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Objectives New to Healthy People 2020
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MICH HP2020–28:
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Increase the percentage of live births that occur in facilities that provide recommended care for lactating mothers and their babies.
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Status: New to Healthy People 2020.
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View Objective Comments
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Objective Clarification, Objective Text, Data Source, Status:
The U.S. Breastfeeding Committee (USBC) supports this objective. It is a key to improving both breastfeeding duration and breastfeeding quality.
We suggest a slight re-wording: Increase the percentage of births that occur in facilities which provide care for mothers and babies consistent with the WHO/UNICEF “Ten Steps to Successful Breastfeeding.”
What happens in the hospital has profound effects on breastfeeding outcomes even many months later. Research has repeatedly shown that women who give birth in such facilities breastfeed longer and more exclusively. The “Ten Steps,” an evidence-based set of standards, has been endorsed by the American Academy of Pediatrics.
Breastfeeding is not “health care.” It is a health-related behavior in the lives of infants, young children, and women. More than 99% of breastfeeding happens outside the health care system. However, the health care system is important because that is where breastfeeding gets its start. It is where women get their prenatal care and birth care, and it is the appropriate place for them to look for help with certain breastfeeding problems. The health care system is the place where we can reach women with information and link them with breastfeeding support in the community. It is the place where data can be collected to demonstrate the health effects of infant feeding. Health data can then be translated into economic data to demonstrate the cost saving associated with better infant feeding practices.
Even if we fix everything that is wrong with the ways breastfeeding is treated within the health care system, we are fixing only a fraction of the life events that impact whether or not women breastfeed their children. The health care system is not responsible for most of the social, psychological, economic, and cultural challenges that affect breastfeeding. However, the health care system is a good place to tackle those challenges and to make people aware of the impact of infant feeding on health and on other outcomes.
It is over 20 years since the global introduction of the Ten Steps. The CDC’s Breastfeeding Report Card was launched in 2007 and provides state-by-state data about key process indicators, including hospital practices. CDC’s bi-yearly mPINC survey also collects reports on birthplace practices, including facilities that follow some but not all of the Ten Steps. Thus, we now have the tools to measure progress on this important objective.
Policy and institutional change are central to instituting appropriate lactation care. This objective can provide a clear impetus to strip away existing barriers to change.
The US Breastfeeding Committee (USBC) is an independent nonprofit coalition of 34 national professional and educational organizations, plus seven government agency partners. USBC works closely with a network of breastfeeding coalitions in every U.S. state and territory.
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The American College of Nurse Midwives strongly supports the addition of this objective to Healthy People 2020.
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Objective Clarification, Objective Text:
The International Formula Council (IFC) appreciates the opportunity to provide comments on the proposed Healthy People 2020 Objectives. The IFC is an association of manufacturers and marketers of formulated nutrition products, e.g., infant formulas and adult nutritionals, whose members are based predominantly in North America.* We fully support and commend the aim of Healthy People 2020 to improve the health of all infants. We also fully support exclusive breastfeeding, especially within the first six months of life, as recommended by numerous health authorities.
We recommend amending the language for this objective to read: “Increase the percentage of live births that occur in facilities that provide comprehensive infant nutrition education and care to mothers and their babies.” Without the revised language, this objective is discriminatory against mothers and infants who cannot, and mothers who choose not to, breastfeed, and could potentially endanger the health of formula-fed infants.
When a mother cannot or chooses not to breastfeed, we agree with the American Academy of Pediatrics, and others, that iron-fortified infant formula is the only safe, nutritious and recommended alternative to breast milk. In order to make informed feeding choices, new mothers should be provided with complete information on all appropriate feeding options. A May 2009 national poll of mothers found that, while a majority believes breastfeeding is best for their baby (84%) and themselves (79%), 78 percent of mothers agree that new moms should receive information on breastfeeding, as well as other feeding options, so they can make in informed choice.
Once a mother chooses her infant feeding method, she has the right to be fully supported in her decision and receive all of the information she needs to safely and successfully deliver nutrition to her baby. A systematic literature review of mothers’ experiences with bottle-feeding, which was published in the August 2009 journal Archives of Disease in Childhood, found that while moms recognize the benefits of breastfeeding, those who bottle-feed do not receive adequate information (including infant formula safe preparation) and support from the healthcare providers and, thus, may ultimately put their babies’ health at risk. A key finding from the review is that mothers who bottle-fed their infants were riddled with negative feelings of inadequacy, guilt and failure. The authors of this study conclude: “While it is important to promote breastfeeding,” {an objective outlined in MICH HP 2020-12 and reinforced in MICH HP 2020-26 and 2020-27}, “it is also necessary to ensure that the needs of bottle-feeding mothers are not overlooked.”
I. Lakshman R, Ogilvie D, Ong K. Mothers’ experiences of bottle feeding: a systematic review of qualitative and quantitative studies. Arch Dis Child. 2009.
* IFC members are Abbott Nutrition, Mead Johnson Nutrition, Nestlé Infant Nutrition, and Pfizer Nutrition.
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Objective Clarification, Data Source:
Again, there needs to be a percent target established based on historical data and stretch goals for 2020.
To achieve that target, once again espouse the implementation of best practices based on programs that have achieved success, such as the CDC, WHO/UNICEF, and the American Academy of Pediatrics.
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Objective Text:
ASTPHND recommends modification:
Add-
-Increase to 50% the number of labor and delivery facilities that are certified as Baby-Friendly Hospitals.
-Increase to 90% the number of infants who experience skin-to-skin contact with their mothers immediately after birth.
