Department of Health Services Breastfeeding Promotion Policy
The Department of Health Services (DHS) promotes breastfeeding as the superior way to feed infants. It is a priority of the Department to promote, protect, and support breastfeeding among all Californians as the most healthy and preferred method of infant feeding for at least the first years of life. DHS has a vital role and a responsibility to create a supportive public environment in order to encourage breastfeeding as the cultural norm.
Breastfeeding is the preferred method of infant feeding. Breastfeeding is acknowledged as the preferred method of infant feeding by the American Academy of Pediatrics, the American Dietetic Association, the American College of Obstetrics and Gynecology, the American Public Health Association, and the National Healthy Mothers/ Healthy Babies Coalition.
Year 2010 health objectives. The U.S. Department of Health and Human Services has identified breastfeeding promotion as a high-priority health objective for the nation. The Year 2010 health objective sets a goal of increasing to at least 75 percent the proportion of women who breastfeed their babies in the early postpartum period, 50 percent the proportion who continue breastfeeding until their babies are five to six months old, and 25 percent the proportion who continue breastfeeding until their children are one year of age. To work toward these goals, DHS must advocate breastfeeding so women have the ability to make informed decisions about infant feeding and support for their decisions.
DHS mission and goals. Breastfeeding promotion is important to the Department's mission "to protect and improve the health of all Californians." Breastfeeding particularly applies to the following Department goals.
Promoting Disease Prevention
Breastfeeding promotion clearly supports the Department's goal to "develop and implement initiatives that systematically attack the underlying causes of preventable disease or hazardous conditions." Breastfeeding provides the following health benefits decreasing the incidence of certain preventable conditions:
Women: Breastfeeding promotion will enhance existing Department efforts to reduce cancer incidence since breastfeeding reduces the risk for certain cancers. For example, the longer a woman breastfeeds, the more she reduces her risk for developing not only breast but also ovarian and cervical cancer. Women who breastfeed are also less likely to develop osteoporosis, a major preventable health condition.
Infants: Human milk provides a boost to the immune system. A breastfeeding woman reduces the risk of her child developing Type I insulin dependent diabetes mellitus, sudden infant death syndrome (SIDS), certain childhood cancers, lower respiratory infections, ear infections, baby bottle tooth decay, and a host of other illnesses.
In DHS, preventive health programs target chronic diseases such as breast and ovarian cancers, diabetes and osteoporosis. In addition, the Maternal and Child Health Branch targets funding to reduce infant mortality and morbidity. Success in promoting breastfeeding can augment the efforts of these prevention programs. Increasing the incidence and duration of breastfeeding should become a part of DHS' strategy for dealing with these public health concerns.
Closing Gap in Health Status
Another Department goal is to "close the gaps in health status and access to care among the States' diverse population subgroups." Successful breastfeeding promotion can affect this effort. Data from California's Newborn Screening Program shows that although 80 percent of all California mothers choose to breastfeed, only 62 percent of African American mothers initiate breastfeeding. In contrast, nearly 85 percent of White and 80 percent of Latino women initiate breastfeeding. According to the Executive Director of United Nations International Children's Emergency Fund (UNICEF) "Breastfeeding is a natural safety net against the worst effects of poverty." Breastfed infants are four times less likely to suffer from diarrheal diseases or to contract infections causing meningitis. Breastfed infants also have a 60 percent lower risk for ear infections and an 80 percent decreased risk for lower respiratory infections. Increased breastfeeding rates in these populations could narrow the gap in health status for their infants.
Saving Health Care Costs
Breastfeeding promotion will allow the Department to ensure cost-effective use of health care resources. The cost savings of breastfeeding due to reduction in illness, associated medical visits and hospitalization for infants and their mother are important for health care programs. It has been estimated that two to four billion health care dollars could be saved annually in the United States if all women breastfed their infants for as little as 12 weeks. (This estimation of savings does not include money saved by families not buying artificial baby milk nor the cost savings related to the environmental benefits of breastfeeding.) Looking only at ear infections, infants who are exclusively breastfed for at least four months are half as likely as artificially fed infants to have ear infections during the first year of life. Fewer visits to physicians for ear infection offer tremendous savings in time, money, and emotional trauma for families and the health care system.
A breastfeeding policy is crucial. Given the benefits of breastfeeding in the prevention of chronic diseases and other conditions, the improved health outcomes for at-risk populations, and the economic benefits for families and the health care system, a DHS policy actively advocating breastfeeding is crucial.
Infant feeding choice is an important public health issue. Breast milk is superior to artificial baby milk (or formula). The Department must take an active role in encouraging California's mothers to make an informed choice about infant feeding since bottle feeding does not offer infants the same benefits as breastfeeding. A mother's choice whether or not to breastfeed is important to public health prevention efforts---just as the choice to stop smoking during pregnancy or the choice to immunize a child are individual decisions having significant public health impact.
Some women may experience discomfort at being informed that the choice to formula feed is not in the best health interests of their child. Also, because of the linkage of the breast with sexuality in our society, some individuals or groups may be uncomfortable with promoting breastfeeding. Nonetheless, it is the Department's responsibility to provide scientifically-based leadership that improves the health of mothers and babies
Barriers to breastfeeding. Numerous barriers to breastfeeding have been identified:
- Lack of knowledge about breastfeeding among health care professionals.
- Lack of knowledge about breastfeeding among the general population.
- Lack of consistent and accurate information about breastfeeding.
- Hospital practices which are not supportive of breastfeeding. These include formula discharge packets, hospital feeding schedules, early discharge, and unavailability of rooming-in.
- Lack of a support network during the critical postpartum period.
- Psychosocial barriers including misconceptions, negative attitudes, lack of confidence, and lack of support in the work place.
- Cultural barriers including sexual connotations associated with the breast and/or lack of role models or family support.
- The ready availability and conspicuous display of infant formula and formula advertising in hospitals and public health programs.
Breastfeeding policy is important beginning. Despite these barriers to breastfeeding, breastfeeding promotion initiatives have increased the rates of breastfeeding, especially among low-income women. Many more women would choose to breastfeed their infants if they were given an opportunity to make an informed choice and the support to successfully follow through. A DHS breastfeeding promotion policy can serve as a driving force to develop innovative strategies and partnerships to address these barriers to breastfeeding in order to improve the health of women and children in California.