Briana J Jegier, PhD, is an assistant professor health services administration at D'Youville College. Photo by D'Youville College

Briana J. Jegier, PhD, is an assistant professor of health services administration at D’Youville College. Photo by D’Youville College

August is National Breastfeeding Month, hosted by the United States Breastfeeding Committee to advocate for the policy and practice changes needed to build a “landscape of breastfeeding support.” Breastfeeding has numerous health benefits for infants, children and mothers, yet only 27 percent of U.S. babies meet the American Academy of Pediatrics recommendation of breastfeeding for the first 12 months of their lives.

Briana J. Jegier, PhD, of APHA’s Breastfeeding Forum, spoke to Public Health Newswire on why breastfeeding is such a critical public health issue and what all Americans can do to promote it.

Q: Simply put, why is breastfeeding so important for public health?

A: Breastfeeding, including breast milk feeding, is a fundamental public health strategy because of its ability to improve the well-being of families, communities, and society. When compared with alternatives, breast milk is widely available, inexpensive, and is associated with improved short- and long-term health outcomes, economic savings, and environmental benefits. Emerging research demonstrates that breast milk plays a fundamental role in programming the gut microbiome’s ability to respond to diseases ranging from infectious (e.g. gastroenteritis) to chronic (e.g diabetes). In fact, breast milk is the only source of human milk oligosaccharides (HMOs) which laboratory studies demonstrate act as both a protective and decoy agent when we fight disease. Collectively, breastfeeding and breast milk are core to public health as increasing exposure to both provide an opportunity to improve all facets of health and to provide families and communities with an optimal start.

Q: Nationally, nearly 80 percent of mothers have breastfed their babies, but only 50 percent are breastfeeding at six months. What are the barriers to sustained breastfeeding?

A: Breastfeeding barriers are multifaceted but generally fall into three interconnected categories: inadequate education, insufficient support, and systemic undervaluing of breastfeeding. Families encounter these barriers throughout the prenatal period and birth hospital stay: they do not receive information and support necessary to make fully informed decisions about breastfeeding, they experience practices that obstructs breastfeeding intentions, and healthcare systems undermine the value of breastfeeding by exposing families to commercial formula advertisements. Barriers to breastfeed become all-the-more stark after hospital discharge. Although 80 percent of families initiate breastfeeding, only 60 percent are still exclusively breastfeeding after just 7 days. This dramatic drop continues through the first 6 months. At 6 months, only 20 percent of families are still exclusively breastfeeding in spite of professional recommendations that exclusive breastfeeding be supported and protected throughout this period.

Inadequate education begins in elementary school and continues through university. Evidence-based infant feeding and lactation education is not systematically provided at any level, including in undergraduate, graduate, and postgraduate health professions programs. Without adequate education and training, under-informed families seek help from under-prepared providers; this creates a perfect storm for the perpetuation of myths, inadvertent breastfeeding sabotage, and over recommendation of breast milk alternatives as a blanket solution to any challenge. Moreover, this lack of education and training means that healthcare systems provide insufficient breastfeeding support. Shortages of trained, qualified lactation support professionals and communities devoid of policies, practices, and places that support breastfeeding leave too many families without resources they need to fulfill their breastfeeding intentions. Finally, and perhaps most important, breastfeeding is systemically undervalued. National conversations continue to characterize breastfeeding as a lifestyle choice rather than the life-saving, evidence-based intervention it is. Without appropriate value, requiring adequate education and developing comprehensive breastfeeding support – particularly paid family leave and adoption of the WHO code – will continue to face uphill battles.

Q: This is the fifth anniversary of The Surgeon General’s Call to Action to Support Breastfeeding. What progress have we seen since then, and how is our Breastfeeding Forum advocating for more?

A: Significant strides have been made on each of the 20 action items included in the Surgeon General’s Call. Breastfeeding rates continue to rise and the number of children born in facilities that are designated as Baby-Friendly has risen from roughly 3 percent in 2007 to 17.9 percent in 2016. This rise is in part due to programs supported by public health entities, including CDC and NACCHO, and led by our Breastfeeding Forum members that have enabled facilities to receive the support they need to receive Baby-Friendly designation.  Breastfeeding coalitions and public health departments across the US have also created state specific designations that recognize businesses, childcare facilities, and healthcare providers that adopt baby and breastfeeding friendly practices. We also see a bigger and more vibrant USBC that has built coalitions with partners, including APHA, to form work groups that address each of the 20 areas and other emerging breastfeeding issues. Finally, we have seen increases in funding initiatives and organizations dedicated to increasing lactation professional diversity and availability.

The Breastfeeding Forum in partnership with other APHA sections has worked to promote the Surgeon General’s Call. We have revised APHA policy to incorporate the call and we have worked with our colleagues to ensure that new policies consider the impact of breastfeeding on the issues they address. We have also worked with APHA leaders to revise disaster preparedness fact sheets to ensure they reflect evidence-based information for breastfeeding families. Currently, we are developing a public health policy to address the growing practice of milk sharing.  We are also utilizing technology to increase collaboration (e.g. webinars, twitter chats) throughout the year. Finally, we have prioritized developing diversity in our membership so that all voices are at the table as we address the challenges faced in breastfeeding and public health.