Following an extensive evidence review, the U.S. Preventive Services Task Force (USPSTF) concluded that doctors, nurses, hospitals and health systems have a role to play in encouraging and supporting breastfeeding. In an update to its 2003 recommendation on counseling to promote breastfeeding, the USPSTF recommends primary care interventions before, around, and after child birth to encourage and support breastfeeding.
For the study, the Task Force evaluated more than 25 randomized trials of breastfeeding interventions conducted in the United States and in developed countries around the world. The Task Force concluded that coordinated interventions throughout pregnancy, birth, and infancy can increase breastfeeding initiation, duration, and exclusivity. For example, a cluster-randomized trial of more than 17,000 mother-infant pairs in the Republic of Belarus found that breastfeeding interventions increased the duration and degree (exclusivity) of breastfeeding.
Infants in the intervention group were significantly more likely than those in the control group to be exclusively breastfed (exclusive breastfeeding is when an infant receives no other food or drink besides breast milk). The intervention emphasized health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support.
"Our review produced adequate evidence that multifaceted breastfeeding interventions work," said Task Force Chair Ned Calonge, MD, MPH, who is also Chief Medical Officer for the Colorado Department of Public Health and Environment, Denver. "We found that interventions that include both prenatal and postnatal components may be the most effective at increasing breastfeeding duration. Many successful programs include peer support, prenatal breastfeeding education, or both."
In 2005, 73 percent of new mothers initiated breastfeeding, nearly reaching the U.S. Healthy People 2010 goal of 75 percent. However, only 14 percent of infants were exclusively breastfed for their first six months, as recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the U.S. Surgeon General.
Breastfeeding has substantial health benefits to babies and their mothers. Babies who are breastfed have fewer infections and allergic skin rashes than formula-fed babies and also are less likely to have sudden infant death syndrome (SIDS). After breastfeeding ends, children who were breastfed are less likely to develop asthma, diabetes, obesity, and childhood leukemia. Women who breastfeed have a lower risk for type 2 diabetes, breast cancer, and ovarian cancer than women who have never breastfed.
"We hope that these recommendations will help women and their physicians understand what they need to do to start and continue breastfeeding their babies," said Dr. Calonge. "Simply telling mothers they should breastfeed or giving them pamphlets is not enough."
The recommendation appears in the October 21, 2008, issue of Annals of Internal Medicine, the American College of Physicians' flagship journal.
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