Health Care Strategies to Promote Breastfeeding: U.S. Preventive Services Task Force Recommendations

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The summary below is from the full reports titled "Primary Care Interventions to Promote Breastfeeding: U.S. Preventive Services Task Force Recommendation Statement" and "Interventions in Primary Care to Promote Breastfeeding: An Evidence Review for the U.S. Preventive Services Task Force." They are in the 21 October 2008 issue of Annals of Internal Medicine (volume 149, pages 560-564 and pages 565-582). The first report was written by the U.S. Preventive Services Task Force; the second report was written by M. Chung, G. Raman, T. Trikalinos, J. Lau, and S. Ip.

Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Breastfeeding has health advantages for both children and their mothers. Evidence shows that babies who are breastfed have fewer infections and allergic skin rashes than formula-fed babies and are also less likely to have sudden infant death syndrome (SIDS). After breastfeeding ends, children who were breastfed are less likely to develop asthma, diabetes, obesity, and childhood leukemia. Women who breastfeed have a lower risk for type 2 diabetes, breast cancer, and ovarian cancer than women who have never breastfed. For these reasons, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists recommend breastfeeding as the preferred choice for feeding babies. However, a 2002 survey showed that only 71% of American children had ever been breastfed, only 35% were breastfed at 6 months of age, and only 16% were breastfed at 12 months of age.

The USPSTF wanted to find out what is known about whether strategies in health care settings to promote breastfeeding actually increase the chance that women will choose to breastfeed. They also wanted to see whether there was evidence of harms related to these strategies.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research on strategies used by physicians, nurses, midwives, or counselors to increase breastfeeding in developed countries.

What did the authors find?

The authors found 1 large, good-quality study, conducted in Belarus, that demonstrated that hospital practices that support breastfeeding improve health outcomes for infants. They also found 36 studies that addressed whether strategies increased the numbers of women who chose to breastfeed. In summary, these studies showed that several different strategies to promote breastfeeding increased breastfeeding rates. Strategies that contacted women before and after delivery were more effective than those that involved only one of these periods. Although the authors found no studies that investigated potential harms associated with strategies to promote breastfeeding, their opinion was that the potential harms, if any, were probably small.

What does the USPSTF recommend that doctors and patients do?

The USPSTF recommends that health care settings use strategies that work with women and families both before and after delivery to encourage and support breastfeeding.

What are the cautions related to these recommendations?

The available studies used different strategies to promote and support breastfeeding, and the authors could not determine which specific type of strategies increase breastfeeding the most. In rare circumstances, such as when mothers have HIV or infants have galactosemia, breastfeeding may not be appropriate. Breastfeeding does not guarantee that babies and mothers will not develop the previously mentioned health problems.