A New Vision for Breastfeeding Support in the United States
Ifeyinwa Asiodu, a national leader in addressing maternal and child health disparities, shares recommendations from Breastfeeding in the United States, a landmark National Academies of Sciences, Engineering, and Medicine report she co-led.
About 84 percent of the 3.5 million women who give birth in the U.S. every year start breastfeeding, but many aren’t able to continue to do so for as long as they’d like.
Ifeyinwa Asiodu, PhD, RN, FAAN, associate professor at the UCSF School of Nursing, recently served as co-chair for a National Academies of Sciences, Engineering, and Medicine (NASEM) report, Breastfeeding in the United States: Strategies to Support Families and Achieve National Goals, which lays out 16 recommendations to help support families in meeting their breastfeeding goals.
What prompted the development of this report?
The report is a result of bipartisan support in Congress. Rep. Lucille Roybal-Allard (D-CA) and Rep. Jaime Herrera Beutler (R-WA) led the development of the committee’s charge, in partnership with members of the Congressional Caucus on Maternity Care. Once this project was included in the Consolidated Appropriations Act of 2023, our committee worked with the U.S. Department of Health and Human Services Office of Women’s Health to contract and set up the study.
How did this become a congressional priority?
In 2022, the U.S. experienced a severe formula shortage. This resulted in an increased focus on infant feeding, with many asking why the U.S. had such a high reliance on infant formula. At the same time, there was a resurgence of breastfeeding. Families in a position to re-lactate did so, or they continued to breastfeed even if they had originally planned to start weaning. There was a great deal of community milk sharing, where those who had extra milk or were still lactating began pumping for other families and mothers in their communities.
Additionally, there is currently increased attention on Healthy People 2030, national objectives to improve health and well-being over the next decade. We have not met those goals yet, particularly as it relates to breastfeeding.
As the report shows, breastfeeding rates are not reaching goals, across multiple different metrics. Why is this a national concern?
This is a public health issue because breastfeeding has many health benefits, not only for the infant but also for the lactating person.
For the infant, it provides immunoprotection and decreases the chances of them having respiratory and gastrointestinal infections. We’ve also seen breastfeeding reduce the chance of sudden infant death syndrome, and lower the risk of developing childhood obesity and diabetes.
For critically ill infants, including those who are born before 37 weeks, increased access to human milk helps reduce the risk of necrotizing enterocolitis, which is one of the leading causes of death in neonates, and sets the infant up for a healthier life as they grow up.
There are benefits for the lactating person, too. In the short term, breastfeeding helps with the contraction of the uterus after birth. This reduces the risk of bleeding and hemorrhage, which is one of the leading causes of maternal death. In the long term, women who breastfeed also see protections against cardiovascular disease, hypertension, high blood pressure, and reduced risk of developing breast, ovarian, and uterine cancer.
What’s the goal of the report?
In the U.S., about 84 percent of mothers start breastfeeding, which means that a significant number of individuals want to breastfeed. But many women are not able to meet their breastfeeding goals. We wanted to identify why, and what could be done to help them, while also addressing ongoing breastfeeding disparities.
For example, we looked at breastfeeding during the COVID-19 pandemic stay-at-home orders. We saw an increase in breastfeeding for those who were able to work from home, which informed our recommendation for paid family and medical leave.
That’s one of 16 total recommendations, which you can read in the report, that we feel will help move us as a country towards the Healthy People 2030’s breastfeeding goals. Recommendations range from calling for further investment in the WIC Program, to supporting local, community-based organizations that provide breastfeeding support to pregnant women, new mothers, and their families, to calling for implementation of maternity care practices which support breastfeeding such as the Baby-Friendly Hospital Initiaitve, to investing in community-centered breastfeeding biomedical and translational research.
How does this report help parents who can’t breastfeed?
The stance that everyone can breastfeed, and breastfeed for as long as they’d like, is extremely dismissive. It does not consider how much work goes into breastfeeding. It’s not as easy as turning on a faucet. It’s a psychological and biological process.
Plus, not everyone can breastfeed due to their own maternal complications, infant complications, or just the desire to not breastfeed. Those individuals need support, education, and resources too, which is why we also call for strengthening infant formula supply, including the safety and accessibility of formula.
The U.S. has federal breastfeeding goals, but each individual person and family has their own goals. When we worked on the report, we wanted to ensure everyone was included, and we created a resource that identifies the uniqueness of those goals, in a way that is supportive and understanding of the significant challenges and barriers that some families face when it comes to lactation.
What do you hope people take away from the report?
Everyone has a role. Breastfeeding is often thought of as an individual act, that it’s only one person by themself having a baby at the breast or chest or pumping by themself, but this is really a family, community, and public health issue. We all play an important role in ensuring infants have access to human milk, mothers and lactating people can breastfeed and express milk, and that everyone has the opportunity to lead healthier lives.
