Tag Archives: breastfeeding

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.


Filed under In the news, Politics

Educated motherhood

More educated moms get all the credit, everyone feels the heat.

More news on inequality for children according to the education levels of their mothers. Do more educated parents do it better, or are there other things about these homes, families, neighborhoods, friends, schools, etc., that account for this pattern? If education really is the issue, it’s a big part of how families transmit inequality — how rich parents produce rich children, and poor kids turn out poor.


For example, preschool-aged children are more likely to be obese if they (a) watch more TV, (b) don’t eat regular dinners with their families, and (c) don’t get enough sleep. That pattern holds in an analysis that controls statistically for a host of demographic variables, including family structure, race/ethnicity and socioeconomic status.

OK, so TV is bad and sleep and family dinners are good. Maybe educated parents do that better — because of their know-how or other resources. But the effect of those daily routine factors is not as great as the association  between obesity and mothers’ education:


According to a recent study in Pediatrics, failure to reach the public health goal of 90% of mothers using breastfeeding exclusively for 6 months leads to 900 deaths per year in the U.S. We know that mothers with more education are much more likely to breastfeed.

In this case, we have some pretty good ideas about the barriers to breastfeeding for poorer women, including inflexible workplaces and commutes, in addition to the know-how issue — which is why new rules in the health care bill are supposed to make breast pumping more accessible for working mothers. That doesn’t stop people from beating up on poor mothers who don’t breastfeed. (The Pediatrics analysis estimates every death costs more than $10 million in lost productivity and other costs. Which I don’t get. If that’s true, how much does it cost to not have children in the first place?)


Time with children also substantially favors more educated women:

Before 1995, mothers spent an average of about 12 hours a week attending to the needs of their children. By 2007, that number had risen to 21.2 hours a week for college-educated women and 15.9 hours for those with less education.

That accords with an earlier study, in which several colleagues and I found inequality in childcare time by parents’ education. But parents spend more time with their children than they did in the 1970s, and there was no increase in the college-noncollege gap.

Whether childcare time is actually beneficial for children — rather than being just another cultural craze — depends on the quality of parenting, family relationships, and the quality of the alternative arrangements available. But in other areas, parenting behavior has clear effects. For example, mothers who don’t know about the back-to-sleep thing are more likely to put their babies to sleep on their stomachs or sides, which increases the risk of sudden infant death.

The more things change

The parenting madness — if madness is what it is — is cyclonic, with news (and blogs) like this feeding the practices that they report on. And this at least contributes to the decisions by some high-end working women to scale back or drop out of their careers. Once no longer employed, these overachievers apply their many skills to parenting, ratcheting up the pressure on everyone else.

This all might seem new. But education for perfect parenting — in the modern era — goes back more than a century.  A great online exhibit at Cornell University’s library traces the history of its Home Economics program from 1900 to 1969. I didn’t know till a recent NYT Book Review that they used practice babies — real babies — to train college students to be mothers:

Cornell secured infants through area orphanages and child welfare associations. Babies were nurtured by the students according to strict schedules and guidelines, and after a year, they were available for adoption. Prospective adoptive parents in this era desired Domecon babies because they had been raised according to the most up-to-date scientific principles.

Now the better-parenting treadmill doesn’t stop at the Ivy League door. The curriculum is available everywhere:

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Filed under In the news, Research reports

Breastfeeding gaps persist

The American Academy of Pediatrics recommends nothing but breast milk for the first six months of life, and continued breastfeeding for 12 months, when possible. The Federal and state governments have set these as public health goals. However, the achievement of these goals is unequally distributed according to race/ethnicity and education level, according to a new report.

This is not just a matter of awareness, although that is part of the story. Among the many barriers to breastfeeding are the potential problems for working moms, and the fact that only some places protect mothers’ right to breastfeed in public.

There are many sources of support for breastfeeding, for sure.  But maybe it would catch on more if people could post their pictures on Facebook, or if people got the breasfeeding doll for their daughters:


Filed under Research reports