JOG” 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 state- ment summarizes principles and action steps to im- prove perinatal breastfeeding worldwide (WHO & UNICEF, 1989). The United States has been ag- gressive in establishing these ideals in developing countries, but somewhat indifferent to promoting, protecting, and supporting breastfeeding at home.

Breastfeeding promotion focuses on the “ad- vantages of breastfeeding at the personal, com- munity, 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 re- cent 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 commu- nity? The United States is in need of some advan- tages, 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 exclu- sively. 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 pro- moted for only these reasons, the lives and health of every human on the globe would be improved.

Breastfeeding protection relies on govern- mental, corporate, and social strategies to mini-

mize barriers to breastfeeding initiation and con- tinuation. Unfortunately, Americans experience many barriers, most notably the marketing of ar- tificial 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 sev- eral cans of artificial milk in my mail along with coupons for many more. These marketing strate- gies are effective barriers to breastfeeding because they entice women to bottle-feed; otherwise, man- ufacturers would have stopped using them long ago.

Breastfeeding support focuses on “the inter- actions 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 reestab- lish 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 world- wide 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 Breast- feeding. (1997). Breastfeeding and use of human milk. Pediatrics, 100, 1035-1039.

World Health Organization and United Nations Inter- national Children’s Emergency Fund. (1989). Pro- tecting, promoting, and supporting breast-feed- ing: The special role of maternity services. Geneva, Switzerland: World Health Organization.

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