Most recent news stories

AAP Endorses Ten Steps

September 30, 2009

Elk Grove Village, IL-The American Academy of Pediatrics has now officially endorsed the WHO/UNICEF Ten Steps to Successful Breastfeeding. In a private letter to the heads of the World Health Organization and UNICEF dated August 25, the president of the American Academy of Pediatrics announced that the Executive Committee of the Board of Directors of AAP approved the endorsement. AAP have asked to be listed as an official signatory, with the “footnote” that that there are certain circumstances where newborns may benefit from the use of pacifiers, such as for “calming in a drug exposed infant” and “painful procedures.” Dr. David Tayloe, head of the AAP, made it clear in the letter that AAP is not asking for the WHO to revise the Ten Steps.

The Ten Steps are part of the WHO/UNICEF Baby-Friendly Hospital Initiative, which adds an additional requirement to Step 6, requiring that hospitals purchase their formula at fair-market value rather than receive it for free, as is typically done as part of the industry’s standard marketing procedures to market name-brand formula. Because the AAP letter does not specifically mention the Baby-Friendly Hospital Initiative, AAP is not endorsing the requirement to pay fair-market value for formula.

The AAP already has a curriculum on breastfeeding designed for resident physicians training in pediatrics. AAP’s endorsement comes on the tail of the new perinatal Core Measures from the Joint Commission, which will start requiring hospitals to record their rates of exclusive breastfeeding in nursing mothers.

The AAP’s endorsement letter is available here.

Celebrating World Breastfeeding Week with a new hip ad

August 27, 2009

The Best for Babes Foundation has released the second in its series of ads to suppport breastfeeding, by eliminating “booby traps” that trip up new moms. See the ad and read more here.

Joint Commission approves breastfeeding measure

July 31, 2009

Oakbrook Village, IL–In a major step forward for public health, the group that accredits US hospitals will hold maternity hospitals accountable for the quality of care they provide to breastfeeding mothers and babies.

“This is one huge step for breastfeeding in the US,” says Melissa Bartick, MD, Chair of the Massachusetts Breastfeeding Coalition. “This move will really help moms get the support they need in order to reach their own breastfeeding goals.” Multiple studies have shown that maternity care makes a huge difference for breastfeeding success.

The new measure, which is part of the Joint Commission’s new Perinatal Care measure set, requires hospitals to report the rate of exclusive breastfeeding among mothers who intend to breastfeed. The measure does not affect women who do not plan to breastfeed.

A recent CDC survey found that many US hospital routines undermine mothers who want to breastfeed. Giving formula to healthy breastfed infants was common, despite evidence from multiple studies that babies who receive formula in the hospital wean earlier than those who do not.

More than half of US mothers wean their babies earlier than they want to, and their struggles begin with poor care during their maternity stay. “Mothers deserve high-quailty support,” Bartick said. This measure is expected to encourage hospitals to adopt a variety of measures to support breastfeeding mothers and infants. For example, breastfeeding in the first hour of life, skin to skin contact, and rooming-in all help promote exclusive breastfeeding.

The exclusive breastfeeding measure was pioneered as part of a quality improvement effort in California, where public health officials found huge differences in exclusive breastfeeding rates from hospital to hospital. In some cases, nearly all breastfed infants were being supplemented with formula. In the top ranked hospitals, including San Francisco General Hospital, fewer than 10% of breastfed infants received supplements. Public reporting of differences in formula use has led hospitals to review their routines and improve quality of care.

The exclusive breastfeeding measure is one of 5 indicators that comprise the new perinatal core measure set. Other indicators include rates of cesarean section, elective delivery before 39 weeks, use of steroids for women at risk for preterm birth, and health care-associated infections in newborns.

The Joint Commission accredits US hospitals, and their measures have a strong influence on quality improvement priorities. Data collection is expected to begin in April 2010. To read more, go to the Joint Commission’s page.

New study shows breastfeeding links with less maternal cardiovascular disease

April 28, 2009

A woman’s breastfeeding history continues to affect her health even after menopause, according to a new study announced this month in Obstetrics and Gynecology. According to the study, the longer a woman breastfeeds, the lower her risk of high blood pressure, high cholesterol, diabetes and cardiovascular disease. The massive study, of over 130,000 women from the Women’s Health Initiative, boosts previous research from other large studies from the Nurse’s Health Study showing that longer lifetime breastfeeding is linked with lower risk of maternal type 2 diabetes and coronary artery disease.

