Breastfeeding still underused in the U.S., despite obvious health benefits

When it comes to breastfeeding, the US ranks right down there with (or below) many poor countries. Chartsbin, WHO

Unlike most things that sound too good to be true, the list of benefits from breastfeeding is so long (and growing) that this practice could qualify as a bonafide magic bullet for health and wellness.

Whether in a poor or rich country, studies show breastfeeding significantly reduces the risk in infants for respiratory tract infections, diarrhea, asthma, allergies, childhood leukemia, many other infectious diseases and, over the course of a lifetime, Type 1 diabetes or obesity.

According to the World Health Organization, breastfeeding is the best form of nutrition for infants during the first 6 months of life. The American Academy of Pediatrics notes that breastfeeding is also beneficial for mothers as it lowers their risk of breast and ovarian cancers, lessens postpartum bleeding and even helps them lose the extra weight acquired during pregnancy faster.

Yet despite these many benefits, fewer than one in five infants in the U.S. are exclusively breastfed through 6 months of age, which is much lower than many other countries in the world. The map below, from Chartsbin (interactive on their site – just click on image) shows how the U.S. compares:

Percentage of Infants Exclusively Breastfed for the First Six Months of Life

The most recent chart (below) available from the OECD, the Organization for Economic Cooperation and Development, which contains data from around 2005, shows that the percentage of infants who were exclusively breastfed through 6 months was lower than many other OECD nations.

Proportion of children, by nation, exclusively breastfed at 3, 4 and 6 months (2005)

Breastfeeding Chart OECD

Note: Chart derived from the OECD Family database: http://www.oecd.org/els/family/43136964.pdf

The next screen grab (below) shows prevalence of exclusive breastfeeding at 6 months in Peru, Ghana, Nigeria and Indonesia, shows that levels in the U.S. were lower than those in Peru, Ghana and Indonesia in 2010.

Exclusive breastfeeding prevalence under 6 months in selected countries, 1990 to 2010­­­­

breastfeeding chart

Source: Roberts T.J., Carnahan E., Gakidou E. Can breastfeeding promote child health equity? A comprehensive analysis of breastfeeding patterns across the developing world and what we can learn from them. http://www.ncbi.nlm.nih.git’s theov/pmc/articles/PMC3896843/

The percent of infants exclusively breastfed at 6 months ranges from less than 11 percent in Arkansas and Mississippi to more than 20 percent in states including California, Colorado, Virginia and Washington.

Infants in U.S., by state, exclusive breastfed through 6 months

USBreastfeedingmap

Data source: Nutrition, Physical Activity and Obesity Data, Trends and Maps web site. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity, Atlanta, Ga., 2015. Available at http://www.cdc.gov/nccdphp/DNPAO/index.html.

Why do so few American women exclusively breastfeed their children through six months?

There are many factors, such as lack of breastfeeding-friendly practices at the health-care center where the mother gives birth and mothers having to return to work shortly after birth. Another factor that is shown to influence a mother’s likelihood to breastfeed her child is infant formula marketing.

Since 1981, the international community has recognized that infant formula marketing poses a threat to the promotion of breastfeeding. That year, 118 WHO member states signed the International Code of Marketing Breastmilk Substitutes to, among other things, ban advertising of infant formula. The Code was created in response to international outcry about the marketing of infant formula in developing countries and the deaths of children who drank this formula when it was mixed with unsafe water and/or prepared improperly. The U.S. was the only member state that voted against the Code.

Infant formula marketing is common in the U.S. When mothers-to-be go to buy clothes at maternity stores, they can sign up for up to a rewards program that promises up to $400 in savings. As part of this program, they receive free samples of formula in the mail as well as coupons for it.

When I was pregnant, I purchased a book written by the American Academy of Pediatrics, titled “Your Baby’s First Year,” published in 2010, at a children’s consignment store here in Seattle. Only after I purchased the book did I notice the fine print on the bottom front page stating that the book was a gift from an infant formula manufacturer.

Inside, I found that the book clearly recommends breastfeeding as the healthiest choice for feeding infants. At the same time, the formula advertisement on the front made me question the credibility of the book’s contents. Upon further investigation, I discovered that the health-care industry has been sending conflicting signals about the benefits of breastfeeding versus formula for a long time.

Until recently, many health-care providers in the U.S. have helped formula manufacturers market their products. Many hospitals in the U.S. give mothers formula samples as they leave the hospital. Studies, such as this 2008 article published in the American Journal of Public Health, found that this practice makes mothers less likely to breastfeed their infants. Fortunately, more hospitals in the U.S. are banning the practice. According to a 2015 study in the journal Pediatrics, the percentage of hospitals providing infant formula to new mothers upon discharge dropped from 73 percent in 2007 to 31.6 percent in 2013.

Pediatricians’ offices are another place where new parents can encounter infant formula advertisements. A 2014 study published in the journal Breastfeeding Medicine found that 50 percent of the pediatricians’ offices they sampled in Maricopa County, Ariz., which includes Phoenix, contained infant formula promotional materials. Only 18 percent of the offices contained breastfeeding support information and materials.

Alongside other important interventions that help mothers breastfeed, such as ensuring more mothers give birth in baby-friendly birthing facilities and hospitals (hospitals or birthing facilities that successfully implement the WHO’s Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breastmilk Substitutes) and providing paid maternity leave, taking steps to limit infant formula marketing in the U.S. could further improve breastfeeding rates in the country.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.