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A Natural Selection: Evolving Efforts to Promote Breastfeeding

Every August is celebrated as National Breastfeeding Awareness Month, along with World Breastfeeding Week (August 1-7), to highlight the many benefits of breastfeeding (for both moms and babies) and recognize the world-wide efforts to make breastfeeding the priority that it should be.

Breastfeeding Benefits

There are many benefits of breastfeeding for both the mother and the baby—several of which might come as a surprise to the public. For example, many healthcare professionals focus on the immediate or short-term benefits of breast milk for the infant, such as increased immunity, decreased risk of asthma, allergies, ear infections, necrotizing enterocolitis (NEC), diarrhea and Sudden Infant Death Syndrome (SIDS); or the short-term maternal benefits of rapid weight loss, involution of the uterus, and savings in preparation time and the cost of formula. However, there are many important long-term benefits of breastfeeding that are often forgotten. For the infant, breast milk may protect against many childhood cancers and obesity in later life and has been closely linked to higher IQ scores in later childhood. Long-term maternal benefits of breastfeeding include a lower risk of developing breast and uterine cancer, and a decreased risk for osteoporosis in later life.

The Provider’s Part in Breastfeeding

“Then why is breastfeeding not more common?” Sadly, it is far easier for healthcare professionals to “prescribe” formula feeding, where ounces can be measured and documented, than to spend time helping new mothers develop the skills they need to breastfeed successfully. Working with a new breastfeeding mother takes time, patience, skill and persistence.

A study published in the Journal of Perinatal Education in 2015, found that provider lack of knowledge and skill in providing breastfeeding support are the biggest impediments to encouraging women to breastfeed. The descriptive study by Radzyminski & Callister examined attitudes toward breastfeeding of more than 50 healthcare providers, and found that the main barriers to providing breastfeeding support to women included lack of knowledge of the benefits of breastfeeding, lack of assessment and therapeutic skills, and a failure to perceive how support from healthcare providers can make a difference to breastfeeding rates.

Factors in Breastfeeding Promotion

On a positive note—there has been a move by both national and international agencies to support and promote breastfeeding, including the U.S. Department of Health & Human Services (USDHHS), the American Academy of Pediatrics (AAP), American Congress of Obstetricians and Gynecologists (ACOG), the Academy of Breastfeeding Medicine (ABM), the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF).

The USDHHS has campaigned tirelessly for the promotion and support of breastfeeding, and one of the goals of Healthy People 2020 is the achievement of a 75% initiation rate for breastfeeding. These efforts are finally paying off, as more and more hospitals are recognizing the importance of supporting breastfeeding mothers and babies.

In addition, the Affordable Care Act (ACA) mandated insurance coverage for comprehensive breastfeeding support and counseling, and the funding of supplies in 2012. This provided the financial incentive for facilities to consider obtaining Baby-Friendly® designation.

The Baby-friendly Hospital initiative® (BFHI) was initially launched in 1991 by UNICEF and the WHO, to ensure that all maternal facilities would eventually become centers of breastfeeding support and excellence. Since the BFHI® began, more than 15,000 facilities in 134 countries have been awarded Baby-Friendly status, and more than 500 hospitals or birthing centers in the U.S. have been designated as Baby-Friendly in the United States. Baby-Friendly designated facilities are now getting the recognition they deserve in protecting, promoting and supporting breastfeeding and more and more knowledgeable consumers are now demanding this standard of care.

Breastfeeding Knowledge and Training

As an International Board Certified Lactation Consultant, I’m hopeful we will see a continued movement towards supporting breastfeeding mothers and babies, as evidence of the unique health benefits of breastfeeding become more common knowledge.

However, to really impact our standard of care we need to implement strategies to fill breastfeeding-related knowledge and training gaps for healthcare providers in all specialty areas. To this end, the AAP has developed a Physician Education & Training on Breastfeeding Action Guide to increase the availability of breastfeeding education and training for physicians. The Centers for Disease Control & prevention (CDC) has also developed a Guide to Strategies To Support Breastfeeding Mothers and Babies in which clinical breastfeeding support protocols are available to local healthcare providers, offering professional development training and promoting access to evidence-based, online training for all healthcare professionals. Hopefully, these measures will ensure that healthcare professionals develop the knowledge and skills needed to truly protect, promote and support breastfeeding.


To support an organization’s efforts in increasing breastfeeding knowledge and training, CE Direct, now powered by Relias, offers courses on breastfeeding basics, trends, and clinical pediatric nutrition.

One of CE Direct’s most popular courses includes a review course that offers 16 hours of CE credit for nursing staff, who work at facilities that are applying for breastfeeding designation status.

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