Overcoming Barriers to Breastfeeding

Breastfeeding is a key strategy to improve public health across all communities because of its many health benefits for infants, children, and mothers. The American Academy of Pediatrics recommends that infants be breastfed exclusively for the first six months of life, followed by a combination of breastfeeding and the introduction of complementary foods for at least one year, and continuation of breastfeeding for as long as mutually desired by mother and baby.

Recognizing the importance of breastfeeding, the U.S. Department of Health and Human Services (HHS) sets national breastfeeding objectives every decade through Healthy People (HP), a national health promotion and disease prevention initiative. The HP2020 initiative set the following goals for breastfeeding: 81.9% of all mothers to initiate breastfeeding, with 60.6% continuing for at least six months postpartum, and 34.1% continuing to one year. As to exclusive breastfeeding, the goals are: 46.2% at three months, and 25.5% exclusively at six months.

The Centers for Disease Control and Prevention’s (CDC) “2016 Breastfeeding Report Card” shows that more than half of states have already met the HP2020 objective of 81.9% ever breastfed. The report states that four out of five (81.1%) infants born in 2013 started to breastfeed, with over half (51.8%) breastfeeding at six months, and almost one-third (30.7%) at 12 months.

Disparities and Barriers

Despite these promising figures, most states do not yet meet HP2020 breastfeeding duration and exclusivity goals. In fact, socio-demographics among children born in the five-year period of 2009 to 2013 demonstrate disparities in breastfeeding initiation, exclusivity, and duration; low-income mothers, less educated mothers, unmarried mothers, African American mothers, and young mothers (under age 20) all have lower breast feeding rates. The Surgeon General’s Call to Action to Support Breastfeeding, released in 2011, identified numerous barriers to breastfeeding, including:

• Lack of knowledge
• Social norms
• Poor family and social support
• Embarrassment
• Lactation problems
• Employment and child care

The Call to Action also included “Barriers Related to Health Services,” which highlights challenges related to breastfeeding resulting from hospital policies and clinical practices, such as not prioritizing education and support for women to breastfeed, improper or disjointed care routines, and inadequate facilities.

Health Providers: Roles and Resources

The U.S. Preventive Services Task Force recommends interventions during pregnancy and after birth, to support breastfeeding, and it provides guidance on different approaches, categorized as professional support (individual counseling provided by a health professional), peer support (referrals to peer counselors for education and support), and formal education (usually group sessions that include general education and practical breastfeeding skills).

Additionally, the Surgeon General’s Call to Action seeks the implementation of the Baby-Friendly Hospital Initiative, a global program to ensure that maternity care practices fully support breastfeeding. Baby-Friendly recognizes hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. The 2016 Breastfeeding Report Card notes the percentage of live births at Baby-Friendly designated hospitals more than doubled from 7.8% in 2014 to 18.3% in 2016.

The CDC provides information on breastfeeding intervention strategies, with program examples and resources. Additionally, the CDC has worked with the Illinois Department of Public Health, the Cook County Department of Public Health, and the Chicago Department of Public Health to provide information, including a Hospital Breastfeeding Toolkit and the Illinois Physicians’ Statement on Breastfeeding, which provides guidance and evidence-based standards of care for physicians.

The HHS national campaign, “It’s Only Natural: Mother’s Love, Mother’s Milk,” was launched in 2013 to increase breastfeeding rates among African American mothers and families. The campaign provides educational resources and messaging that focus on breastfeeding barriers identified through formative research. Resources are available at www.womenshealth.gov/breastfeeding.

High breastfeeding initiation rates show that most U.S. mothers want to breastfeed and attempt to do so. Clinicians play a pivotal role, supporting women directly, or through referral, so that mothers can make informed choices and are successful in their decision to breastfeed.

Breastfeeding Rates

Anna Gonzales, MPH, is a Captain in the U.S. Public Health Service and Acting Regional Health Administrator at the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health—Region 5 (IL, IN, MI, MN, OH, WI). Contact us at Lesley.Craig@hhs.gov