Breastfeeding is up — but not enough, especially in Pennsylvania

By Michael Yudell

The Centers for Disease Control and Prevention released their annual Breastfeeding Report Card last week and there's good news and bad. Thanks to a concerted effort by the CDC and health workers in states and localities across the country, breastfeeding rates continue to rise nationally.

Here in Pennsylvania, however, rates still lag behind the national average (we rank 40^th nationwide); the Commonwealth also fares poorly on "how well maternity care practices at hospitals and birth centers support breastfeeding." Neighboring New Jersey, on the other hand, ranks above the national average on both counts.

The report shows that nationally almost 77 percent of all babies have ever been breastfed, that 47 percent are nursing at six months of age, and 25 percent at 12 months. The numbers are lower for exclusive breastfeeding: at three months, 36 percent of babies are only nursing, and at six months, 16 percent. "Rising breastfeeding rates in the United States means good news in the public health arena," according to Katja Pigur, the breastfeeding coordinator at Philadelphia's Maternity Care Coalition.

But in Pennsylvania, only 68 percent of moms have ever breastfed, 42 percent are breastfeeding at three months, and 22 percent are breastfeeding at 12 months, whereas just 37 percent are exclusively breastfeeding at three months, and 14 percent at six months.

"Breast milk as first food offers protection from childhood diseases and a reduced risk of obesity," Pigur told me. We wrote about this back on Mother's Day, highlighting the immediate and long-term advantages to breastfed newborns. During the first year of life, according to one study, any breastfeeding "is associated with a 64 percent reduction in the incidence of nonspecific gastrointestinal tract infections," and significant decreases in colds, throat, and ear infections. Hospitalization for lower respiratory tract infections in infants are decreased by 72 percent for kids nursed more than four months.

Breastfeeding's health advantages can last a lifetime. Breastfed kids have lower lifelong risk of developing diseases like leukemia, for example. Reductions in both type 1 and type 2 diabetes have also been found, and breastfeeding has been linked to a 30 percent reduction in obesity – for adolescents and adults.

Let's also not forget that the American Academy of Pediatrics — an organization of 60,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults—recommends that when possible, infants should be breastfed "for about 6 months, followed by continued breastfeeding as complementary foods are introduced."

The CDC's report highlights the threefold increase, from 2006 to 2012, in babies born at "Baby-Friendly Hospitals"—that is, facilities that "offer an optimal level of care for infant feeding" and help foster what the Baby-Friendly hospital initiative calls the "Ten Steps to Successful Breastfeeding." Despite the success, however, there is little to celebrate. That threefold increase—the percent of U.S. births at baby-friendly hospitals — represents the difference from a barely registering 2 percent to a not-much-to-be-happy-about 6 percent. In Pennsylvania, babies born in such facilities account for a paltry .08 percent of live births.

Even acknowledging that the baby-friendly hospital standards nationwide are an aggressive measure and are low everywhere (Maine leads the nation with almost 28 percent of its hospitals meeting the criteria), Pennsylvania doesn't fare particularly well on other measures of breastfeeding support. The statewide mPINC score (Maternity Practices in Infant Nutrition and Care) that assesses overall maternity practices in infant and nutrition care ranks the Keystone State towards the bottom nationally. Pennsylvania showed little change in this from 2009-2011, and breast feeding advocates like Pigur acknowledge "that maternity hospitals in Pennsylvania could do a much better job in supporting and promoting breastfeeding." But there may also be good news here. "More and more hospitals have recognized the need to improve and are working hard to change their maternity care practices and better support breastfeeding," Pigur said.

To be fair, Pennsylvania is not ignoring this problem: the Department of Health's Bureau of Family Health supports programs and organizations that are trying to "support and enhance existing breastfeeding activities within community-based breastfeeding coalitions across Pennsylvania" through mini-grants to support breastfeeding, through their Healthy Baby toll free help line (800-986-BABY) for families with breastfeeding concerns, and through the Business Case for Breastfeeding Program, which works with employers to help them support nursing moms as they return to work. Still, the amount of financial support the state offers for these programs is dreadfully low.

The state, however, is getting added help from the federal government's Women, Infants, and Children Program, better known as WIC, which "provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk." This year, according to state health department spokeswoman Kait Gillis, Pennsylvania's WIC program received more than $820,000 "as a federal bonus for increasing breastfeeding rates in the WIC population in our state." The program will use the funds to support the nine hospitals with the lowest breastfeeding rates statewide.

So there's progress, but still much to do — and limited funding statewide to do it. Whatever your political inclinations may be, there are few public health interventions (increasing breastfeeding rates) that can have such a dramatic and long term public health impact. It behooves the governor and General Assembly to increase funding for breastfeeding promotion and support. At the same time, hospitals throughout Pennsylvania need to move towards the baby-friendly standard.

The return on investment would be tremendous for new babies and their families across the state.

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