Section 3: Role of Broader Factors in Infant Feeding Decisions and Practices
The risks of not breastfeeding are not adequately grasped because infant formula is presented and perceived to be equivalent or better than breastfeeding by the general population even though it is not. Pregnant mothers may be subject to aggressive marketing of formula (samples, gifts, coupons) through hospitals and clinicians’ offices. Research shows that prenatal exposure to human milk substitute advertising significantly increases early termination of breastfeeding in the first 2 weeks and shortens overall duration among women with uncertain breastfeeding goals or goals of 12 weeks or less.17
Dr. David Meyers, Director of the Center for Primary Care at the AHRQ made the following statements about breastfeeding: “Breastfeeding is an amazingly complex and incredibly adaptive system. Breastfeeding represents an intricate process of interaction between mother and infant that is far more than nutrition; it is creating a new person: immune system, brain function, socialization, and long-term health. The evidence suggests that the debate over the relative value of breastfeeding compared with artificial means of feeding is over, as the data are unequivocal in favor of breastfeeding. The challenge must now be to establish appropriate systems and resources to support women and families who are interested in breastfeeding.”18
Impact of pregnancy, birth, and other healthcare practices on breastfeeding outcomes
Data from the 2011 National Survey of Maternity Practices in Infant Nutrition and Care (mPINC) conducted by the Centers for Disease Control and Prevention (CDC) indicate that a substantial proportion of U.S. maternity care facilities engage in practices that are not evidence-based and are known to interfere with breastfeeding.19 For example, 26.4% of birth facilities reported supplementing more than half of healthy, full-term, breastfed newborns with something other than breast milk during the postpartum stay20, a practice shown to be unnecessary and detrimental to breastfeeding.21,22 In addition, 54.5% of facilities reported giving breastfeeding mothers gift bags containing infant formula samples.20 Currently, there are two states whose hospitals have completely ‘banned the bags’, Massachusetts and Rhode Island (49 hospitals and 7 hospitals, respectively).
The mPINC results reflect how far hospitals still need to go despite existing efforts at improvement. Numerous interventions aimed at increasing the initiation and duration of breastfeeding have been attempted at multiple levels in the U.S.23 The most comprehensive attempt to change hospital practices is the Baby-Friendly Hospital Initiative (BFHI), an international program designed to encourage health care providers to create an environment designed to support, protect, and promote breastfeeding by recognizing and rewarding facilities that model optimal breastfeeding practices.24,25
The 10 Steps to Successful Breastfeeding are evidence-based practices known to result in optimal breastfeeding outcomes. Baby-Friendly designated hospitals have been shown to have persistent elevated rates of breastfeeding initiation and exclusivity.26 The uptake of the BFHI has been slow in the U.S., however, with only 6.7% of births occurring in Baby-Friendly hospitals, while the HP2020 goal is set at 8.1%.27 Mothers who delivered in hospitals that practiced 6 or 7 of the 10 steps were 6 times more likely to achieve their intention to exclusively breastfeed than were those in hospitals that practiced none or 1 of the steps.28 Interventions that successfully change hospital practices in breastfeeding could have a major impact on infant health in the U.S.23
The Joint Commission’s Perinatal Care Core Measure Set includes exclusive breast milk feeding at discharge as one of its five core measures.29 Effective with January 1, 2016 discharges the threshold for mandatory reporting for the Perinatal Care Performance Measure Set will change from a minimum of 1,100 births to a minimum of 300 births per year.
In March 2002, The Joint Commission, together with the Centers for Medicare and Medicaid Services, launched a national campaign (Speak-Up) to urge patients to take a role in preventing health care errors by becoming active, involved and informed participants on the health care team. The program features brochures, posters and buttons on a variety of patient safety topics. One related to breastfeeding was launched in August 2011.
