Why Breastfeeding Matters for Mothers and Children (and Families) Everywhere: A Public Health Imperative

By Naomi Bar-Yam, PhD, and Christopher Duggan, MD, MPH

Ranging from scuttling of environmental air and water protections, seeking rescindment of the Affordable Care Act or casting aspersions on the safety of life-saving vaccines, the Trump administration is clearly antagonistic in promoting US and global public health. But this May’s attempt by US representatives to the World Health Assembly to reduce support for global infant nutrition guidelines represents a new low in this trend. World Breastfeeding Week gives us reason to review hard facts and real news about how and why to support nursing mothers and their infants.

First, the good news: the importance of breastfeeding for infant survival and health continues to be appreciated. This includes early initiation (starting breastfeeding within 1 hour of birth) and exclusive breastfeeding (feeding only breast milk for the first six months of life). Recent data from Tanzania confirm that compared with early initiation, delayed breastfeeding initiation is associated with a 48% higher risk of difficulty breathing during the first 6 months of a child’s life [1], an important finding in countries where pneumonia is a common cause of death.

Second, in many countries, breastfeeding rates are rising. According to the CDC [2], US breastfeeding initiation has risen from 73% in 2004 to 83% in 2014, over half of infants are breastfeeding at 6 months, and almost one third are breastfeeding at 12 months. This means that more infants and young children are receiving nutritional, immunologic, growth and emotional factors that are their biological norm. Studies now show that these benefits extend into adulthood, and are mediated by important changes in infant metabolism, immune function and the microbiome (the large population of commensal microbes residing in the human gastrointestinal tract).

Next, some hard facts about why we need to do even better. Globally, suboptimal breastfeeding practices lead to 823,000 child deaths each year [3]; of these, an estimated 721 child deaths and 2,619 maternal deaths occur in the US alone. Annual morbidity from suboptimal breastfeeding in the US includes 600,000 ear infections, 2.6 million gastrointestinal illnesses, 5,000 cases of breast cancer and more than 900 maternal heart attacks [4]. Personal and family losses, additional health care costs, compromised economic productivity from lost work days for parent and child illnesses are staggering. In the US alone, suboptimal breastfeeding costs $13 billion per year for preventable infant and maternal illnesses [5].

Infant feeding is a personal parental decision and society has a responsibility to ensure that each family has the information and social support to make this informed personal choice. Whatever each family decides, as a society, we must normalize breastfeeding wherever mothers and their babies are for as long as they choose to nurse–workplaces, playgrounds, airplanes, schools, places of worship and physical activity.

Health disparities permeate US health care and culture and they begin with pregnancy and the first food–human milk. Compared with their white counterparts, African American mothers are 57% more likely to receive inadequate (late or no) prenatal care [6], almost twice as likely to deliver prematurely, and 23% less likely to breastfeed [7]. Safety net hospitals, those that treat high proportions of Medicaid and uninsured patients, are more likely to treat mothers with high-risk pregnancies and premature babies, but are less likely to provide donor human milk. Use of donor milk results in better short- and long-term health outcomes for babies and in more mothers breastfeeding in hospital and on discharge.

Support for newborns and their parents must reach beyond the walls of hospitals, health clinics and medical offices. For example, the US is the only high-income country that does not have national paid parental leave. As a result, almost ¼ of employed women return to the workplace within 10 days of birth [8]. The lack of a clear social policy to support women’s ability to heal from birth and nurture their children, however they feed them, is known to undermine breastfeeding. Several states and some companies already have various paid parental leave policies in place, with no detrimental effect on business or the economy. Finally, peer support groups, Baby-Friendly hospitals (which promote optimal infant nutrition practices), lactation consultants, health provider education, appropriate use of donor milk and other steps are all important ways to support breastfeeding mothers.

Trump tweeted, “We don’t believe women should be denied access to formula.” We and others believe that women (and their families and societies) should not be denied access to support for successful, early and exclusive breastfeeding.

Dr. Bar-Yam is Executive Director of Mothers’ Milk Bank Northeast in Newton, MA, and immediate past president of the Human Milk Banking Association of North America. Dr. Duggan is Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard TH Chan School of Public Health.

1. Smith ER, Locks LM, Manji KP, McDonald CM, Kupka R, Kisenge R, Aboud S, Fawzi WW, Duggan CP. Delayed Breastfeeding Initiation Is Associated with Infant Morbidity. J Pediatr. 2017;191:57-62 e2. Epub 2017/11/28. doi: 10.1016/j.jpeds.2017.08.069. PubMed PMID: 29173323.
2. Centers for Disease Control and Prevention. Breastfeeding report card: Progresing toward national breastfeeding goals, United States 2016 2016. Available from: https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf.
3. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 2016;387(10017):475-90. doi: 10.1016/s0140-6736(15)01024-7.
4. Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, Bogen DL, Schaefer AJ, Stuebe AM. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. 2017;13(1). Epub 2016/09/21. doi: 10.1111/mcn.12366. PubMed PMID: 27647492.
5. Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010;125(5):e1048-56. Epub 2010/04/07. doi: 10.1542/peds.2009-1616. PubMed PMID: 20368314.
6. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf
7. https://www.cdc.gov/nchs/data/hus/2016/005.pdf
8. https://www.dol.gov/asp/evaluation/fmla/fmla2012.htm