Breastfeeding & Public Health 2011

1. Breastfeeding & Public Health 2011

3. Levels of Influence in the Social-Ecological Model Structures, Policies, Systems Local, state, federal policies and laws to regulate/support healthy actions Institutions Rules, regulations, policies & informal structures Community Social Networks, Norms, Standards Interpersonal Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs

4. Functions of Public Health • Assessment • Policy Development • Assurance

5. Objectives Students will be able to: • Identify advantages to increasing breastfeeding rates in the population • List 2010 Healthy People goals for breastfeeding • Access population-based breastfeeding data and describe patterns of breastfeeding in the US • Apply evidence-based approaches to improve breastfeeding rates • Use knowledge about the physiology of breastfeeding to advocate for policies that support breastfeeding

6. Benefits of Breastfeeding • Health outcomes • Infant – short term • Infant – long term • Maternal • Economic • Environmental

7. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries(Agency for Healthcare Research and Quality, 2007) • Systematic reviews/meta-analyses, randomized and non-randomized comparative trials, prospective cohort, and case-control studies on the effects of breastfeeding • English language • Studies must have a comparative arm of formula feeding or different durations of breastfeeding. Only studies conducted in developed countries were included in the updates of previous systematic reviews. • Studies graded for methodological quality.

8. Limitations of Breastfeeding Outcome Studies • Definitions of breastfeeding; misclassification • Lack of randomization; confounding & residual confounding • “Wide range in quality of evidence”

9. AHRQ: Positive Findings for Infants

10. AHRQ: Equivocal or insignificant infant outcomes • Cognitive development in term or preterm infants • CVD • Infant mortality in developed countries

11. AHRQ: Positive Maternal Outcomes

12. AHRQ: Equivocal or insignificant maternal outcomes • Effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible • Effect of breastfeeding on postpartum weight loss was unclear • Little or no evidence for association with osteoporosis

13. Breastfeeding and Obesity: Reviews & Meta-analysis • Owen et al. Pediatrics. 2005 • 61 studies • Odds ratio = 0.87 (95% CI 0.85-0.89) for reduced risk of later obesity associated with breastfeeding compared to formula • Arenz et al. Int J obes relat metab disord. 2004 • 9 studies met criteria • Odds Ratio = 0.78, 95% CI (0.71, 0.85) protective effect of breastfeeding for obesity • Found dose response • Harder et al. Am J Epidemiol. 2005

14. Breastfeeding and risk of obesity Does Breastfeeding Reduce the Risk of Pediatric Overweight? CDC. 2007

15. Harder et al. Am J Epidemiol. 2005 (17 studies)

16. Breastfeeding & Obesity: Support for the Evidence • Secular trends • Trend for increased breastfeeding is opposite that for obesity • Dose Response • Some studies find, others do not • Plausible mechanisms • Changes in leptin production and sensitivity • Lower energy and protein intake in breastfed infants • Insulin response to feeding; higher in formula fed infants • Differences in the feeding relationship; self-regulation of energy intake • Changing composition of human milk during feedings

17. Dubois et al. Public Health Nutrition, 2003 • Social inequalities in infant feeding during the first year of life. The Longitudinal Study of Child Development in Quebec (LSCDQ 1998-2002) • “Social disparities in diet during infancy could play a role in the development of social and health inequalities more broadly observed at the population level.”

18. Economic Costs of Formula Feeding(US Breastfeeding Committee) • Families: ~$2,000 for the first year • Employers: loss of productivity, increased absence, more health claims • Health care: 3.6 billion a year to treat infant illnesses, $331-475 per child for one HMO • Food assistance: costs to support breastfeeding mothers in WIC are 55% the cost for providing formula

19. Environmental Benefits of Breastfeeding(ADA Position Paper, 2005) • Human milk is a renewable natural resource. • Produced and delivered to the consumer directly • Formula requires manufacturing, packaging, shipping, disposing of containers • 550 million formula cans in landfills each year* • 110 billion BTUs of energy to process and transport* • Breastfeeding delays return of menses, increases birth spacing, limits population growth • Note ADA position statement 2009 – environmental benefits not included….. *USBC

