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White House Taskforce on Childhood Obesity prominently features breastfeeding

May 12, 2010

Washington, DC– As part of its campaign to end childhood obesity, the White House just released a series of 70 specific recommendations, four of which involve breastfeeding as an obesity preventive measure. The four measures are as follows:

  • Recommendation 1.3: Hospitals and health care providers should use maternity care practices that empower new mothers to breastfeed, such as the Baby-Friendly hospital standards.
  • Recommendation 1.4: Health care providers and insurance companies should provide information to pregnant women and new mothers on breastfeeding, including the availability of educational classes, and connect pregnant women and new mothers to breastfeeding support programs to help them make an informed infant feeding decision.
  • Recommendation 1.5: Local health departments and community-based organizations, working with health care providers, insurance companies, and others should develop peer support programs that empower pregnant women and mothers to get the help and support they need from other mothers who have breastfed.
  • Recommendation 1.6: Early childhood settings should support breastfeeding.

In February 2010, First Lady Michelle Obama launched the Let’s Move! Campaign with the goal of solving the childhood obesity epidemic within a generation. As part of this effort, President Barack Obama established the Task Force on Childhood Obesity to develop and implement an interagency plan that details a coordinated strategy, identifies key benchmarks, and outlines an action plan to end the problem of childhood obesity within a generation. The action plan defines the goal of ending childhood obesity in a generation as returning to a childhood obesity rate of just 5 percent by 2030, which was the rate before childhood obesity first began to rise in the late 1970s.

The website for the Let’s Move! campaign contains the downloadable report to the president from the White House Task Force on Childhood Obesity, Solving the problem of childhood obesity within a generation. It also includes recommendations for families to reduce childhood obesity by providing information on simple ways to make healthy choices for the family.

Landmark study shows low breastfeeding rates cost US $13 billion/year

April 5, 2010

Study coauthors Melissa Bartick and Arnold Reinhold

A study by two Massachusetts researchers published today in Pediatrics found that failure to comply with medical recommendations around breastfeeding is costing the US $13 billion per year, with 911 excess, preventable deaths. Those recommendations suggest newborns breastfeed exclusively for 6 months with continued breastfeeding for at least the first year of life. The authors compared the costs of 10 pediatric diseases at current US breastfeeding rates with what those costs would be if 90% of new mothers complied with the medical recommendations. For each disease, costs were calculated for direct cost of health care, indirect costs such as time missed from work, and the cost of premature death.

Of the 911 excess deaths, 95% are in infants. The infant deaths are from Sudden Infant Death Syndrome (SIDS), necrotizing enterocolitis (NEC, a disease seen primarily in preterm infants), and lower respiratory tract infections such as pneumonia, said the study’s lead author, Dr. Melissa Bartick of Cambridge Health Alliance and an instructor of medicine at Harvard Medical School.

While nearly 3/4 of all US mothers initiate breastfeeding, only 32% are breastfeeding exclusively at 3 months. Just 12% of US infants meet the medical recommendation to breastfeed exclusively for 6 months. Only 22% are breastfeeding at all at one year. Other countries, such as Sweden and Kenya, do much better.

Dr. Bartick notes, “People shouldn’t blame moms, because they are really not supported well from the moment their babies are born.” According to Bartick, what happens in the first hours and days of life can dramatically influence whether mothers are still breastfeeding months later. CDC data shows that the average US maternity hospital performs quite poorly when it comes to providing evidence-based care around infant feeding.

For example, research shows that keeping mother and baby together, skin-to-skin, uninterrupted, in the first hour of life is something vitally important to ultimate breastfeeding success, but this does not happen consistently in most US hospitals. Only 86 US hospitals are certified as Baby-Friendly, a WHO/UNICEF quality initiative on breastfeeding, which includes avoiding separation of mother and baby, and not introducing formula without a medical reason.

Inadequate worksite accommodation and lack of social and cultural support also contribute to poor breastfeeding rates, as does aggressive marketing of infant formula, she adds.

