Saturday, July 7, 2012

The US has the Least Favorable Environment for Mothers Who Want to Breastfeed

I first heard about this shocking statistic while reading a blog post  The author of the post had been referring to a report by the organization Save the Children.  The report, "Nutrition in the First 1,000 days - State of the World's Mothers 2012" is the 13th such report.  "The focus (of the report) is on the 171 million children globally who do not have the opportunity to reach their full potential due to the physical and mental effects of poor nutrition in the earliest months of life. This report shows which countries are doing the best – and which are doing the worst – at providing nutrition during the critical window of development that starts during a mother’s pregnancy and goes through her child’s second birthday. It looks at six key nutrition solutions, including breastfeeding, that have the greatest potential to save lives, and shows that these solutions are affordable, even in the world’s poorest countries."  "Good nutrition during the critical 1,000-day window from pregnancy to a child’s second birthday is crucial to developing a child’s cognitive capacity and physical growth. Ensuring a child receives adequate nutrition during this window can yield dividends for a lifetime, as a well-nourished child will perform better in school, more effectively fight off disease and even earn more as an adult."

"The Breastfeeding Policy Scorecard examines maternity leave laws, the right to nursing breaks at work and other indicators to rank 36 developed countries on the degree to which their policies support women who want to breastfeed."  "In the industrialized world, the United States has the least favorable environment for mothers who want to breastfeed.  Norway tops the Breastfeeding Policy Scorecard ranking. The United States comes in last."

The report found the following barriers to breastfeeding:
"Experts recommend that children be breastfed within one hour of birth, exclusively breastfed for the first 6 months, and then breastfed until age 2 with age-appropriate, nutritionally adequate and safe complementary foods. Optimal feeding according to these standards can prevent an estimated 19 per- cent of all under-5 deaths, more than any other child survival intervention.  Yet worldwide, the vast majority of children are not breastfed optimally.

What are some of the reasons for this? Cultural beliefs, lack of knowledge and misinformation play major roles. Many women and family members are unaware of the benefits of exclusive breastfeeding. New mothers may be told they should wait several hours or days after their baby is born to begin breast- feeding. Aggressive marketing of infant formula often gives the impression that human milk is less modern and thus less healthy for infants than commercial formula. Or mothers may be told their breast milk is “bad” or does not contain sufficient nutrients, so they introduce other liquids and solid food too early.

Most breastfeeding problems occur in the first two weeks of a child’s life. If a mother experiences pain or the baby does not latch, an inexperienced mother may give up. Support from fathers, mothers-in-law, peer groups and health workers can help a mother to gain confidence, overcome obstacles and prolong exclusive breastfeeding.

Women often stop breastfeeding because they return to work. Many aren’t provided with paid maternity leave or time and a private place to breastfeed or express their breast milk. Legislation around maternity leave and policies that provide time, space, and support for breastfeeding in the workplace could reduce this barrier. For mothers who work in farming or the informal sector, family and community support can help them to continue breastfeeding, even after returning to work. Also many countries need better laws and enforcement to protect women from persecution or harassment for breastfeeding in public."

"In the United States alone, it is estimated that low rates of breastfeeding add $13 billion to medical costs and lead to 911 excess deaths every year.142"  "Children who are not breastfed are at higher risk of obesity. In addition, breastfeeding for at least the first six months of life appears to be a factor protecting against obesity.144  In the United States, 10 percent of children under age 5 are overweight and an additional 10 percent of 2- to 5-year-olds are at risk of overweight.145  In the United States, for example, 4 percent of young children are estimated to be stunted, which translates into 840,000 stunted children.147

