Only 3.5 percent of hospitals in the U.S. are providing the full range of support measures that mothers need to breastfeed, a new report from the Centers for Disease Control and Prevention (CDC) says.
Such measures include practices that many hospitals have already enacted, such as teaching breastfeeding techniques and explaining to new moms how to determine when a baby wants to feed, but also practices that few hospitals are doing, such as limiting the use of formula in the hospital and following up with mothers after they are discharged, the report said.
The report, based on a 2009 survey of nearly 2,700 U.S. hospitals, shows a small improvement over the 2.4 percent of hospitals that were providing full support for breastfeeding in 2007, but more needs to be done, the CDC said.
"Hospitals need to better support breastfeeding, as this is one of the most important things a mother can do for her newborn," said CDC director Dr. Thomas R. Frieden. "Those first few hours and days that a mom and her baby spend learning to breastfeed are critical."
Among the health benefits of breastfeeding, the agency emphasized the role of breastfeeding in fighting the obesity epidemic. Breastfeeding for nine months reduces a child's odds of becoming overweight by more than 30 percent, yet only 31 percent of moms breastfeed for that long, the CDC said.
Supporting mothers
The American Academy of Pediatrics recommends moms exclusively breastfeed (meaning a baby is given no formula, solids or other liquids other than vitamin supplements or medications) for about the first six months of infancy, and continue breastfeeding, along with introducing iron-rich foods, for at least the first year.
Although about 80 percent of U.S. women indicate before delivery that they intend to breastfeed, and 75 percent initiate breastfeeding, at one week, half of women have already given formula to their baby, the report said.
"In the United States, most women want to breastfeed, and most women start," said Ursula Bauer, director of CDC's National Center for Chronic Disease Prevention and Health Promotion. "But without hospital support, many women have a hard time continuing to breastfeed, and they stop early."
In 1991, the World Health Organization and United Nations Children's Fund developed the Baby-Friendly Hospital Initiative, which outlines 10 steps that hospitals should take to support breastfeeding. The CDC report surveyed hospitals in terms of how many of these steps they have undertaken.
The WHO recommendation that the highest number of hospitals are meeting is to include breastfeeding education as part of prenatal classes. The CDC found that 92.8 percent of hospitals are doing this.
The report also found that 89.1 percent of hospitals are teaching breastfeeding techniques, and 81.8 percent are teaching mothers to recognize and respond to infant feeding cues, as recommended, instead of feeding on a set schedule.
However, only 14.4 percent of hospitals had a written policy that communicates all 10 of the WHO recommendations to their staff, 21.5 percent of hospitals limit the use of supplements such as infant formula, and 26.8 percent contact mothers to support their breastfeeding efforts after they leave the hospital, the report said.
Giving infants formula when it is not medically necessary makes it much harder for mothers and babies to learn how to breastfeed and continue breastfeeding at home, the report said.
The recommendation that saw the biggest gain in the number of hospitals complying with it was initiating breastfeeding early, which the CDC defined as making sure that at least 90 percent of healthy, full-term infants delivered without complications are breastfed within one hour of birth. The CDC said 43.5 percent of hospitals met this goal in 2007, and 50.9 percent met it in 2009.
The costs of not breastfeeding
Suboptimal breastfeeding practices in the United States annually results in an estimated $2.2 billion in additional direct medical costs, the report said.
Babies who are fed formula and stop breastfeeding early have higher rates of obesity, diabetes and respiratory and ear infections, and tend to require more doctor visits, hospitalizations and prescriptions, the CDC said.
And substantial evidence now shows that breastfeeding is an important public health strategy for preventing childhood obesity, the CDC said. Currently, 21 percent of children ages 2 to 5 years are overweight, and half of those children are obese.
The Northeast had the highest rate of hospitals complying with the 10 recommended practices. However, even there, only 50 percent of hospitals were meeting at least six of the 10 recommendations.
The report is based on data from CDC's national survey of Maternity Practices in Infant Nutrition and Care. The report was limited, the CDC said, because the survey questions were answered by a single person at each hospital, and because practices could differ between hospitals surveyed and those not surveyed.
Pass it on: The CDC says hospitals should be doing more to support breastfeeding mothers.
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