Bartick and co-author Arnold Reinhold point out that the vast majority of cost savings described in the study could be achieved even if the exclusive breastfeeding rate at 4 months was 80-90% and if the rate of any breastfeeding at 6 months was 90%. That is a potentially achievable goal, provided there is strong central leadership, as there is in other developed countries with high breastfeeding rates, notes Bartick. “After all, it wasn’t that long ago when rates were 100%,” says Reinhold.

The study’s release comes on the heels of a letter sent to Congress on March 16, asking for the appropriation of $15 million per year to help build the support necessary to breastfeeding rates. The letter was signed by 90 organizations, including the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians.

The authors based the excess disease burden associated with lack of breastfeeding on a comprehensive 2007 report from the US Agency of Healthcare Research and Quality (AHRQ). For each disease studied, the authors used the type and duration of breastfeeding described in the AHRQ report’s conclusion. For example, the excess cost gastroenteritis was based on exclusive breastfeeding for six months; the cost of asthma used any breastfeeding for 3 months.

The largest costs came from premature death due to Sudden Infant Death Syndrome (SIDS), necrotizing enterocolitis (NEC), and lower respiratory tract infection, followed by the overall costs of otitis media (middle ear infections) and atopic dermatitis. The other diseases studied were childhood asthma, childhood obesity, type 1 diabetes in childhood, gastroenteritis, and childhood leukemia.

Although breastfeeding also has been linked to lower rates of maternal cardiovascular disease, type 2 diabetes, breast cancer and ovarian cancer, these costs were not included in this study. In particular, despite convincing data from the AHRQ report that type 2 diabetes in children is higher in people who were not breastfed, it could not be included in the study because the AHRQ report did not have enough data on the duration and exclusivity of breastfeeding required to reduce risk. Thus, the true cost of poor US breastfeeding rates is likely to be significantly higher than $13 billion.

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Health Care Reform Law includes workplace breastfeeding support

April 4, 2010

The new health care reform law includes a provision for workplace breastfeeding support, a first for federal legislation. Under a provision of the Patient Protection and Affordable Care Act, employers shall provide reasonable, unpaid break time and a private, place for an employee to express breast milk for her nursing child for one year after the child’s birth. The private place cannot be a bathroom. Employers with less than 50 employees are not subject to the requirement if it would cause “undue hardship.”

Joan Younger Meek, MD, IBCLC, chair of the United States Breastfeeding Committee applauds the legislation’s recognition of breastfeeding as a major preventive health care strategy. “Mothers, babies, and employers all win with breastfeeding support,” says Dr. Meek. “Research clearly demonstrates the value of breastfeeding for the health of women and children, and medical experts agree with the U.S. Department of Health and Human Services (DHHS) in recommending exclusive breastfeeding for six months and continued breastfeeding for the first year of life and beyond. But returning to work can be a major hurdle for new mothers struggling to balance working and breastfeeding without the simple support measures this law ensures.”

Although many are aware of the health benefits of breastfeeding, employers may not recognize the economic benefits that accrue to them also. The Business Case for Breastfeeding, published in 2008 by DHHS, demonstrates an impressive return on investment for employers that provide workplace lactation support, including lower health care costs, absenteeism, and turnover rates. Employees whose companies provide breastfeeding support consistently report improved morale, better satisfaction with their jobs, and higher productivity. As part of The Business Case for Breastfeeding initiative, coalitions in 32 states and territories received training to assist employers in establishing lactation support programs.

Dr. Meek says it takes little for a company to provide lactation support. Basic needs include a clean place to express milk in privacy and break time to express milk approximately every 3 hours during the work period. A model law in Oregon defines reasonable time for milk expression as 30 minutes for every four hours worked; a good match between natural breastfeeding cycles and the rhythms of the workday. Meek adds that a growing number of companies across the United States offer worksite lactation programs that also include access to information and professional support from a lactation consultant or other health experts.

Currently, 24 U.S. states, Puerto Rico, and the District of Columbia have legislation related to breastfeeding in the workplace. The new federal provision will provide a minimum level of support in all states, but it will not preempt a state law that provides stronger protections. “This looks to be a strong legal provision, providing for and protecting nursing mothers in the workplace,” says labor and employment attorney Thomas Doyle, JD, of Portland’s Bennett Hartman Morris and Kaplan. “The implementation of this law will help women care for their babies while contributing to the U.S. workforce.”

