For the past 21 years, the first week in August has been known as World Breastfeeding Week. Maryland, recognizing the importance of breast-feeding for both personal and public health, has annually expanded this to declare August Maryland Breastfeeding Month. Breast-feeding rates have increased significantly across the country over the last four decades, following many years of promotion of formula by both health professionals and formula companies. In 1976, only 36 percent of moms initiated breast-feeding, and only 14 percent were still breast-feeding at 6 months. Data released this month by the Centers for Disease Control and Prevention show that 76.5 percent of mothers nationally are initiating breast-feeding (69.4 percent in Maryland), 49 percent are still breast-feeding by 6 months (52 percent in Maryland), and 16.4 percent make it to 12 months (15.1 percent in Maryland).
The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months and breast-feeding for at least a year or longer as long as mutually desired by mother and baby. The AAP also states: "The decision to breastfeed is … a basic and critical health decision regarding infant welfare."
Why is that? Studies have repeatedly shown that babies breast-fed (especially breast-fed exclusively) for three to six months have lower risks of ear infections, eczema, gastrointestinal infections, asthma, diabetes, childhood leukemia, sudden infant death syndrome, and many other illnesses. More recent studies have also continued to demonstrate that babies who are breast-fed have decreased risks of obesity and slightly higher IQ's. For every year a mother breast-feeds, her risk of breast cancer decreases by at least 4.3 percent.
So what are the obstacles, and what is Maryland doing to help moms achieve their breast-feeding goals? I always say that breast-feeding is natural but not always easy. Women encounter challenges in every setting. There may be misinformation and/or lack of support from health professionals, families, friends, employers and society at large.
Maryland has been making much progress in supporting breast-feeding. In November, the Department of Health and Mental Hygiene (DHMH) launched a statewide initiative to improve hospital support for breast-feeding mothers. All 32 birthing hospitals have signed on to the state's recommendations, and nine have expressed their intent to go further and become "Baby Friendly." That means these hospitals will work within a well-delineated, rigorous set of guidelines to strengthen even more their breast-feeding supports. It does not mean that women who choose to bottle feed their babies at any of these hospitals are led to feel ashamed. Both DHMH's program and Baby Friendly believe that women should be supported in whatever method they choose to feed.
Maryland employers are also beginning to recognize that supporting a breast-feeding mother in the workplace leads to decreased absenteeism (due to a sick baby) and increased job loyalty. The Affordable Care Act requires employers provide reasonable break time and a place other than a bathroom in which a mother can express her milk. It also requires insurance companies to provide pumps for mothers. The Maryland Breastfeeding Coalition has been awarding its Breastfeeding-Friendly Workplace Awards since 2010 to businesses that go the extra mile in their supports. To date, more than 30 businesses have been recognized. (Nominations for 2013 are open through mid-September and may be submitted at http://www.mdbfc.org.)
Despite the tremendous progress we have seen in Maryland and across the country, some still feel that breastfeeding in public is somehow "indecent." Maryland law states: "A mother may breastfeed her child in any public or private location in which the mother and child are authorized to be. A person may not restrict or limit the right of a mother to breastfeed her child." All 50 states and the District of Columbia have similar laws. There have been several recent incidences in which a mother nursing her child in public has been asked to leave or been shamed in other ways. A Laurel mother on an American Airlines flight experienced this, as did a Texas mother who fed her 16-day old infant while watching an older daughter's dance class at a recreation center. In a commentary this month, Mark Hyman on Fox Channel 45 compared breast-feeding in public to passing gas in an elevator or other situations where people "intentionally violate the commonly accepted standards of public decency."
I cannot recall ever seeing a mother breast-feeding in public completely exposing her breasts. We are no longer a Puritanical society and certainly often see more exposure daily from women wearing low-cut shirts and mini-skirts, or bathing suits at public pools and beaches. Breasts have been sexualized in our society for so long that we have forgotten their main purpose.
I am proud of how far Maryland has come. I commend the DHMH, Maryland's hospitals, community groups and businesses for their growing support. As word and recognition spread, I am confident that perceptions will continue to change.
Dana Silver is a pediatrician at the Samuelson Children's Hospital at Sinai Hospital, breastfeeding coordinator with the Maryland branch of the American Academy of Pediatrics, and secretary of the Maryland Breastfeeding Coalition. Her email is email@example.com.