With breast-feeding rates still not at the levels health-care providers and policymakers would like, two U.S. health agencies have decided it's time to take action.
Representatives of the U.S. Centers for Disease Control and Prevention and the Office of Women's Health, which is part of the Department of Health and Human Services, are spending much of Thursday at CDC headquarters in Atlanta listening to breast-feeding experts tell them what needs to be done to get more women to breast-feed.
Then, by the middle of next year, the agencies say, they plan to issue a "Call to Action" -- a federal document that recommends specific policies and activities to address what they refer to as "an urgent public health priority."
"Helping women breast-feed is a no-brainer in the health and well-being of mother and baby," said Dr. Sheela R. Geraghty, medical director of the Center for Breastfeeding Medicine at Cincinnati Children's Hospital Medical Center. "It's a completely cost-effective mechanism to improve maternal and infant health in the U.S. And, it's an economic benefit, with less formula costs, less bottles."
"Everybody welcomes this," Geraghty said of the government's efforts. "Basically, they are trying to gather information to identify the need. We know moms in lower socioeconomic categories don't breast-feed as often as other moms and that the workplace environment [can be a hindrance]."
In the decade since the federal government issued a "Blueprint for Action on Breastfeeding," some gains have been made but not nearly enough, say many experts.
According to CDC statistics, about 68 percent of women in 1999 breast-fed in the days right after birth, increasing to about 74 percent in the 2005-2006 period.
By the time their babies were 6 months old, only 32 percent of women were still breast-feeding in 1999, compared with 43 percent in 2005-06. And by the time the babies were 1 year old, the number had declined even further: to 15 percent in 1999 and 22 percent in 2005-06.
"We have come a long way in helping moms start," Geraghty said, but "those are still pathetic numbers."
The American Academy of Pediatrics and the World Health Organization recommend that mothers exclusively breast-feed their infants for at least the first six months of life and then continue the for as long as mother and baby both wish.
But just 12.3 percent of mothers exclusively breast-fed their babies for the first six months of life in 2005, according to the CDC.
Breast-feeding has been shown to benefit both babies and mothers. Breast-fed babies, for instance, have a lower risk for sudden infant death syndrome, diabetes, obesity and asthma. And by breast-feeding, women can reduce their risk for ovarian and breast cancer along with hip fractures and osteoporosis later in life.
But there are obstacles to getting more women to breast-feed. A big one, according to Geraghty, is the American "culture of maternal-infant separation," which she said is partly driven by women working and going to school. Also, many hospitals separate mothers and babies.
"If you want to be successful with breast-feeding, you need to keep the mother and baby together as much as possible," said Dr. Michael Giuliano, director of neonatology at Hackensack University Medical Center in New Jersey. "There are routines in hospitals that do not do that very well."
Most women of childbearing age in the United States now work, and some women return to their jobs as early as six weeks after their baby is born. That can interfere with breast-feeding, Geraghty said, because "it can take a month to six weeks just to establish breast-feeding."
To deal with this, women sometimes "pump" their own breast milk so their babies can be given breast milk while they are at work, but this can be difficult for some.
"Pumps are expensive, and often people don't have a place to pump at work," Geraghty said.
In addition, many women becoming mothers today were not breast-fed as babies, nor did they see their mothers breast-feeding siblings, so they have few role models. "Women are just starting from scratch, and that's very hard," Geraghty said. "You add all of that together, and women are having such a challenging time."
Giuliano seemed to agree. "Lots of moms have difficulties breast-feeding, and most don't have three generations of family members around to help them," he said. "We've found that lots of mothers need support, and that takes lots of time and specialized training. Our institution has just hired another lactation specialist."
The goal, Geraghty said, is for "moms to breast-feed as long as they can and to have a good experience."