with long-term risk reduction in mothers who breastfeed. The longer a mother breastfeeds, the larger the reduction risk of developing many of these NCD’s (Peters et al. 2017).
Schwarz and Nothnagle (2015) reported that breast and ovarian cancers are more common among mothers who did not breastfeed. According to their 2015 article, written following a meta-analysis of 47 studies, invasive breast cancer risk is reduced by at least 4%. The authors also reported that mothers with the BRCA1 mutation have a 37% reduction in breast cancer risk if they breastfeed for at least one year. Ovarian cancer is 32% more likely in mothers who did not breastfeed (Schwarz and Nothnagle, 2015). In 2016, Victoria et al. reported a reduction in invasive breast cancers by 4.3% for each 12-month increase in lifetime breastfeeding.
The American Academy of Pediatrics (AAP) reported similar percentages of breast cancer reduction for each year of breastfeeding. They also reported cumulative breastfeeding duration of greater than 12 months being associated with a 28% decrease in breast and ovarian cancer. Following a meta-analysis review, Victoria et al. reported that longer periods of breastfeeding were associated with a 30% reduction in ovarian cancer. These authors estimated that 20,000 maternal deaths are prevented annually at the current rate of breastfeeding, and another 20,000 breast cancer deaths could be prevented annually by improving breastfeeding practices. There is a growing body of evidence supporting improved metabolic health later in life in women who breastfeed. Schwarz and Nothnagle (2015) reported a significant reduction of risk of developing diabetes later in life for mothers who breastfed for at least one month. The authors also report a reduced risk of maternal obesity later in life. Mothers without a history of gestational diabetes showed a 4-12% reduced risk of developing type 2 diabetes mellitus, for each year of breastfeeding (AAP 2012).
According to data from the Women’s Health Initiative, cardiovascular disease risk was reduced by 28% after the first delivery in mothers who breastfed for seven to twelve months, compared to mothers who did not breastfeed. The Nurses’ Health Study looked at combined time of breastfeeding and documented that women who breastfed for a total of two or more years decreased their coronary heart disease risk by 23%, compared to mothers who did not breastfeed (Schwarz and Nothnagle 2015). Aortic calcification was significantly reduced in mothers who breastfed all of their children for at least 3 months. Mothers who did not breastfeed were five times more likely to develop aortic calcification compared to these mothers. The AAP Breastfeeding Policy Statement reports on the Women’s Health Initiative Study results, which included a signification reduction in hypertension, hyperlipidemia, and cardiovascular disease associated with cumulative breastfeeding of 12-23 months.
Maternal depression is clearly associated with a reduced prevalence in breastfeeding women. Women who do not breastfeed or who wean early have been observed to have higher rated of postpartum depression compared to breastfeeding mothers
(AAP 2012). However, studies are not clear on whether breastfeeding reduces maternal depression or maternal depression impacts breastfeeding initiation and duration (Victoria et al. 2016).
Breastfeeding significantly decreases mortality from NCDs and all causes. Schwarz and Nothnagale reported that if 90% of mothers breastfed for one year, an estimated 14,000 heart attacks would be prevented and hypertension treatment would be avoided for 54,000 women. This could save the United States billions of dollars annually and prevent premature deaths in 4,000 women (Schwarz and Nothnagle 2015). Heart disease is the number one killer in Utah according to the American Heart Association (2015). Bartick et al. also reported on a cost analysis of maternal disease associated with suboptimal breastfeeding rates in 2012, and they determined annual maternal deaths in the United States as follows; 986 due to myocardial infarction, 838 due to breast cancer and 473 due to diabetes. The authors also indicated maternal medical costs of 2.37 billion dollars associated with suboptimal breastfeeding duration and 11.2 billion dollars associated with premature deaths. One last statistic from Bartick et al. estimates was that for every 597 women who optimally breastfed for one year, one maternal or child death was prevented. Review of Utah’s Public Health Data Resource consistently shows statistics of NCD prevalence in the state, where Utah is below the national average.
Using CDC Breastfeeding Report Card data, in 2917 Wallenborn, Perera and Masho reported that 51.8% of mothers across the United States breastfed to 6 months. In Utah that number was 70.4%. The authors reported that mothers who had knowledge of breastfeeding benefits were 11.2 times more likely to initiate breastfeeding and 5.6 times more likely to have longer duration of breastfeeding compared to women who did not have knowledge of these benefits. The authors concluded that breastfeeding as a behavior to reduce risk and possibly prevent illness is a dependent factor. Education to mothers on benefits to their baby is important; however, mothers also need to be provided education on short and long-term benefits for themselves as a method to improve breastfeeding duration. This can be done prenatally and in hospitals and physician offices following delivery. Practices that support breastfeeding are essential for mothers and babies. As Bartick et al. reported, “Breastfeeding has a larger impact on women’s health than previously appreciated” (Bartick et al. 2017).
- American Academy of Pediatrics (2012). Committee on Nutrition, Section on Breastfeeding Policy Statement. Breastfeeding and the Use of Human Milk. Pediatrics, 129(3), e827-841, doi:10.1542/peds.2011-3552.
- American Heart Association Utah Fact Sheet (2015). Retrieved from http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_493916.pdf. Accessed April 30, 2019.
- 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 April 30, 2019.
- Dermer, A. (2001). A Well-Kept Secret Breastfeeding’s Benefits to Mothers. New Beginnings 18(4) 124-127. Healthy People 2020. About Healthy People (2014). Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People Accessed April 30, 2019.
- Kelishadi, R. and Faraijan, S. (2014). The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence. Adv Biomed Res, 3,3.
- Schwarz, E. B., and Nothnagle, M. (2015). The Maternal Health Benefits of Breastfeeding. Amer Fam Phys 91(9), 603-604.
- Victoria, C.G. et al. Lancet Breastfeeding Series Group (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 387,475-490.
- Wallenborn, J. T., Perera, R. A., and Masho, S. W. (2017). Breastfeeding after Gestational Diabetes: Does Perceived Benefits Mediate the Relationship? J of Pregnancy, 2017:9581796. Doi:10.1155/2017/9581796.
- World Health Organization Noncommunicable Diseases Fact Sheet (2018). Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases Accessed April 30, 2019.
Lechtenberg E. (2019). Breastfeeding Protects Mothers. Utah Women’s Health Review. doi: 10.26054/0K8E5MVQR6.