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Breastfeeding: Making It Happen at Home
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GUEST EDITORLAL
Breasqeeding: Making I t Happen at Home T h e United States has been slow to embrace the 1989 World Health Organization (WHO)/United Nation’s International Children’s Emergency Fund (UNICEF) statement on breastfeeding. This statement summarizes principles and action steps to improve perinatal breastfeeding worldwide (WHO & UNICEF, 1989). The United States has been aggressive in establishing these ideals in developing countries, but somewhat indifferent to promoting, protecting, and supporting breastfeeding at home. Breastfeeding promotion focuses on the “advantages of breastfeeding at the personal, community, state, or global level” (Cadwell, personal communication, 1998). The personal advantages for the infant have been best enumerated by the American Academy of Pediatrics (1997)in their recent statement, which gives a clear message that human milk promotes infant health and is always superior to artificial milk. Yet, providers continue to ask mothers “Are you going to breastfeed or bottle-feed?”as if those two choices are equivalent. What about the advantages for the community? The United States is in need of some advantages, because it ranks 25th in perinatal mortality in the world. Sudden Infant Death Syndrome (SIDS) is the third leading cause of infant death in the United States; infants who do not breastfeed are at higher risk for SIDS. Further, the three most common reasons for hospital readmission during infancy-diarrhea, ear infections, and sepsis-are rarely seen among infants who are breastfed exclusively. The U.S. government has recognized these benefits and has dramatically increased funding for breastfeeding promotion since 1989. However, the United States continues to be the largest purchaser of artificial milk in the world. What about the global advantages? There is concern about overpopulation and conservation of resources. Exclusive breastfeeding reduces fertility and eliminates the waste created by artificial milk leftovers and containers. If breastfeeding were promoted for only these reasons, the lives and health of every human on the globe would be improved. Breastfeeding protection relies on governmental, corporate, and social strategies to mini]uly/August P 998
mize barriers to breastfeeding initiation and continuation. Unfortunately, Americans experience many barriers, most notably the marketing of artificial milk. In 1994, the United States became the last industrialized nation to endorse the underlying principles of the WHO’S International Code of Marketing of Breast-Milk Substitutes. Violations of the code continue, however, as manufacturers give artificial milk free to hospitals and as a “gift pack” to new mothers. And as a new subscriber to a consumer magazine for mothers, I received several cans of artificial milk in my mail along with coupons for many more. These marketing strategies are effective barriers to breastfeeding because they entice women to bottle-feed; otherwise, manufacturers would have stopped using them long ago. Breastfeeding support focuses on “the interactions of ‘helpers’ with family as well as program development and implementation” (K. Cadwell, personal communication, 1998). Peers often have been more helpful than health care providers, who have been slow to role model, preserve, or reestablish breastfeeding as the cultural norm in American society. What about program development that supports breastfeeding? The best example is the Baby-Friendly@‘Hospital Initiative, begun worldwide in 1991. Although there are more than 13,000 hospitals in the world that have met the criteria for the Baby-Friendly@‘program, only 14 hospitals in the United States are included. Sadly, support for breastfeeding in the United States is still inadequate. Marie Biancuzzo, RN, MS Vice President, Baby-Friendly USA REFERENCES American Academy of Pediatrics Work Group on Breastfeeding. (1997). Breastfeeding and use of human milk. Pediatrics, 100, 1035-1039. World Health Organization and United Nations International Children’s Emergency Fund. (1989).Protecting, promoting, and supporting breast-feeding: The special role of maternity services. Geneva, Switzerland: World Health Organization.
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363
GUEST EDITORLAL
Breasqeeding: Making I t Happen at Home T h e United States has been slow to embrace the 1989 World Health Organization (WHO)/United Nation’s International Children’s Emergency Fund (UNICEF) statement on breastfeeding. This statement summarizes principles and action steps to improve perinatal breastfeeding worldwide (WHO & UNICEF, 1989). The United States has been aggressive in establishing these ideals in developing countries, but somewhat indifferent to promoting, protecting, and supporting breastfeeding at home. Breastfeeding promotion focuses on the “advantages of breastfeeding at the personal, community, state, or global level” (Cadwell, personal communication, 1998). The personal advantages for the infant have been best enumerated by the American Academy of Pediatrics (1997)in their recent statement, which gives a clear message that human milk promotes infant health and is always superior to artificial milk. Yet, providers continue to ask mothers “Are you going to breastfeed or bottle-feed?”as if those two choices are equivalent. What about the advantages for the community? The United States is in need of some advantages, because it ranks 25th in perinatal mortality in the world. Sudden Infant Death Syndrome (SIDS) is the third leading cause of infant death in the United States; infants who do not breastfeed are at higher risk for SIDS. Further, the three most common reasons for hospital readmission during infancy-diarrhea, ear infections, and sepsis-are rarely seen among infants who are breastfed exclusively. The U.S. government has recognized these benefits and has dramatically increased funding for breastfeeding promotion since 1989. However, the United States continues to be the largest purchaser of artificial milk in the world. What about the global advantages? There is concern about overpopulation and conservation of resources. Exclusive breastfeeding reduces fertility and eliminates the waste created by artificial milk leftovers and containers. If breastfeeding were promoted for only these reasons, the lives and health of every human on the globe would be improved. Breastfeeding protection relies on governmental, corporate, and social strategies to mini]uly/August P 998
mize barriers to breastfeeding initiation and continuation. Unfortunately, Americans experience many barriers, most notably the marketing of artificial milk. In 1994, the United States became the last industrialized nation to endorse the underlying principles of the WHO’S International Code of Marketing of Breast-Milk Substitutes. Violations of the code continue, however, as manufacturers give artificial milk free to hospitals and as a “gift pack” to new mothers. And as a new subscriber to a consumer magazine for mothers, I received several cans of artificial milk in my mail along with coupons for many more. These marketing strategies are effective barriers to breastfeeding because they entice women to bottle-feed; otherwise, manufacturers would have stopped using them long ago. Breastfeeding support focuses on “the interactions of ‘helpers’ with family as well as program development and implementation” (K. Cadwell, personal communication, 1998). Peers often have been more helpful than health care providers, who have been slow to role model, preserve, or reestablish breastfeeding as the cultural norm in American society. What about program development that supports breastfeeding? The best example is the Baby-Friendly@‘Hospital Initiative, begun worldwide in 1991. Although there are more than 13,000 hospitals in the world that have met the criteria for the Baby-Friendly@‘program, only 14 hospitals in the United States are included. Sadly, support for breastfeeding in the United States is still inadequate. Marie Biancuzzo, RN, MS Vice President, Baby-Friendly USA REFERENCES American Academy of Pediatrics Work Group on Breastfeeding. (1997). Breastfeeding and use of human milk. Pediatrics, 100, 1035-1039. World Health Organization and United Nations International Children’s Emergency Fund. (1989).Protecting, promoting, and supporting breast-feeding: The special role of maternity services. Geneva, Switzerland: World Health Organization.
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363