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.18
Dr. David Meyers, Chief Medical Officer 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.”19
Impact of pregnancy, birth, and other healthcare practices on breastfeeding outcomes
Data from the 2015 National Survey of Maternity Practices in Infant Nutrition and Care (mPINC) National Survery of Maternity in Infant Nutrition (mPINC) and Care 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 evidence-based and promote better breastfeeding outcomes. For example, 73% of birth facilities reported not supplementing breastfed newborns with something other than breast milk during the postpartum stay unless medically indicated. 79% of facilities reported not giving breastfeeding mothers gift bags containing infant formula samples.
The mPINC results demonstrate that some hospitals still have to do work 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.23,24
The 10 Steps to Successful Breastfeeding are evidence-based practices known to result in optimal breastfeeding outcomes. 21,22,23,24,25 Baby-Friendly designated hospitals have been shown to have persistent elevated rates of breastfeeding initiation and exclusivity. In 2007, less than 3% of births occurred in approximately 60 Baby-Friendly designated facilities in the United States. In 2018, more than 25% of births in more than 500 Baby-Friendly designated facilities, and this number continues to rise. Baby-Friendly hospitals and birthing centers can be found in all 50 states, the District of Columbia, and Puerto Rico. According to a 2018 systematic review of breastfeeding programs and policies by AHRQ, the Baby-Friendly Hospital Initiative (BFHI) is associated with improved rates of breastfeeding initiation and duration. The full systematic review can be found here.
The Joint Commission and Exclusive Breastmilk Feeding
The Joint Commission’s Perinatal Care Core Measure Set includes exclusive breast milk feeding at discharge as one of its six core measures. The Joint Commission defines exclusive breast milk feeding as: “a newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines.” Breast milk feeding includes expressed mother’s milk as well as donor human milk. As of January 1, 2019, The Joint Commission will require data collection for a new Perinatal Care (PC) performance measure in addition to the five currently required for accredited hospitals with at least 300 live births per year and for all hospitals seeking Perinatal Care certification.
The Joint Commission, together with the Centers for Medicare and Medicaid Services, mantains 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.