After championing the most detailed of the state workplace support laws in Oregon (passed in 2007), U.S. Senator Jeff Merkley introduced “Reasonable Break Time for Nursing Mothers” as an amendment to the Senate HELP Committee’s health reform bill last year. Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon, celebrates Senator Merkley’s impact on shifting the paradigm to recognize that: “Breastfeeding is the natural outcome of pregnancy, and workplace support is the natural outcome of a society where the majority of mothers and babies are separated due to work.”

Although the law was effective immediately upon President Obama’s signing of the Patient Protection and Affordable Care Act, the U.S. Department of Labor must now work to define terms and enforcement procedures. USBC will be closely monitoring and supporting this process and stands ready to support employers and breastfeeding employees with tools, information, and resources. Employers, human resources managers, and breastfeeding employees who are interested in helping to establish worksite lactation programs at their place of employment can find additional information and Frequently Asked Questions on the USBC Web site.

For more information and to access copies of The Business Case for Breastfeeding resources, visit The National Women’s Health Information Center. To locate health care providers and knowledgeable breastfeeding support personnel that can offer assistance and answer questions about breastfeeding, visit the Breastfeeding FAQs page on the USBC Web site.

To see the April 1 CNN news story on the new provision, go to http://www.youtube.com/watch?v=MXDHWBXWerg.

Joint letter for breastfeeding goes to Congress

March 16, 2010

A letter signed by 90 national and state organizations was sent to Congress today, asking for $15 million per year in line-item funding to promote breastfeeding. The letter also calls for the establishment of a new Interagency Work Group on breastfeeding to help decide how to use the funds to support a strategic plan to improve breastfeeding rates.

The letter, which originated from the American Public Health Association, has 35 national signatories that include organizations focused on many aspects of health, from public health, to women’s health, to children’s health. Among the signatories are the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Nurse Midwives, the American Dietetic Association, Lamaze International, and the National WIC Association.

In addition to the national signatories, there are 55 state, local, and tribal signatories representing 43 states, the District of Columbia, the Northern Mariana Islands, and the Navajo Nation.

The letter comes as the House and Senate Appropriations Committees are marking up the current appropriations bills.

“We need to speak loudly and with one voice,” said Dr. Melissa Bartick of Massachusetts, who helped spearhead the letter as the chair of APHA’s Breastfeeding Forum. You can read the letter online here.

Massachusetts Gets Second Baby-Friendly Facility

January 19, 2010

Jubilant staff today celebrated the new Baby-Friendly award given to Cambridge Birth Center. Cambridge Birth Center is now the second facility in Massachusetts to become Baby-Friendly. The first facility, Boston Medical Center, earned the prestigious designation in 1999.

The Baby-Friendly Hospital Initiative is a WHO/UNICEF program which awards Baby-Friendly status to birthing facilities that implement ten evidence-based steps around best infant feeding practices. Started in 1991, only 86 facilities in the United States are Baby-Friendly, compared with over 19,000 worldwide. Baby-Friendly facilities need to meet a series of strict criteria to be certified. Women who have given birth in a Baby-Friendly facility have repeatedly been shown to have longer duration of breastfeeding even months later, and higher exclusive breastfeeding rates.

The award was presented today by Sarah Coulter Danner, acting president of Baby-Friendly USA. Danner’s grandson was born at Cambridge Birth Center on November 29.

“This is a momentous occasion!” said Kate Reist, the center’s lactation consultant. Cambridge Birth Center is a member of the Massachusetts Baby-Friendly Collaborative, a group of thirteen facilities working together to improve their practices around infant feeding.


Sarah Coulter Danner presents the Baby-Friendly award to Leslie Ludka and Kate Reist of Cambridge Birth Center.


Dr. Bobbi Philipp of Boston Medical Center presents a card from BMC staff to Kate Reist, welcoming the Birth Center as the state’s second Baby-Friendly facility.



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