By Amy Weintraub

Sunday, April 23, 2006

Some of the most serious and costly epidemics facing West Virginia children and women are directly related to breastfeeding.   Children who are not breastfed are at increased risk for a myriad of diseases, including SIDS, diabetes, respiratory infections, allergies, and diarrhea.  In addition, breastfeeding duration is inversely associated with risk for childhood obesity – that is, the longer children breastfeed, the less likely they are to be overweight.  Breastfeeding is associated with health benefits for mothers too, including reduced risk for ovarian cancer and pre-menopausal breast cancer. The cumulative weight of scientific and health evidence is categorical: breastmilk and breastfeeding lower these risks.

Increasing rates of breastfeeding also reduces healthcare costs. The American Academy of Pediatrics (AAP) estimates that increasing the proportion of American children breastfed in their first few months from 64% in 2000, to 75% by 2010, would save an estimated $3.6 billion in healthcare costs annually.  The massive amounts the federal government spends on formula would be slashed as well; in 2005, $7.5 million of public funding was spent on formula for low-income families in West Virginia alone.

Promoting breastfeeding has become a consistent feature of public health nutrition policy.  West Virginia pediatricians, backed by the AAP, recommend breastfeeding for at least the first year of life, and beyond for as long as mutually desired by mother and child.  Despite this, West Virginia breastfeeding rates remain among the lowest in the nation.

The process of going to scale – transforming health recommendations into action in communities – is mediated by culturally determined attitudes, expectations and practices.   A study released on March 31 by the Center for Disease Control (CDC) spells out the impact that mothers’ backgrounds can play in choosing, or not choosing, to breastfeed. 

Racial differences in breastfeeding rates were found, with 71.5% of white children having been breastfed, compared with only 50.1% of black children. Among those breastfed, 53.9% of white and 43.2% of black children continue breastfeeding until at least age 6 months.   Within all income groups, the proportion of black children who were breastfed was 10 to 17 percentage points lower than that of white children. 

Economic differences among mothers played a role as well.  Within each race studied, the proportion of children breastfed was 23 to 26 percentage points higher among those in the highest income group compared with the lowest.   Women with financial resources are more likely to choose to breastfeed their children.

Maternal and child health advocates the world over continually seek ways to increase both the incidence of breastfeeding – the proportion of children who breastfeed for any length of time – and the duration of exclusive breastfeeding (for 6 months) and continued breastfeeding (for up to a year of age or beyond). Approaches include developing a comprehensive policy on infant and young child feeding; protecting, promoting and supporting breastfeeding through the health care system; and fostering mother-to-mother support in the community.  Other approaches work to end disruptive hospital maternity-care practices (e.g., delays in breastfeeding initiation, use of pacifiers by newborns, and hospital promotion of formula through the provision of free formula in hospital discharge packs).

As the CDC urges, public health measures to promote breastfeeding should continue and should target groups with the lowest initiation rates, such as black mothers in rural areas or teen mothers, mothers who have not completed high school, and participants in the WIC program. Public health policies and programs also should increase protection and support of breastfeeding continuation among all mothers.

These efforts must address the society-wide ignorance of human milk’s unique, species-specific properties and the inescapable implications for the health of all people, throughout the life course.  Nearly every other barrier to breastfeeding can be traced directly to this cross-cutting core ignorance – from individual attitudes and how they are formed, to non-supportive health services, to the multiple unhelpful ways society is presently structured for mothers with young children, particularly for those mothers with few resources.

For the last two years, women, state-wide, have asked the Legislature to give us protection to breastfeed our children anywhere in the state where we would otherwise have the right to be, free of harassment from security guards and management.  Yet, this simple protection remains a low priority to elected officials, dying again in 2006, despite the fact that most other states enacted such laws years ago.

When will the government, including our Legislature, move society forward and, in the process, stretch imaginations and expectations regarding normal child-feeding behavior? After all, until the 1940s with the commercialization of formula, the lives of nearly all West Virginia babies depended on the unique, perfect milk of their own mother – other options were not available and breastfeeding was a natural, expected part of every mother’s experience.  Promoting and sustaining healthy nutrition for today’s children and tomorrow’s adults depends on identifying and removing the cultural stumbling blocks to making this cost-saving, universal survival strategy ordinary once again.

Weintraub is a Charleston mother of two and a member of La Leche League, a breastfeeding support and advocacy group.