Newborn & Infant Nursing Reviews 13 (2013) 58–59
Contents lists available at SciVerse ScienceDirect
Newborn & Infant Nursing Reviews
journal homepage: www.nainr.com
Family Dynamics
The Importance of Breastfeeding Education for All Women of Childbearing Age
Emily Tuthill BS, RN, Jacqueline McGrath PhD, RN, FNAP, FAAN ⁎
University of Connecticut, Storrs, CT
a r t i c l e i n f o
Keywords:
Breastfeeding
Infant feeding
Recommendations
Education
Pregnancy
Exclusive breastfeeding for the first 6 months optimizes nutrition
and immunological protection for infants and improves health for
mothers. Given the strong evidence supporting breastfeeding benefits it
is the recommendation of both the World Health Organization (WHO)1
and Center for Disease Control (CDC) 2 for mothers to breastfeed their
infant exclusively for the first 6 months. United States (US) trends on
breastfeeding prevalence have been improving with rates up to 74% in
having ever breastfed in 2009. 3 However, exclusive breastfeeding
remains a rare practice with rates of 33% exclusive breastfeeding up to
3 months4 and progressively decreasing at 6 and 12 months.
Increased attention on the importance of breastfeeding as well as
established programs supporting its uptake is evident. Research has
shown that birth facilities and their healthcare provider staff
significantly impact whether a mother initiates breastfeeding and
how long she continues to breastfeed. 3 In 1981, the WHO together
with the United Nations Children's Fund (UNICEF) established its
global baby-friendly hospital initiative 5 in an effort to increase
breastfeeding support. Today, the US division of baby-friendly
hospitals is actively engaged in increasing its presence in more
hospitals throughout the US and thus its reach in promoting breast
milk as optimal infant feeding nutrition. As of 2012, 153 hospitals and
birth centers in 34 States held the baby-friendly designation, which is
acquired through applying and meeting their 10-step program to
supporting breastfeeding and the International Code of Marketing of
Breast Milk Substitutes. 6 Ultimately a hospital's commitment to
becoming a baby-friendly facility is a comprehensive process that
includes using evidence-based care for maternal and newborn
patients that promotes optimal infant feeding outcomes through
breastfeeding support. The promotion and attainment of US hospitals
⁎ Address correspondence to Jacqueline McGrath, PhD, RN, FNAP, FAAN, Connecticut
Children's Medical Center, Hartford, CT. University of Connecticut, 231 Glenbrook Rd.,
Unit 4026, Storrs, CT, 06269.
E-mail addresses: emily.tuthill@uconn.edu (E. Tuthill),
jacqueline.mcgrath@uconn.edu (J. McGrath).
1527-3369/1302-0511$36.00/0 – see front matter © 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1053/j.nainr.2013.04.004
meeting the baby-friendly designation move the US closer to
achieving its breastfeeding initiatives.
In addition, several of the main objectives regarding US breastfeed-
ing rates are addressed through Healthy People 2020. Specifically,
Healthy People 2020 calls for the need to increase live births occurring
in baby-friendly designated hospitals from the 2.9% in 2007 to 8.1% by
2020 (i.e., MICH-24). 7 Other objectives highlighted in Healthy People
2020 include increasing the number of breastfed babies and more
specifically those exclusively breastfed at 6 months from 14.1% in 2006
to a target of 25.5% (i.e., MICH- 21.5). Somewhat surprisingly, Healthy
People 2020 notes that despite promotion of exclusive breastfeeding,
24% of infants are fed supplemental formula in their first 2 days of life.
Their goal is to reduce this percentage to 14.2% by 2020. 7
In complement with the Healthy People 2020 objectives and global
initiatives, such as baby-friendly hospitals, other organizations and
governmental groups include breastfeeding support as a top priority.
In 2011, Surgeon General Regina M. Benjamin released her call to
action to support breastfeeding. 8 In this report, she outlines
recommendations for overcoming barriers to breastfeeding through
increased education, family and community support (i.e., action 1),
care continuity (i.e., action 8) and clinical care quality (i.e., action 10).
Lactation teams to support breastfeeding mothers (i.e., action 11)
were also highlighted, as well as holding marketers accountable for
minimizing negative impressions of exclusive breastfeeding through
their promotional campaigns of formula (i.e., action 6). Furthermore,
she emphasizes the physical, emotional and long-term benefits
breastfeeding has for infants and their mothers. 8 In conjunction
with the surgeon general's call to action and in keeping with Healthy
People 2020 goals, the National Breastfeeding Campaign was funded
to carry out these recommendations. 9 Non-governmental organiza-
tions, like the March of Dimes and La Leche League, have extensive
support groups and information for mothers and the public in support
of breastfeeding. Furthermore, organizations such as American
College of Nurse-Midwives, American College of Obstetricians and
Gynecologists and the American Dietetic Association all pledge their
support to increasing breastfeeding in the US. Despite these increases
in organizational support, barriers exist to breastfeeding.
In the 2008, a report by Labbok and Taylor found that rates of
exclusive breastfeeding vary by marital status and age. 10 Specifically,
married women who were older were twice as likely to successfully
exclusively breastfeed to 6 months. 10 Another interesting finding was
that mothers NOT enrolled in WIC programs were two times as likely
to exclusively breastfeed as WIC-enrolled mothers (14% vs 8%). In
effect, nationality and race/ethnicity are associated with exclusive
breastfeeding, and level of education is highly correlated with
initiation and duration of exclusive breastfeeding. 10 In addition,
 E. Tuthill, J. McGrath / Newborn & Infant Nursing Reviews 13 (2013) 58–59 59