Women who breastfed more than twelve months had significantly lower risks of these four conditions. The study controlled for many possible confounding factors, including body mass index, family history, race, age, number of children, and age at menopause.

These results further support the rising demand for better support of breastfeeding as a women’s health issue. While over 3/4 of women initiate breastfeeding, most stop in the first weeks or months. The causes are multi-factorial, but include widespread failure of hospitals in the US to practice evidence-based care around breastfeeding, lack of insurance reimbursement for lactation care and services, aggressive marketing of infant formula by hospitals and health professionals, and lack of paid maternity leave and worksite support. Less than 3% of US hospitals are certified as “Baby-Friendly,” and a recent CDC survey found the average US hospital scored only 63 out of 100 possible points in their compliance with evidence-based care around breastfeeding. The US joins Lesotho, Swaziland, and Papua New Guinea as the only four countries in the world without paid maternity leave.

While evidence around the health effects of not breastfeeding tends to focus on the health of the infant, the evidence for the importance of breastfeeding on women’s health is growing. Previous studies have already linked duration of breastfeeding with lower risks of maternal breast and ovarian cancer.

“When we fail to provide the support young families need to breastfeed, we increase the risks of health problems for mothers and for babies,” states Dr. Alison Stuebe, a North Carolina obstetrician and one of the authors of the new study.

JAMA article advises severing of industry ties

April 13, 2009

Eleven leading US physicians have published a special article in the April 1 issue of the Journal of the American Medical Association (JAMA) recommending that all professional medical associations sever their ties with pharmaceutical and device manufacturers. The statement may have broad implications for the infant formula industry, even though infant formula is not specifically mentioned. The eleven authors of the proposal include Dr. Catherine DeAngelis, editor-in-chief of the JAMA, and Dr. Carol Berkowitz, past president of the American Academy of Pediatrics (AAP).

The statement recommends that professional medical associations (PMAs), start by limiting their budgets to 25% industry funding, and work toward with the goal of “$0.” Many PMAs, which are defined as physicians’ organizations, have gotten funding for activities ranging from conferences and annual meetings, to funding the development of practice guidelines, as well as unrestricted grants, often totaling millions of dollars. The statement recognizes that some valuable activities may need to be curtailed, and recommends that all funding come from membership dues and advertising sales in their journals and vendor fees at conferences. The authors of the proposal stipulated that they are writing as individuals, not as representatives of their own medical organizations.

For some time, breastfeeding advocates have cited conflicts of interest between the American Academy of Pediatrics and the infant formula industry, which is largely controlled by pharmaceutical companies. The AAP has engaged in many of the practices specifically condemned by the JAMA statement. These relationships with industry have been commonplace in many professional medical organizations, not just the AAP, and arguably have compromised practice guidelines and policy in many areas of medicine. Members of the AAP’s Section on Breastfeeding have repeatedly tried to get the organization to sever its ties with the formula industry, but so far without success.

The relationship with the formula industry has arguably influenced AAP’s medical policies. The AAP has been relatively silent in advocating for the WHO/UNICEF Baby-Friendly Hospital Initiative, which eliminates marketing of infant formula by hospitals and substantially increases breastfeeding rates at the expense of infant formula. The AAP committee on nutrition recommends only 4-6 months of exclusive breastfeeding, in contrast to the AAP Section on Breastfeeding and all other major medical organizations in the world, which recommend exclusive breastfeeding for 6 months.

According to Naomi Baumslag and Dia Michels in their 1995 book Milk, Money, and Madness, the formula industry contributed $3 million to the building of AAP’s headquarters, and had been giving annual $1 million grants to the organization.

Overwhelming evidence exists to show that aggressive marketing of infant formula undermines breastfeeding duration and exclusivity. The formula industry competes with breastfeeding for market share of infant nutrition. Its profits go down when breastfeeding goes up.

The JAMA statement, “Professional Medical Associations and their Relationships with Industry,” is available at http://jama.ama-assn.org/cgi/reprint/301/13/1367.