Breastfeeding promotion here and there

We have just concluded another annual World Breastfeeding Week, and the U.S. Centers for Disease Control has a new report on how well hospitals are promoting breastfeeding. The results show progress in the direction of public health objectives, but the distribution of services is very unequal. Here’s the background:

Childhood obesity is a national epidemic in the United States. Increasing the proportion of mothers who breastfeed is one important public health strategy for preventing childhood obesity. The World Health Organization and United Nations Children’s Fund (UNICEF) Baby-Friendly Hospital Initiative specifies Ten Steps to Successful Breastfeeding that delineate evidence-based hospital practices to improve breastfeeding initiation, duration, and exclusivity.

The CDC did a survey of obstetric hospitals and birth centers in 2007 and 2009, and found progress on some of the Ten Steps (click on the image to read the labels):

Just as compliance on the Ten Steps is uneven, so too is the percentage of births at the top-rated “Baby-Friendly facilities” by state:

The CDC estimates that 4.5% of all U.S. babies are born at “Baby-Friendly facilities.”

Finally, the CDC report is linked to a Report Card for states, which shows how well each state is doing in terms of breastfeeding outcomes, as well as “process indicators,” which measure some of the policy supports in place in each state, such as child care center regulations, state health department workers tasked with promoting breastfeeding, and the number of lactation consultants.

To look under the cultural hood a little, I loaded the national Maternity Practices in Infant Nutrition and Care (mPINC) scores for each state into Google Correlate to see what Google searches are most highly correlated with breastfeeding success and failure at the state level. The Google tool gives the 100 most correlated searches, and they are mostly cooking terms, including 8 references to Martha Stewart or Julia Child, Epicurious, and highbrow recipes like “pumpkin lasagna” and “asparagus prosciutto.” So, that’s kind of fun to know but not really useful.

Surprisingly relevant, however, was the high prevalence of searches for “Nutrition Action” and “Nutrition Action Healthletter,” which both were correlated at .84 or higher with the mPINC scores across states. That is a newsletter put out by the Center for Science in the Public Interest, which actively promotes — among other things — breastfeeding policies intended to improve health and nutrition. Here are the maps showing where mPINC scores are higher and more people Google the Nutrition Action Healthletter:

This does not mean the relationship is causal, of course. But it appears that the places were CSPI resonates are also those that do a better job of promoting breastfeeding. Hopefully, this will further motivate the social science of search behavior.

Anyway, as I noted last year, breastfeeding rates are strongly associated with the race/ethnicity and education level of mothers:

This may be because of working conditions or other demands on time, mothers’ health, or other factors — but it might also reflect the failure of public health and education programs to inform many mothers about the importance of breastfeeding and support their efforts to breastfeed. Public health promotion of breastfeeding can help extend its health benefits, but to do that will require sustained state-supported efforts.