Table 1
Recommendations Promoting Breastfeeding in the US.

For Mothers For Healthcare Providers For Hospitals For Organizations

Feed only breast milk to one's infant, optimally Education in breastfeeding recommendations Seek baby-friendly designation (http:// Increase education to
for 6 months and lactation www.babyfriendlyusa.org/get-started) all women
Seek additional support through Educate mothers: physical, emotional, and Avoid free formula sampling Outline objectives for
established networks. long term health benefits to infant and mother family support
Give birth in a designated baby-friendly hospital Care continuity: provide links to lactation Community outreach education to Target populations at
(http://www.babyfriendlyusa.org/find-facilities) consultants, outside resources, women of childbearing age higher risk for non-
support groups and families breastfeeding practice
Provide lactation consultants Increase marketing around
exclusive breastfeeding
practice

families and/or mothers with higher incomes are more likely to
initiate exclusive breastfeeding and maintain its practice for longer
durations than lower income groups. 10 Labbok and Taylor 10 made
recommendations from their report to the United States breastfeeding
committee that included the importance of lactation education for all
healthcare providers. They also targeted recommendations for family
and community support programs and the improvement of marketing
around exclusive breastfeeding within communities while simulta-
neously reducing access to free formula samples, gifts, and coupons.
Finally, they brought to the attention of others that of grant monies
expended on nutrition/breastfeeding/lactation from 2003–2006 less
than 1% was specified targeted for increasing breastfeeding of any
type, let alone exclusive breastfeeding. 10
In this way, educating mothers has been identified as an important
step toward increasing breastfeeding initiation and duration. In fact, a
review by the US Preventive Services Task Force in July 2003
determined education on breastfeeding was the most effective
intervention for increasing initiation and short-term duration. 11
These data were collected from 30 controlled trials and 5 systematic
reviews. Education can occur prenatally and, during the intrapartum
with follow up support postpartum. Baby-friendly hospitals are an
example of where breastfeeding education is taking place as one of
the main priorities of its designation.
The promotion of exclusive breastfeeding and breastfeeding, in
general, through US governmental bodies, global initiatives and
non-governmental organizations has increased its efforts over the
past decade. This has been highlighted through specific objectives in
Healthy People 2010 and Healthy People 2020 and the National
Breastfeeding Campaign. Although breastfeeding initiation rates and
duration have seen increases (e.g., initiation 74% to 76% in 2009) 3 as
well as more hospitals applying and achieving baby-friendly
designation, sustained efforts are needed to maintain and increase
breastfeeding initiation and duration rates in the US. Evidence
shows interventions aimed at increasing maternal education
followed by supportive networks established throughout the
breastfeeding period have been effective at increasing breastfeed-
ing 11 (see Table 1). Likewise, education and support for family
members are imperative to breastfeeding success. Clear recommen-
dations on how to educate and involve family members in
supporting breastfeeding are lacking, however literature points to
the importance of such support. Furthermore, raising awareness of
breastfeeding among the public may be the key to redirecting
attitudes more favorably towards breastfeeding as a mother's
optimal infant feeding option.
References
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