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Jonathan E. Fielding, MD, MPH, MBA

Director of Public Health and Health Officer

L.A. County Department of Public Health

Public Health Breastfeeding Public Health Breastfeeding Policy InitiativePolicy Initiative

Breastfeeding MattersBreastfeeding MattersApril 7, 2010April 7, 2010

Chronic Disease & Health Disparities

• Health disparities are associated with:

• Poverty• Education• Race/Ethnicity

• Breastfeeding has a role to play in disease prevention and addressing health disparities

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Breastfeeding evens the playing field

Breastfeeding is a natural "safety net" against the worst effects of poverty...It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born. 

James P. Grant

Former Executive Director UNICEF

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Why is breastfeeding important?

Exclusive and extensive breastfeeding reduces the risk for many diseases.

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Breastfeeding: Important for BabiesRisk Differences for Various Disease

-23%

-42%

-64%

-40% -39%

-19%

-36%

-24%

-70%

-60%

-50%

-40%

-30%

-20%

-10%

0%

Ris

k D

iffe

ren

ce

Acute Chronic

Source: Ip, AHRQ, 2007

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Breastfeeding Reduces the Risk of Childhood Obesity

• Leptin, ghrelin, adiponectin play a role• Infants self-regulate at the breast• Different maternal behavior• Reduced risk for early growth acceleration• Other variables• Reduces the risk of obesity by 4% for each month of exclusive breastfeeding

Ip, AHRQ, 2007Dewey, JHL, 2003Miralles, Obesity, 2006

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Breastfeeding Reduces the Risk of Childhood Obesity

• Exclusive BF for 3 to 6 months is associated with reduced risk for childhood overweight

• Not a panacea, but the start of our obesity prevention efforts

• BF promotion has become an important component in larger efforts to reduce childhood obesity

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Breastfeeding: Important for MothersRisk Differences of Various Disease

-28%

-21%

-12%

-30%

-25%

-20%

-15%

-10%

-5%

0%

Ris

k D

iffe

ren

ce

Ip, AHRQ, 2007

Breastfeeding =Optimal Infant Nutrition

Good public health outcomes are associated with: extensive breastfeeding exclusive breastfeeding

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Public Health Breastfeeding Policy Initiative

Increase exclusive and extensive BF ratesBaby Friendly Hospital designation

LAC DHS committed, bringing along others

Evidence based approachBuy-in from the topConvening regional quality improvementCollaborative approachMultidisciplinary team

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California Any and Exclusive In-Hospital Breastfeeding: 1994-2007

43%43%44% 44% 43% 44% 44% 44% 43% 43% 43% 42% 42% 42%

87%87%86%86%86%85%84%84%83%82%80%79%77%77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Exclusive Breastfeeding Any Breastfeeding

11Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

The “GAP” is Growing

87%83%

43%

24%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

California Average LA County Average

Any BF Exclusive BF

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Percent Any/Exclusive In Hospital Breastfeeding: 2007

Gap

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Maternity Care Policy & Practices

• The maternity care experience exerts unique influence on both breastfeeding initiation and later infant feeding behavior

• Breastfeeding is an extremely time-sensitive relationship

• Experience with breastfeeding in the first hours and days of life significantly influence an infant’s later feeding

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Evidence-Based Interventions• Significant evidence that changes in

maternity care at the institutional level can increase breastfeeding initiation, exclusivity, and duration

• CDC recommends bringing key decision makers together to address the importance of evidence-based breastfeeding practices

Source: Shealy 2005

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We look forward to your partnership on

this important Public Health issue.

Works Cited• California Department of Public Health, Maternal, Child and Adolescent Health Program.

“California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database, 1994-2007.” Available at: http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx

• Dewey KG. Is breastfeeding protective against child obesity? J Hum Lact 2003;19(1):9-18.

• Ip S, Tufts-New England Medical Center. Evidence-based Practice Center., United States. Agency for Healthcare Research and Quality. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality; 2007.

• Miralles O, Sanchez J, Palou A, Pico C. A physiological role of breast milk leptin in body weight control in developing infants. Obesity (Silver Spring) 2006;14(8):1371-7.

• Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM. The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf

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