Dr. Alison Stuebe, Distinguished Scholar of Infant and Young Child Feeding at the University of North Carolina Gillings School of Global Public Health, helped conduct an expansive review of breastfeeding research to assess breastfeeding’s connection to positive maternal health outcomes and summarize the effectiveness of policies and programs that promote breastfeeding.
The 524-page comparative effectiveness review, Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries, was published in July and commissioned by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).
“Nearly 84 percent of women start out breastfeeding their babies, but the problem lies in making sure they have what they need to continue,” said Dr. Stuebe, who is also associate professor of maternal-fetal medicine in the UNC School of Medicine’s Department of Obstetrics and Gynecology. “We need better systems in place to support mothers in their breastfeeding goals – which is not only good for the babies, but also good for the moms. Reviewing the literature can identify what community-based breastfeeding programs are effective, and if they be replicated for larger populations.”
A 2007 AHRQ review showed that breastfeeding was associated with reduced maternal Type 2 diabetes, breast cancer and ovarian cancer, but other maternal health outcomes were unclear. This review found literature published in the intervening years that supports the conclusions of the prior review and also shows a relationship between breastfeeding and lower rates of hypertension.
“We see that breastfeeding is associated with lower rates of chronic health conditions women may experience later in their lives,” said Dr. Cynthia Feltner, assistant professor in the Division of Internal Medicine at UNC’s School of Medicine and associate director of the RTI-UNC Evidence-Based Practice Center at the Cecil Sheps Center for Health Services Research. “We hope entities such as the Centers for Disease Control and Prevention, policy makers, health care agencies and women’s health care providers will use this review to inform others on the maternal health benefits of breastfeeding. Researchers and others can refer to this review to secure funding for initiatives we know are working, but also to conduct research that will fill in the gaps on what we don’t know.”
One key finding of the review was the enormous impact of the Baby-Friendly Hospital Initiative on breastfeeding rates. The initiative is a worldwide program of the World Health Organization and UNICEF to support hospitals in their efforts to enable mothers to breastfeed. Women who give birth at Baby-Friendly designated hospitals are much more likely to be breastfeeding at and after discharge.
The Carolina Global Breastfeeding Institute (CGBI), part of the Department of Maternal and Child Health of the Gillings School, has been instrumental in helping hospitals across the country implement Baby-Friendly practices by providing a framework that hospitals can use to work through the requirements for the designation.
“At CBGI, we developed a coaching dyad model in our CDC funded project, EMPower Breastfeeding, that provides technical assistance for hospitals working through the Baby-Friendly Hospital Initiative designation journey,” said Ms. Catherine Sullivan, CGBI director and assistant professor of maternal and child health. “We recently worked with more than 90 hospitals in 24 states. Sixty-one of those hospitals now are designated Baby-Friendly hospitals, and many more are in the process of becoming designated.”
Ms. Sullivan said the ARQH review determined there is still a lack of information on the impact of workplace or school-based community interventions. With a grant from The Duke Endowment, CGBI already is addressing that need by equipping hospitals and communities in North and South Carolina with the tools they need to support and promote breastfeeding in clinics providing prenatal care and child care settings.
“Your hospital can be Baby-Friendly, but your community and health care settings might not have the tools to support that,” said Ms. Sullivan. “We’re piloting that in 20 communities right now with the intent to bring better support to all communities in both states.”
[Photo: Ms. Catherine Sullivan (left) and Dr. Alison Stuebe]