The goal was to move away from focusing on individual responsibility, shame and guilting, and evaluate what communities, health care providers, agencies and employers can do to support the process.
Barriers identified included inequities in parental education, community resources and whether care teams follow best practices. Researchers also identified the lack of a national paid maternity leave policy in the United States, as a significant barrier. “We are one of the only developed nations in the world to not have universal, paid maternity leave,” Kellams said.
She recalled that during her residency, sales representatives from baby formula companies routinely gave presentations to her class of pediatric residents.
“Everything I was taught about breastfeeding in the ’90s wasn’t right, which happens in medicine as discoveries are made and understanding advances,” Kellams said. “Both because breastfeeding rates were low and it wasn’t considered a priority, traditional medical and nursing curriculae did not include breastfeeding and lactation physiology, management and support.”
After World War II, the rise of breastmilk alternatives led commercial milk companies to launch marketing campaigns – which the World Health Organization has since labeled exploitative and predatory – that encouraged mothers to use baby formula, resulting in decreased breastfeeding rates. In 1981, the International Code of Marketing of Breast-milk Substitutes was established to prevent misleading marketing of formula; it barred companies from several practices, including giving free samples to mothers and hospitals.
“By the ’70s, only 22% of mothers were even attempting to breastfeed,” Kellams said. “And by the time studies showed differing health outcomes between breastfed and formula-fed babies in the late ’80s, you had doctors, nurses, parents, grandparents who were not prepared to support that.”
It takes a village to support new mothers, Kellams noted, emphasizing the further society has gotten from extended family units and close-knit communities interacting on a daily basis, the more challenging breastfeeding and parenthood has become.
Breastfeeding and lactation medicine, a relatively new medical field, is beginning to bridge that gap. Instead of separate doctors focusing on mothers and children, Kellams said she sees both mothers and babies every visit.
“We realize we’re filling a gap when we have something over 85% of people want to do and only 25% to 30% are successfully meeting their own personal breastfeeding goals,” she said. “You realize people need a lot more help than they have traditionally gotten.”
The good news, she said, is most of the reasons people end breastfeeding earlier than they want to are preventable if they have the right support and encouragement. Additionally, increased societal awareness and emphasis on maternal and infant health has resulted in more funding and resources for research and initiatives.
She recalled former Surgeon General Regina Benjamin’s first call to action in 2011 was to support breastfeeding.
“You can imagine this is a person with access to a lot of public health data, who chose to prioritize this,” she said. “It stresses the importance.”