Breastfeeding practices tend to vary widely across race, ethnicity, education and income levels. Often, disadvantaged mothers breastfeed less that their more privileged counterparts.  In the United States, more than 80 percent of Hispanics and Asians begin breastfeeding, but only 74 percent of whites and 54 percent of blacks do so.150  Women with higher levels of education are more likely to breastfeed, but racial differences are apparent across education levels. For example, even among wom- en with a college degree, blacks are less likely to breastfeed than whites.151 There are sharp geographical differences as well: in eight states, most in the Southeast, less than 10 percent of infants are exclusively breastfed at 6 months.152  A recent study in the United States found that less than 2 percent of low- income mothers who planned to breastfeed were able to meet their goals, while 50 percent of women from a more affluent population did. The low-income women reported the obstacles they encountered when breastfeeding led them to stop sooner than they had planned. The study suggested better support is needed from medical professionals to help low-income mothers succeed in their breastfeeding plans.156"

The implementation of the Baby-Friendly Hospital Initiative was started to ensure hospitals provide more breastfeeding support.  Sweden is currently the only country where all the hospitals are considered "baby friendly."

"Countries with generous maternity and parental leave policies – such as Denmark, Norway and Sweden – tend to have high breastfeeding rates. Public health researchers in the United States recently found that women whose maternity leave lasted longer than six weeks were more likely to initiate breastfeeding, continue for more than six months and rely mostly on exclusive breastfeeding beyond three months, compared with women who returned to work between one and six weeks after giving birth.161  Apart from the United States, all developed countries now have laws mandating some form of paid compensation for women after giving birth. Depending on the country, maternity leave can range from 12 to 46 weeks, with pay from 55 to 100 percent of regular salary."

Under the best policies – in countries such as Germany, Poland and Portugal – women may take an hour or more of paid nursing breaks each day, for as long as they need them. Laws in France, Japan, New Zealand, Norway, Sweden, Switzerland and the United States give women the right to nursing breaks, but without guaranteed pay. In Australia, Canada, Denmark, Finland, Iceland and the United Kingdom, women do not have the explicit right to nursing breaks, paid or unpaid.

The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country – and one of just a handful of countries worldwide – where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as “baby-friendly” and none of the provisions of the International Code of Marketing of Breast-milk Substitutes has been enacted into law. While 75 percent of American babies are initially breastfed, only 35 percent are being breastfed exclusively at 3 months."

There is much to be desired in the United States regarding breastfeeding and support.  I have touched upon the lack of paid maternity leave and the difficulties with maintaining breastfeeding once returning to work in previous blog posts. Unless there is a fundamental shift in the way American mothers are treated, the United States will continue to have dismal breastfeeding rates.

ENDNOTES from the 2012 State of the World's Mothers Report
142 Bartick Melissa and Arnold Reinhold. “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis” Pediatrics. April 5, 2010. pp.e1048–e1056
144 WHO Europe Region. Nutrition: Facts and Figures. health-topics/disease-prevention/nutrition/ facts-and-figures
145 Ogden, Cynthia, Margaret Carroll, Lester Curtin, Molly Lamb and Katherine Flegal. “Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008.” Journal of the American Medical Association. Vol.303, No. 3. January 13, 2010. pp.242- 249
145 Ogden, Cynthia, Margaret Carroll, Lester Curtin, Molly Lamb and Katherine Flegal. “Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008.” Journal of the American Medical Association. Vol.303, No. 3. January 13, 2010. pp.242- 249
150 Centers for Disease Control and Prevention. “Racial and Ethnic Differences in Breastfeeding Initiation and Duration, by State – National Immunization Survey, United States, 2004-2008,” Morbidity and Mortality Weekly Report, Vol. 59, No. 11, March 26, 2010. pp.327-334.
151 Ibid.
152 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Breastfeeding Report Card – United States, 2011. (Atlanta: August 2011)
156 Hanna, Jennifer and Mari Douma.
Barriers to Breastfeeding in Women of Lower Socioeconomic Status, Michigan State University. 2012.
161 Ogbuanu, Chinelo, Saundra Glover, Janice Probst, Jihong Liu and James Hussey. “The Effect of Maternity Leave Length and Time of Return to Work on Breastfeeding.” Pediatrics. Vol.127, Issue: 6. May 30, 2011. pp.e1414-e1427

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