“Breastfeeding: Just 10 Steps. The Baby Friendly Way” is the theme for World Breastfeeding Week (WBW), which takes place August 1-7 in more than 170 countries worldwide. According to the World Alliance for Breastfeeding Action (WABA) “an estimated 28% of all maternity facilities in the world have at some point implemented the Ten Steps which has contributed to an encouraging increase in breastfeeding rates.” Despite these increases, WABA is far from its original goal of all maternity facilities practicing the Ten Steps.

Because suboptimal breastfeeding persists, coordinators of WBW chose to renew focus on “The Ten Steps.” Suboptimal breastfeeding results in 1.4 million preventable infant deaths in the developing world, as wells as countless hospitalizations for infants with diarrhea, ear infections, and asthma, to name a few. The World Health Organization defines optimal breastfeeding as “exclusive breastfeeding for the first six months of life.”

Although, I had heard “breast is best,” I was not aware that breastfeeding actually saves lives, improves maternal health, and can provide relief for economically burdened families and societies around the globe. In the U.S.A., according to a recent Harvard study, these steps could lead to $13 billion in healthcare savings annually.

When I returned to work after the births of each of my two children, my handy manual, one-on-one support, and a state-of-the-art breast pump helped me maintain my milk supply. With these resources, each of my boys received breast milk for around a year. But I realize I am one of the lucky ones. Not everyone has a model for breastfeeding, a supportive husband, or a boss with whom she is comfortable asking for her legally provided pumping break. This is not to say I had an appropriate pumping place and did not get walked in on once or twice. Pumping locations included my classroom, a supply room, an abandoned locker room, and the fax room with a door leading to the school’s front office.

According to Dr. Miriam Labbok, director of the Carolina Global Breastfeeding Institute and steering committee member of the WABA, “The biological norm is breastfeeding. Anything we do other than optimal breastfeeding carries risks.” Not only do infants suffer from preventable conditions, breastfeeding for less than six months increases the risk of diabetes and breast cancer for mothers. It also means a more rapid return to fertility, increasing risk of death for women without access to birth control and adequate maternal health facilities.

In the United States just 13.6% of infants are exclusively breastfed to six months, according to the Centers for Disease Control’s 2009 Breastfeeding Report Card. Rates are higher in many developing countries – 38% overall – but increased urbanization and Westernization is undoing what was once common and appropriate infant-feeding behaviors, says Labbok. Working Bangladeshi mothers, for example, rarely bring their infants to work with them and often introduce complementary foods as early as the second month. In Nigeria, where women once carried babies to market, increased urbanization has meant a shift to non-baby-friendly jobs. Even in countries with official maternity leave policies, working mothers in the informal sectors are denied the benefits of legislation.

Recent federal healthcare legislation passed in the United States has addressed the working-mother dilemma by requiring employers to provide time and a clean non-restroom space for mothers to express or “pump” breast milk. It is a step in the right direction but falls short of ideal says Dr. Audrey Naylor, director of Wellstart International, who has sought to improve breastfeeding outcomes since the late 1970’s.

Citing the example of European countries where mandatory paid time off for women with newborns is the norm Naylor feels “If we are going to have a national goal of exclusive breastfeeding for six months, we need to extend paid maternity leave.” Providing moms more time with their babies is preferable because breastfeeding and breast milk feeding are different.

Babies given expressed breast milk do not completely lose out on the “health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits” cited by the American Academy of Pediatrics. “But,” says Naylor, “There are significant benefits for feeding directly from the breast. The mother’s hormones, such as oxytocin, will rise higher, and the baby will have the opportunity to see her facial expressions and response to whatever the baby is doing. It’s nature’s way.”

• Baby with mother. Photo courtesy of Flickr user ODHD. •

To increase exclusive breastfeeding rates, comprehensive maternity care policy changes in hospitals need to occur. The most recent Centers for Disease Control National Survey of Maternity Practices in Infant Nutrition and Care (mPINC) found that 30% of healthy hospital-born babies in the U.S.A. spend 30 to 90 of their first minutes of life separated from their mothers. Initiating breastfeeding within the first half-hour of birth is one of the Ten Steps. “It’s wonderful bonding for the mother and baby. It helps breastfeeding get off to a really good start,” says Trish MacEnroe, director of Baby Friendly USA.

Often formula companies stand between a hospital and its “Baby Friendly” potential. In order to earn this designation, hospitals must purchase formula instead of receiving it free from manufacturers. “When a hospital really supports breastfeeding, the need for formula will decrease, but not immediately,” says Naylor. “This increased financial responsibility causes hospitals not to be interested in the designation. However, even without the “Baby Friendly” designation, many hospitals are increasingly compliant with the Ten Steps.”

Since Baby Friendly USA introduced new tools to help manage and clarify the designation process, MacEnroe has seen interest increase exponentially. “[Hospitals] really care about the quality of the care that they provide to their patients,” she says. “They also see it as a quality improvement project. Third, it improves the stature of the facility within their community. It’s a global designation.”

No one intends to make women feel guilty about formula feeding, says Labbok. There are legitimate medical reasons for artificial feeding and complex social and cultural barriers to overcome. The United States, with its lack of healthcare worker support, stealth formula marketing in hospitals, and absence of paid maternity leave may be the “number one problem country” in placing the burden to breastfeed on the mother’s shoulders.

“Breastfeeding is accepted as absolutely normal in most of the world, except here,” says Labbok. Our society simply does not provide women with unbiased information and sufficient support. Our reality is that women are in the work force, at home, and even overseas in the military – so, if we care about children and our future, it is up to us to provide every woman with the support she needs - whether it is breastfeeding skills, or paid maternity leave, or social acceptance - to provide the best start on life for her children, because those children are our future.”

As I await the birth of my third child – with high hopes to breastfeed him longer than I did the other two – it still amazes me that something as simple as bringing a baby to the breast for nourishment is so powerful and also so fraught with cultural complexities. I look forward to those first precious minutes and hours, during which nothing has yet come between us.

About the Author:
Janelle Weiner is a writer and mother of two, soon to be three. She graduated from UC Berkeley with a Bachelor’s degree in English and holds a Master’s in Special Education from Boston University. Janelle has taught in city schools in Oakland, Boston, and Sacramento, where she currently resides. Her work has also appeared in the Sacramento News and Review, Opposing Viewpoints: Childbirth, and Drugs, Society, and Behavior.