US Surgeon
General Blueprint on Breastfeeding
By Martha Hartney-Schatzle
Palos Verdes, CA USA
From: NEW BEGINNINGS,
Vol. 18 No. 2, March-April 2001, pp. 74-75
December 2000
At the turn of the millennium,
the United States is still not a breastfeeding friendly society. But
one man hopes to change that. He is a scholarly looking gentleman, graying
beard and spectacles, in a navy blue suit with brass buttons, the uniform
of his office. He is the Surgeon General of the United States. And the
first black man to hold that position.
On October 31, 2000, Surgeon
General David Satcher and the US Department of Health and Human Services
(HHS) released the "Blueprint for Action on Breastfeeding"
making it an important policy-setting document issued by the federal
government affirming the superiority and importance of breastfeeding.
Dr. Suzanne Haynes, chairperson
for the Subcommittee on Breastfeeding and Senior Science Advisor at
the Office on Women's Health, said the document was released to widespread
media coverage. "This public policy document gives a new sense
of credibility to breastfeeding and will allow more doors to be opened
that may have been closed before."
The Blueprint was drafted
by a committee of governmental agencies and reviewed by liaisons from
a variety of professional organizations. The committee examined scientific
data both in favor of and cautious about breastfeeding and the document
concludes with a list of broad changes in the health care system, workplace,
and community needed to make breastfeeding easier for all mothers.
Breastfeeding advocates around
the country have given the Blueprint mixed reviews. On one hand, the
document is unabashedly pro-breastfeeding. As a scaffold upon which
HHS policy makers intend for the country to build upon, their position
is backed up by deeply scrutinized evidence. It recognizes immunological,
nutritional, developmental, maternal, and socioeconomic benefits of
breastfeeding.
On the other hand, members
of the committee and breastfeeding advocates acknowledge that the document
is a compromise, like all public policy documents.
Workplace Environment
The Blueprint states, "a
large proportion of employed mothers who have children under three years
of age work full time." The plan asks that employers institute
programs to facilitate breastfeeding or breast milk expression and includes
a list of recommended practices for corporations to consider when developing
mother friendly policies.
However, the plan does not
make specific recommendations about legislation that would support a
mother's plans to breastfeed. Most employers do not perceive breastfeeding
to be an issue warranting their attention. In the United States, in
comparison to many other industrialized nations, there are no federal
statutes with specific provisions and protections for nursing mothers.
The Blueprint may serve nursing
mothers seeking understanding and change in their workplaces. By presenting
a federally approved document detailing their needs in so credible a
manner, mothers may find more receptive audiences.
The International Code
of Marketing of Breast Milk Substitutes
The Committee included a
short paragraph about the International Code of Marketing of Breast
Milk Substitutes. The International Code was drafted in 1981 by the
World Health Organization to protect breastfeeding from the undue influence
of formula manufacturers' marketing schemes. Most specifically, it prohibits
marketing and advertising to mothers and health care professionals and
proscribes sample distribution under all circumstances.
While the plan does not specifically
obligate infant formula manufacturers or distributors to act in accordance
with the Code, many hail the brief mention as a monumental step in American
policy. The Code has been virtually ignored in the US until the Subcommittee
saw fit to include it in the Blueprint which brings with it the opportunity
to pursue it legislatively and socially.
Baby Friendly Hospital
Initiative
While the Blueprint uses
a form of the Baby Friendly Hospital Initiative guidelines as the standard
to which hospitals in the US should aspire, it does not specifically
endorse the BFHI or recommend that hospitals seek the designation 'Baby
Friendly." There are currently only 27 hospitals in the US with
the 'Baby Friendly" designation, the most recent being the prestigious
Boston Medical Center in 1999. Baby Friendly USA states that there are
over 15,000 hospitals carrying the "Baby Friendly" seal worldwide.
Environmental Chemicals
in Human Milk
The plan contains a warning
about environmental pollutants that have been found in human milk without
known exposure. An appendix lists the names of those found over the
last 30 years. It notes, however, "effects on
the nursing child have been
seen primarily in poisonings where the mother herself was clinically
ill."
While the document cautions
about possible contaminants in human milk, no mention is made about
contaminants in artificial baby milk (ABM), a criticism echoed by several
sources. "If they are going to tell mothers that their milk might
be contaminated, then they should tell about contaminants present in
formula so parents can make a more informed choice," stated one
participant who spoke on condition of anonymity.
Breastfeeding with HIV/AIDS
The Blueprint states that
HIV-infected mothers in the US should not breastfeed or give their babies
expressed human milk due to the risk of transmission of the virus to
the child. However, "In countries with populations at increased
risk for other infectious diseases and nutritional deficiencies resulting
in infant death, the mortality risks associated with not breastfeecting
may outweigh the possible risk of transmission of HIV infection."
On the other hand, the section
on HN/AIDS makes no mention of the feasibility of using mother's own
pasteurized milk, an option gaining more attention among lactation specialists
and health care professionals abroad.
