In the United States, we've made progress toward meeting breastfeeding goals. But our rates of breastfeeding initiation at birth and continuation during the first months of life still lag behind those of countries such as Sweden and Germany. In 2006, 96% of German women breastfed their newborns, with 83% continuing to breastfeed in some capacity at three months, while Swedish breastfeeding rates easily exceeded American goals, with 98% of infants breastfed at birth, and 90% exclusively or partially breastfed at two months and 69% at six months.
Gains in the national Healthy People campaign metrics indicate that U.S. women increasingly value breastfeeding: according to the Centers for Disease Control and Prevention, in 2009 the percentage of women who breastfed their newborns was 76.9%, exceeding the Healthy People 2010 goal of 75%, though below the 2020 goal of 81.9%. By six months after giving birth, over 47% of women were still partially breastfeeding, up from 34% in 2000, and slightly below the Healthy People 2010 goal of 50% (the 2020 goal is 60.6%).
How can the United States meet its Healthy People 2020 breastfeeding goals? What's still holding back breastfeeding progress? In a word: work. Though other factors are influential, research indicates that return to the workforce is strongly correlated with breastfeeding cessation. Early return to work has the most damaging effects, and is associated with lower rates of any breastfeeding and with earlier cessation of breastfeeding.
In addition, the more hours a woman works, the more likely she is to stop breastfeeding. A 2009 study by Guendelman and colleagues in Pediatrics found that major risk factors for not establishing breastfeeding included the need to return to work after six weeks or less. Compared with 12-week maternity leaves, those of six to 12 weeks doubled a woman's risk of ending breastfeeding after only a month, while those of less than six weeks quadrupled this risk.
Not surprisingly, pressures culminating in breastfeeding cessation are most apparent in vulnerable populations, such as those having less flexible work schedules or nonmanagerial positions. Interestingly, taking time off to establish breastfeeding may have additional benefits. In 2005 in the Economic Journal, Berger and colleagues found that not only were women with maternity leaves of 12 weeks or longer more likely to breastfeed, but their children were also more likely to have regular health checks, a full immunization panel, and appropriate well-baby care.
In 2010 in Pediatrics, Bartick and Reinhold analyzed rates of acute and chronic disease against rates of breastfeeding and calculated anticipated cost savings from the medically indicated health benefits of breastfeeding. Almost $1.5 billion in savings, along with nearly 150 lives saved, were calculated for the United States if Healthy People 2010 goals for breastfeeding initiation and continuation were met; these economic savings rose congruently as breastfeeding rates increased.
The United States has made strides in breastfeeding initiation and continuation, but we can do better. Persisting in raising Healthy People breastfeeding goals without committing to action those ideas that will truly sustain breastfeeding is not a viable solution. The Patient Protection and Affordable Care Act (ACA) is a sociopolitical start. The ACA offers enhanced Women, Infants, and Children (WIC) program services and food to breastfeeding mothers; support for the Baby-Friendly Hospital Initiative, which recognizes facilities that support and promote breastfeeding; and a requirement that health insurance companies reimburse entirely or partially for lactation support, counseling, and rental of breastfeeding equipment. The ACA also asserts women's right to pump and be provided appropriate pumping facilities in the workplace, though this protection is limited and doesn't apply to all working women.
In order to reap the socioeconomic rewards of an increase in breastfeeding, we need substantive policies such as longer postpartum medical leave. By not investing in breastfeeding, the United States is throwing breast milk, and money, down the drain.