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Objective Clarification:
All health care facilities must provide care for lactating mothers and babies. It would be more appropriate to reframe the objective to measure which facilities provide lactation support services above and beyond normal care (e.g. a lactation consultant).
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Objective Text:
In response to the previous comments that suggest that this means more facilities should become officially "Baby Friendly", as a lactation consultant who has witnessed firsthand the hospital administrators debate the pros (e,g increased rates of BF'ng) and cons (e.g. ongoing administrative costs) of attempting to meet the standards required, I don't agree that that it is necessary to have the official BFHI designation to be able to fully support new mothers in their efforts to breastfeed. Increased rates of BFng are able to be achieved even with official recognition as a Baby Friendly facility, particularly when support is made available once these mothers leave the hospital, when the wheels really hit the pavement and the road gets tougher. I without a doubt view the first few days of a newborn's life as critical time in establishing a solid foundation for successful breastfeeding, but consider the timeperiod spent outside of the hospital as far more crucial to ensure that ongoing support is made available.
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The March of Dimes Foundation strongly supports the addition of this objective to Healthy People 2020.
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This is such a crucial objective to getting mothers and babies off to a good start with breastfeeding. To impact duration, mothers need the support of an IBCLC along with the rest of the healthcare team from the very first feed and throughout the hospital stay.
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Objective Clarification, Objective Text:
This is an important objective, as the CDC's mPINC survey revealed sub-optimal lactation services in many US birthing hospitals. This objective should be re-worded to state, "Increase the percentage of live births that occur in facilities that provide recommended care for lactating mothers and their babies by adhering to the 10 Steps to Successful Breastfeeding." These evidence-based recommendations have been shown to result in optimal breastfeeding outcomes when practiced in birthing facilities.
Too many hospitals lack evidence-based breastfeeding policies, and discharge mothers and infants who have not been adequately taken care of regarding breastfeeding guidance. Hospital staff often lack the necessary knowledge and skills to assist breastfeeding mothers and infants, especially in more complex medical situations.
Hospitals frequently do not have a proper lactation consultant to patient ratio and do not employ lactation consultants with the IBCLC (International Board Certified Lactation Consultant) credential. The US Lactation Consultant Association has members with expertise in hospital based breastfeeding care and can be consulted to better meet this very important objective.
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Objective Text:
I suggest rewording the objective as follows:
Increase the percentage of births occuring in facilities that provide care to protect, promote, and support breastfeeding as recommended by the American Academy of Pediatrics.
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Objective Clarification, Objective Text:
Add:
Increase the percent of labor and delivery facilities with policies that support exclusive breastfeeding.
o Increase to 50% the number of labor and delivery facilities that are certified as Baby-Friendly Hospitals. ™
o Increase to 90% the number of infants who experience skin-to-skin contact with their mothers immediately after birth.
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Objective Clarification, Objective Text:
Recommend adding tobacco products and exposure to second hand smoke.
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Objective Clarification, Objective Text, Data Source:
I strongly support this objective and agree that it needs clarification. Recommended care for lactating mothers and their babies needs to be defined.
The clearest simplest way would be to reword this to say "increase %age... in facilities that are Baby-Friendly certified. The Baby Friendly Hospital Initiative IS the recommended, evidence-based care. It is recognized by the CDC and the 10 Steps to Successful Breastfeeding have been endorsed by the AAP. Why avoid using this clearcut framework for monitoring lactation care in birth facilities?
If BFHI is still too much of a political hot potato, then consider the CDC's mPINC data: increase %age... that have mPINC scores of X amount or higher.
Also, keep in mind during editing that in the immediate postpartum period, ALL mothers are "lactating" whether they choose to breastfeed or not.
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Objective Clarification, Objective Text:
I would recommend changing this objective to "Increase the number of birth facilities that are designated as "Baby Friendly" as defined by the WHO/UNICEF Baby Friendly Hospital Initiative." The Baby Friendly designation is recognized internationally as the optimal level of care for lactating mothers and their babies, and was developed by the World Health Organization and UNICEF. This is considered "best practice" and would allow the US to compare the lactation care provided in our country to other countries internationally. The American Academy of Pediatrics has recently issued a statement supporting the Ten Steps to Successful Breastfeeding that are part of the BFHI. Why not use consistent measures to evaluate the lactation care we providing. There is a clear and internationally recognized definition of the Ten Steps to Successful Breastfeeding. However, use of the phrase "recommended care for lactating mothers and babies" is a defined set of practices that the CDC developed. The Ten Steps to Successful Breastfeeding are evidence-based practices, and have been utilized to evaluate lactation support for close to 20 years throughout the world. I would recommend setting our goals to meet international standards that are well-defined instead of less effective incremental standards set within our own country.
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This objective is synergistic with the other breastfeeding objectives and will be a clear systemic change that will increase successful breastfeeding/exclusive breastfeeding.
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Objective Clarification, Objective Text:
Perhaps the objective should be: Increase the provision of recommended care for lactating mothers and their babies at facilities with live births.
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Objective Clarification, Objective Text:
How about: Increase the percentage of live births that occur in hospitals and birth centers that provide recommended care for lactating mothers and their babies" ? Then, both hospitals and birth centers are spelled out.
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Objective Clarification, Objective Text:
Please keep the term "facilities" as opposed to using the word "hospitals". Births also occur in birth centers.
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Objective Clarification:
I agree the wording of the objective is confusing.
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Objective Clarification:
Can this be reworked to be "increase the number of hospitals in the US who are designated "Baby Friendly" which would then encompass it as written above?
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