The document's statement
on HIVIAIDS represents current understanding of the disease, but it
may not be the last word from the government. More knowledge is amassed
every day on how the virus is transmitted and what factors give rise
to increased risk to infants. In the future, researchers may discover
how to lower the risk of transmission, making the dream of healthy nursing
come true for many more mothers living with HIV/AIDS.
Making Use of the Blueprint
Despite the few shortcomings
that naturally arise out of compromise, the Blueprint is an essential
first step in affecting broad cultural change in the Unites States.
Dr. Haynes urges all mothers wishing to get involved in creating change
to, "Bring a copy of the Blueprint to every pediatrician, obstetrician,
health department, state and local legislator you can find." (See
below for information on how to obtain copies of the Blueprint.)
A Call for Social Action
In his opening message, Dr.
Satcher sums up what he hopes for the Blueprint, "Each of us, whether
we play a role at the Federal, State, local or private level, must turn
these recommendations into programs best suited for our own communities.
Together we can shape a future in which mothers can feel comfortable
and free to breastfeed their children without societal hindrances."
FOR FURTHER INFORMATION
- Department of Health and
Human Services/Office on Women's Health
- To obtain copies of the
Blueprint for Action on Breastfeeding, call the Department of Health
and Human Services Hotline at I800-994-9662 or TDD 1-888-220-5446.
The Blueprint is also available on the HHS/OWH webside at www.4women.gov.
- Introductory packets,
videos and other publications are available through Baby Friendly
USA, 8 Jan Sebastian Way, Unit 22, Sandwich, MA 02563, 1-508-8888092(phone),
wwwbabyfriendlyusa.org, info at babyfriendlyusa.org (email).
- National Alliance for
Breastfeeding Advocacy (NABA) has created Advocacy Kits to help jump
start advocacy efforts. Contact Barbara Heiser, 9684 Oak Hill Drive,
Elliott City, MD 21042-6321 USA 1-410-995-3726 (phone), 1-410-992-1977
(fax), BarbB13 at aol.com (email)
- Available from LLLI catalogue:
Ten Steps to Successful Breastfeeding Poster (277-16, 60¢), Baby-Friendly
Hospital Initiative-2000, WABA Action Folder (843-17, $1.50), AAP
Statement (288-17, $2.50), Becoming a La Leche League Leader (I 66-13,
60@t), LLLI Peer Counselor Training Information Packet (357-18, free),
Breastfeeding Peer Counselor Program (340-20, free), Corporate Lactation
Support
(957-20 free).
SOME ADDITIONAL IDEAS
FOR HOW PRIVATE CITIZENS MIGHT USE THIS BLUEPRINT
- Form local (state or national
level) advocacy groups, perhaps under the banner of a larger group
such as the National Alliance for Breastfeeding Advocacy (US).
- Contact Baby Friendly
USA for information on working to certify local hospitals "Baby
Friendly."
- Formulate plans to obtain
Title V funding from State Appropriations Committees for breastfeeding
promotion activities. Title V funds are federal MateirnaUChild health
funds that are granted to each state. State legislators can help identify
the right departments and committees to approach for funding.
- Contact local service
organizations such as the Mwanis Clubs to form strong community alliances
and make use of their reach.
- Organize fundraisers such
as LLUs World Walk for Breastfeeding to promote and fund your efforts.
- Consider becoming a Peer
Counselor through LLLI's Peer Counselor Program.
- Consider becoming a La
Leche League Leader to provide the mother-to-mother
support so important in successful breastfeeding.
- Provide copies of the
Blueprint to employers to begin educating companies on the need for
their support of breastfeeding families.
- Send copies of the Blueprint
to all media (television, newspapers) involved in portrayals of breastfeeding.
Follow up with phone calls and letters.
REFERENCES
Armstrong, H. C. and Sokol,
E. The International Code of Marketing of Breast Milk Substitutes:
What It Means for Mothers and Babies World-wide. A Special Publication
of the International Lactation Consultant Association, 1994.
Baumsiag, N. and Michels,
D. Milk, Money and Madness. Westport, CT. Bergin & Garvey,
1995.
HHS Blueprint for Action
on Breastfeeding. Department of Health and Human Services, Office on
Women's Health, 2000.
HIV and Infant Feeding: Guidelines
for Decision-Makers; 1997 Policy Statement on HIV and Infant Feeding.
UNICEF Brochure, 1998.
LLLI, THE WOMANLY ART OF
BREASTFEEDING, 6th Edition. Schaumburg, IL: La Leche League International,
1997.
Mohrbacher, N. and Stock,
J. THE BREASTFEEDING ANSWER BOOK, rev. ed. Schaumburg, IL: La Leche
League International, 1997.
NOTE: For
more information on this document, see the LLLI Press Releases: "US
Surgeon General Joins Other World-Renowned Breastfeeding and Parenting
Experts at La Leche League International Conference" and "Surgeon
General to Address La Leche League International Conference".
There is also a report on our 2001 conference pages about the US
Surgeon General's presentation about this document.
Page last edited Sun Oct 14 09:29:34 UTC 2007.
