Report 2 of the Council on Scientific Affairs (A-05)

Factors That Influence Differences in Breastfeeding Rates

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Summary

Objective. To consider breastfeeding rates and factors that influence these rates.

Methods. Literature searches were conducted in the MEDLINE database for English-language articles published between January 1995 and February 2005 using the search terms breastfeeding rates, minority breastfeeding rates, and physician breastfeeding education.  A total of 264 citations were identified and 63 were retrieved for analysis with additional references culled from the bibliographies of these references.  Breastfeeding policies of primary care medical organizations were reviewed in addition to considering federal work-related policies.  Investigations of the differences in these rates were reviewed with attention to policies that affect women’s decisions regarding when they return to work after the birth of their child, circumstances in the work environment that influence breastfeeding, government programs that offer outreach and educational materials on breastfeeding to minority women, and the role of physicians in supporting breastfeeding.

Results. Although breastfeeding initiation rates are close to the Healthy People 2010 target of 75%, some segments of the population are not meeting the 50% target for exclusive breastfeeding for infants at 6 months of age.  Breastfeeding offers infants significant benefits including decreases in the incidence and/or severity of a wide range of infectious diseases; health effects also accrue to mothers who breastfeed.  Economic benefits of breastfeeding result from savings related to purchasing and manufacturing formula and health care savings associated with avoidance of chronic diseases. The prevalence of breastfeeding initiation increased dramatically from 51.1% in 1990 to 69.5% in 2001.  However, the benefits from breastfeeding are most likely to take place when infants are exclusively breastfed for the first 6 months of life. According to recent investigations of breastfeeding rates, 5.4% of non-Hispanic black infants were exclusively breastfed at 6 months compared to 14.6% of non-Hispanic white infants and 13.8% of Hispanic infants. The women least likely to breastfeed were young, low-income, African-Americans who had less than 12 years of education. Returning to work when infants are young and working in environments that do not promote breastfeeding are associated with decreases in breastfeeding rates. Physician’s recognition of the role that culture has on breastfeeding patterns in addition to support for and referral to breastfeeding education programs can influence breastfeeding rates.

Conclusions.  Breastfeeding rates are influenced by a number of societal factors.  Some are economic and relate to the mother’s need to return to work when her children are very young.  Working conditions, especially employer-sponsored day care and flexible work schedules can influence initiation and continuation of breastfeeding. Outreach to populations with lower breastfeeding rates includes the provision of culturally sensitive educational materials and referral to lactation and support programs.  Physicians are vital to the referral and education process at the individual and community level.

RECOMMENDATIONS

The following statements, recommended by Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 2005 AMA Annual Meeting:

1. The AMA:  (a) recognizes that breastfeeding is the optimal form of nutrition for most infants;  (b) endorses the 2005 policy statement of American Academy of Pediatrics on Breastfeeding and the use of Human Milk, which delineates various ways in which physicians can promote, protect, and support breastfeeding practices;  (c) supports working with other interested organizations in actively seeking to promote increased breast-feeding by Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) recipients, without reduction in other benefits;  (d) supports the availability and appropriate use of breast pumps as a cost-effective tool to promote breast feeding; and  (e) encourages public facilities to provide designated areas for breastfeeding and breast pumping; mothers nursing babies should not be singled out and discouraged from nursing their infants in public places. (Policy)
2. The AMA:  (a) promotes education on breastfeeding in undergraduate, graduate, and continuing medical education curricula;  (b) encourages the education of patients during prenatal care on the benefits of breastfeeding;   (c) supports breastfeeding in the health care system by encouraging hospitals to provide written breastfeeding policy that is communicated to health care staff;   (d) encourages hospitals to train staff in the skills needed to implement written breastfeeding policy, to educate pregnant women about the benefits and management of breastfeeding, to attempt early initiation of breastfeeding, to practice "rooming-in," to educate mothers on how to breastfeed and maintain lactation, and to foster breastfeeding support groups and services;  (e) supports curtailing formula promotional practices by encouraging perinatal care providers and hospitals to ensure that physicians or other appropriately trained medical personnel authorize distribution of infant formula as a medical sample only after appropriate infant feeding education, to specifically include education of parents about the medical benefits of breastfeeding and encouragement of its practice, and education of parents about formula and bottlefeeding options;  (f) supports the concept that the parent's decision to use infant formula, as well as the choice of which formula, should be preceded by consultation with a physician.  (Policy)

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