A Call to Action for Human Milk and Breastfeeding

Dr. Diane Spatz, PhD, RN-BC, FAAN / July 2023

Authored By:

Dr. Diane Spatz, PhD, RN-BC, FAAN, Professor of Perinatal Nursing at the University of Pennsylvania School of Nursing and Nurse Scientist-Lactation at the Center for Pediatric Nursing Research and Evidence Based Practice, Children’s Hospital of Philadelphia

For more than 25 years, the World Health Organization (WHO) has promoted breastfeeding as the best source of nutrition for children to ensure optimal health and development, as well as the prevention of morbidity and mortality. The WHO and American Academy of Pediatrics (AAP) recommend exclusive human milk/breastfeeding for the first six months of a baby’s life, followed by continued breastfeeding for 2 years. Decades of research demonstrates that breastfeeding confers short and long-term advantages for both the child and the lactating parent, yet in the United States, only 25% of infants receive an exclusive human milk diet for the first six months. Given the significance of breastfeeding for the health of families and society, one must question: what is preventing families from achieving their personal breastfeeding goals? 

  • One significant impact is the role of the formula industry. Formula marketing is invasive and pervasive (WHO & UNICEF, 2022 report). The Lancet (2023) series on breastfeeding further elucidated its negative impact and the challenges families face in achieving recommendations for human milk feeding. The series reports that an estimated 341.3 billion U.S. dollars are lost globally from the unrealized benefits to health and human development because of the inadequate support, promotion and protection of human milk and breastfeeding.
  • Another impact is the residual influence of the COVID-19 pandemic. During the pandemic, mothers were forced to go through labor and birth by themselves, and skin-to-skin contact for mother and baby following birth was either discouraged or prohibited in some hospitals. Often, there were no staff available to provide breastfeeding assistance and care during the brief hospital stay. In person, peer-to-peer support was eliminated, and families were unable to access tangible breastfeeding assistance following discharge from the hospital. Today across the United States, we find there is still limited or no in-person peer-to-peer support and breastfeeding help available, especially for low-resource families who cannot afford to pay for services out of pocket. The recent formula shortage crisis underscored the reliance of parents on the supply chain for feeding their infants. This was exacerbated by the spike in inflation and increased pricing pressure, and disproportionately impacted low-income families.

As a society, we share a responsibility to provide accessible, accurate research and evidence so that all parents can make informed decisions on the best way for their family to care for and nourish their infant. We must also ensure initiatives to overcoming breastfeeding barriers begin in the prenatal period. All families, regardless of income, should have access to providers who are knowledgeable about human milk and lactation and can help families make informed feeding choices for human milk and breastfeeding. During pregnancy, families should be instructed on the science of human milk and the physiology of lactation. Families need information to understand that there is a critical window to effectively establish milk supply and in the birth hospital they may receive advice or care that interferes with their early initiation of lactation. We need to create a sense of urgency about milk supply so the parent can develop a robust milk supply early, which in turn will make it easier to sustain milk production long term. People need access to high-quality breast pumps, trained lactation professionals, peer-to-peer support and in-person breastfeeding care and intervention, not just during the hospital stay at birth but throughout the entire lactation journey.

  • The inequality and inequity for women is another factor that must be addressed. Many women must return to work to support their families, because the United States funds no government sponsored paid leave. The Affordable Care Act (2010) called for workplace support for women to be given time and space that is not a bathroom to express milk. However, that federal mandate only covered one out of four employed women. A landmark victory occurred when the PUMP Act was signed into law, which expands the right to space and time to pump to almost all workers, with the exception of pilots and flight attendants. This legislation also clarifies that an employee is not completely relieved from duty, and pumping time must be paid. Workers also have the ability to file a lawsuit to seek monetary compensation in the event that their employer fails to comply with the law. Though effective immediately as of December 29, 2022, a 120-day delay for enforcement was included, and the effective date for the law was April 28, 2023. This legislation provides tangible benefits that could help more women achieve their personal breastfeeding goals and in turn improve the health of our society.

With the added support from this type of breastfeeding-positive legislation, we now need to invest in solutions that ensure families have access to an equitable environment that encourages and enables breastfeeding early on, and ultimately promotes the best possible health outcomes for both infants and mothers.

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