The United States Preventive Services Task Force (USPSTF) recently released its first updated breastfeeding intervention recommendations. They discovered large holes in the provision of support in primary care. This new update sheds light on the societal inequities that create obstacles for effective breastfeeding. These challenges remain despite a clear consensus on the health benefits for mothers and infants. The Healthy People 2030 maternal and infant health initiative is working to change that. Their goal is to increase the rate of infants that are exclusively breastfed in the United States to 42.4% by the year 2030. At the moment, no more than 27.2% of infants six months and younger are exclusively breastfed nationwide.
The new breastfeeding recommendations from the USPSTF are a testament to the impact of targeted breastfeeding interventions. When implemented together, these evidence-based approaches can triple exclusive breastfeeding rates for newborns and infants through six months. These behavioral interventions are low-cost, have no reported harms, and continue to be used sub-optimally in clinical practice. Researchers found a moderate positive dose-response relationship between lactation support interventions and increased rates of any breastfeeding and exclusive breastfeeding. This significant finding indicates that extensive education and guidance can lead to improved breastfeeding results.
Maternal Health Benefits of Breastfeeding
The positive health effects of breastfeeding go far beyond the infant, greatly benefiting maternal health as well. Women who breastfeed experience reduced risk of developing ovarian cancer, hypertension, and type 2 diabetes. These results underscore the importance of expanding support and education around breastfeeding practices.
In addition, most primary care providers have not received the lactation education they need to support patients. This gap significantly impacts their ability to implement and scale effective breastfeeding interventions. To address this topic, the USPSTF convened an expansive systematic review, obtaining data from 49,597 participants from diverse populations. To their surprise, only 37 randomized controlled trials (RCTs) on optimal breastfeeding interventions have occurred since their last recommendations in 2016.
“This updated recommendation provides an important, evidence-based directive for delivering lactation support — an area that remains under researched and poorly integrated into health systems,” – Jill R. Demirci, PhD, RN, IBCLC
The lack of basic training in lactation support among healthcare providers comes into play as a key factor. As Dr. Jill R. Demirci notes, “It remains unclear what breastfeeding education topics are most critical, the most effective mediums and formats for delivery, and how often support should be provided.”
Addressing Systemic Barriers
As important as it is to improve individualized support, experts argue systemic changes to culture and pedagogy are just as critical. Dr. Cindy Rubin highlights the emotional struggles many mothers face when they want to breastfeed but lack access to adequate support. They feel disappointed because they know there’s more they can do. Yet, they are unable to access the help and hard as it is for them, their situation adds to the challenge.
Dr. Rubin believes that the medical community has historically left breastfeeding out of medical education. As he describes it, “Nobody learned about it in med school because it’s not studied there. Now it’s the hot new trend. This gap in knowledge forces healthcare professionals into difficult situations. Clinicians report that they are unqualified to provide the necessary support and education expected of them.
Advocating for improved maternity policies like these can help be a part of addressing these widespread disparities. It’s long past time to do better by maternity and family leave. Beyond that, we must improve the working experience for all workers returning to the office. The reality is, the system is failing people who are lactating,” Dr. Rubin continues.
The Role of Public Health Initiatives
The new USPSTF report emphasizes the critical role that public health can and should play in ensuring mothers have access to comprehensive, practical lactation support and education. In reality, experts warn that these initiatives cannot work as well as they could in a vacuum. Dr. Rubin stresses the value of home visits as a form of early postpartum support: “In particular, home visits are invaluable as a form of early postpartum support and education for lactation.”
Additionally, with the right lactation education and guidance, mothers can overcome challenges they experience while breastfeeding. As Dr. Whitney Kathryn Kaefring explains, “They deserve to be seen by a lactation medicine specialist. This highlights the importance of ensuring all mothers have access to trained professionals who can offer tailored support.
The USPSTF recommendations are a B grade, which indicates moderate benefit, and were published in JAMA. Her systematic review of outcomes from 90 randomized controlled trials evaluated different timing, delivery methods, and durations of breastfeeding support interventions.
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