20. Barriers to Breastfeeding (ADA Position Paper 2005) • Individual: Inadequate knowledge, embarrassment, social reticence, negative perceptions • Interpersonal: Lack of support from partner and family, perceived threat to father-child bond • Institutional: Return to work or school, lack of workplace facilities, unsupportive health care environments • Community: discomfort about nursing in public • Policy: aggressive marketing by formula companies

21. 2007 Health Styles Survey

22. Healthy People Goals and Breastfeeding Data

24. National Immunization Survey • Random-digit--dialed telephone survey conducted annually by CDC • Nationally representative data • Breastfeeding questions first added in 2001 • Data organized by birth cohort, not year of data gathering • 2004 data from 17,654 infants

25. Healthy People 2010: Increase the proportion of mothers who breastfeed their babies

26. Percent of U.S. children who were breastfed, by birth year Breastfeeding Among U.S. Children Born 1999—2008, CDC National Immunization Survey

27. Exclusive Breastfeeding

28. Percent of U.S. breastfed children who are supplemented with infant formula, by birth year

29. Provisional Rates of Any and Exclusive Breastfeeding by Age among Children Born in 2008, National Immunization Survey

30. Does Breastfeeding Reduce the Risk of Pediatric Overweight? CDC. 2007

31. Demographics of Breastfeeding(NIS 2004)

32. Percent of Children Ever Breastfed by State among Children Born 2000 2007

33. Percent of Children Ever Breastfed by State among Children Born 2004 2005 2006 2007

34. Percent of Children Breastfed at 6 Months of Age by State 2000 2004 2006 2007

35. Percent of Children Breastfed at 12 Months of Age by State 2004 2006 2007

36. New 2010 Breastfeeding Objectives added in 2007 • To increase the proportion of mothers who exclusively breastfeed their infants through age 3 months to 60% • To increase the proportion of mothers who exclusively breastfeed their infants through age 6 months to 25%

37. Exclusive breastfeeding: definition • Exclusive breastfeeding is defined as an infant receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines

38. Exclusive Breastfeeding

39. Rates of Exclusive Breastfeeding at 3 months (NIS, 2004)

40. Rates of Exclusive Breastfeeding at 3 months (NIS, 2004)

41. Percent of Children Exclusively Breastfed Through 3 Months of Age among Children born 2007 2005 National Immunization Survey, Centers for Disease Control and Prevention, Department of Health and Human Services

42. Percent of Children Exclusively Breastfed Through 6 Months of Age among Children Born 2005 2007

43. Healthy People 2020; 2011 Report Card(2008 births)

44. Assurance:Evidence-Based Interventions The CDC Guide to Breastfeeding Interventions, 2005

45. Six evidence-based interventions • Individual: • Educating mothers • Professional support • Intrapersonal: • Peer support/counseling programs • Institutional • Maternity care practices • Media and social marketing

46. Four Interventions: Effectiveness not established, encourage rigorous evaluation • Use contermarketing techniques to limit the negative impact of formula marketing • Improve the knowledge, skills and attitudes of health care providers re breastfeeding • Increase public acceptance of breastfeeding • Provide assistance to breastfeeding mothers through hotlines or other information sources

47. Breastfeeding Policy Documents

48. Supporting Breastfeeding Mothers & Families Worksites & Childcare Healthcare Legislation

49. Mothers & Families

50. The Surgeon General’s Call to Action to Support Breastfeeding Actions for Mothers and Their Families: 1. Give mothers the support they need to breastfeed their babies. 2. Develop programs to educate fathers and grandmothers about breastfeeding. Actions for Communities: 3. Strengthen programs that provide mother-to-mother support and peer counseling. 4. Use community-based organizations to promote and support breastfeeding. 5. Create a national campaign to promote breastfeeding. 6. Ensure that the marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding