by Heidi Green
March 04, 2008

Recently, the American Public Health Association (APHA) adopted 20 new policies. Health issues addressed by the group’s new policies include tobacco-free schools, obesity, disaster preparedness, eye health, toxic substances—many important, current health topics. Among them, the group looked at an issue close to my heart—breastfeeding.

It has been more than 25 years since the APHA last addressed this issue in 1982. Here, in 2008, the group recognizes breastfeeding as “a fundamental public health issue.”

Highlights include:

• Exclusive breastfeeding: Calls for exclusive breastfeeding for the first 6 months of life.
• Initiation of breastfeeding: Recommends breastfeeding be initiated immediately after birth.
• Duration of breastfeeding: Recognizes continued breastfeeding for at least the first 1 or 2 years of life as being the biological norm.
• Protection of breastfeeding: Calls for breastfeeding protection, education, promotion, and support.
• Success of breastfeeding: Calls for the exclusive breastfeeding rate to be recognized as a leading health indicator in the Healthy People 2020 goals for the nation.
• Research on breastfeeding: Calls for funding for domestic and foreign aid programs, as well as research on breastfeeding support.
• Baby-friendly hospitals: Argues for maternity services accreditation to include the components of the Baby-Friendly Hospital Initiative.
• Human milk substitutes: States that all alternative feeding methods carry health risks, including the risk of chronic diseases in both mothers and their children.
• Marketing of human milk substitutes: Denounces “increasing aggressive marketing,” particularly in health care settings (e.g., controversial “free” formula “gift bags” that hospitals give to new parents at discharge, direct marketing to parents and health care providers).

The policy also restates several priorities from APHA’s earlier breastfeeding policies. Given the amount of time that has passed since those policies were written, it is surprising to realize how much work still needs to be done.

To recap:

• National campaign: Calls for government agencies to develop a national campaign targeting the hospitals and health centers in their jurisdiction.
• Lactation health care: Calls for governments to work with health care providers and reimbursing agencies to ensure that all women have access to care and services before and after giving birth.
• Health care providers: Recognizes the important role of education for health care providers.
• Universal health care: Wants universal health care that includes breastfeeding care and services.
• International Code: Restates its support for the Nestlé boycott, the International Code of the Marketing of Breast-Milk Substitutes, and resolutions of the World Health Assembly.
• Blueprint for Action: Endorses the U.S. Department of Health and Human Services’ Blueprint for Action on Breastfeeding, recognizing the important role of employers in breastfeeding support.
• WIC: Calls on WIC to encourage breastfeeding and provide breastfeeding counseling.
• Media: Encourages portrayals of breastfeeding as “normal, desirable, and achievable for women of all cultures and socio-economic levels.”
• Chemical contamination: Identifies a need for the reduction of environmental contaminants.

Finally, it identifies several barriers to breastfeeding, including—maternity and birthing practices that are not medically indicated, inadequate training and resources of health care providers, inexact coverage of breastfeeding issues by scientific journals, lack of supportive legislation and policies (i.e., paid maternity leave, paid family and medical leave, protection from persecution, employers’ support, health insurance coverage), cultural emphasis on the sexuality of the human breast, and unfavorable media portrayals of breastfeeding.

The policy provides excellent recommendations for supporting and promoting breastfeeding, as well as a solid review of the existing policies and recent studies. It bears reading. Medical News Today provides a summary of all of the APHA’s new policies. For the complete policy statement, visit APHA.org.