We must identify and reduce barriers which keep women from beginning or continuing to @eastfeed their infants. 42. Everett Koop, M.D., Sc.D. Surgeon General REPORTY OF THE SURGEON GENERAL'S WORKSHOP ON BREASTFEEDING & HUMAN LACTATION Presented by the US. DEPARTMENT OF HEALTH & HUMAN SE&ES PubkHeaiihservice Health Resources and services Administmtbn Bureau of Health Care Dekery and Assistance Dh4skx of Maternal and Chw Health h cooperation with The Uriversilv of Rochester Mediial Center June 11th and 12th. 1964 DHHS Publication No. HRS-D-MC 84-2 The Surgeon General's Workshop on Breastfeeding and Human Lactation was supported by grants from The Daisy Marquis Jones Foundation Medella, Incorporated Parke-Davis The Division of Maternal and Child Health-Public Health Service U.S. Department of Health and Human Services This Report was edited by the Editorial Department of The National Center for Education in Maternal and Child Health: Anthony Waddell, Director of Publications. The original drawing on the cover was done by Bob tinge of Rochester, N.Y. Cover design courtesy of the Publications Office and photos courtesy of the Medical Photo/ Illustrations Unit, University of Rochester Medical Center. PREFACE The Surgeon General's Workshop on Breastfeeding and Human Lactation represents a milestone in our continuing efforts to improve the health of our nation's mothers and infants. Research fmdings have docu- mented the benefits of human milk and lactation for babies and mothers. One of the. "Health. Promotion/Disease Prevention Objectives for the Nation" is that by the year 1990, the proportion of women who breast- feed their babies should be increased to 75% at hospital discharge and 35% at 6 months of age. The last decade has seen a steady increase in breastfeeding, predomi- nantly among middle- and upper-income, educated, white women. We need to identify and reduce the barriers that interfere with breastfeeding, especially in those population groups with low prevalence of breastfeed- ing-among women who are minority, low income, and less educated. The Workshop has provided an opportunity o to review progress of past efforts, in both public and private sec- tors, to promote breastfeeding; o to assess the state of the art related to factors that enhance and those that inhibit breastfeeding and human lactation; o to determine remaining challenges; o to develop strategies and recommendations in order to facilitate progress toward achieving the 1990 Objective. Building on the model of the Healthy Mothers/Healthy Babies Coa- lition, this Workshop involved the participation of representatives of major professional and voluntary organizations. These organizations working in the public and private sectors will play a major role in the dissemination and implementation of the national recommendations. The strategies developed at this Workshop will result in promotion of sound infant feeding practices and in informed decisions by more women about breastfeeding their babies. C. Everett Koop, M.D., Sc.D. Surgeon General . . . 111 PLANNING COMMITTEE Planning Committee for the Surgeon General's Workshop on Breastfeeding and Human Lactation WORKSHOP CHAIRPERSON WORKSHOP CO-CHAIRPERSON Ruth A. Lawrence, M.D., F.A.A.P. Department of Pediatrics University of Rochester Medical Center Henry A. Thiede, M.D., F.A.C.O.G. Department of Obstetrics and Gynecology University of Rochester Medical Center WORKSHOP DIRECTOR M. Elizabeth Brannon, M.S., R.D. Division of Maternal and Child Health U.S. Department of Health and Human Services COMMITTEE MEMBERS Organizational Representatives Jeanne F. Arnold, M.D., F.A.A.F.P. American Academy of Family Physicians Richard H. Aubry, M.D., F.A.C.O.G. American College of Obstetricians and Gynecologists Betty Ann Countryman, R.N:, MN. La Leche League International Judith A. Flanagan, C.N.M., M.S. American College of Nurse-Midwives Fred Holmes, M.D., F.A.A.P. American Academy of Pediatrics iv Mary Hughes, Ph.D. March of Dimes Birth Defects Foundation Jennifer R. Niebyl, M.D., F.A.C.O.G. American College of Obstetricians and Gynecologists Julie Norris, R.N. American Hospital Association Judy Perkin, Dr.P.H., R.D. The American Dietetic Association Nancy Whitley, C.N.M. Nurses Association of the American College of Obstetricians and Gynecologists Federal Representatives Joyce 0. Arango, M.P.H., R.D. U.S. Department of Agriculture Thor&n A. Fjellstedt, Ph.D. National Institutes of Health Vince L. Hutchins, M.D., M.P.H., F.A.A.P. Health Resources and Services Administration Patricia Keamey, R.D,, M.S. The White House Michael McGinnis, M.D. Office of the Assistant Secretary for Health Univemity of Rochester Representatives Bernard B. Keele, Jr., Ph.D. Office of Public Affairs Paul Lamb&e Continuing Professional Education Milton B. Lederman, Ph.D. Office of Public Affairs V WORKSHOP PROGRAM June l&19%4 MO am. - 12:oo noon Presiding Welcome Introduction of the Surgeon General 8:x) a.m. Keynote Address 850 km. Humin Lactation as a physiologic Pmcess 93 a.m. the Unique Values of Human Mi 940 a.m. Bra&feeding Patterns in the United StZ%tCS $55 am. opening menery session The Strong Auditorium University of Rochester Elizabeth Brannon, MS.. RD. Nutrition Specialist Division of hlatemal and Child Health United States Department of Health and Human Services Robert Sproull, Ph.D. P&dent University of Rochester Frank Young, M.D., PkD. Vii President for Health Affairs Dean, School of Medicine and Dentistry University of Rochester Ruth A. Lawrence, M.D. ASSO&XC Professor, Departments of Pediatrics and Gbstetrics and Gynecology University of Rochester Henry A. T&de, M.D. Chairmen, Deprtment of Gbstetrics and Gynecology University of Rochester Michael h&Gin& M.D. Deputy Assistant Secretary for Health Disease Prevention and Health Promotion United Statr, Department of Health and Human Services C. Everett Koop, M.D., Sc.D. Surgean Genertd Ruth A. Lawrence, M.D. Cutbcrto Garza M.D., Ph.D. -iate Director, USDA Children's Nutrition Research zent of Pediitrics Baylor College of Medicine Gilbert Martinez, M.B.A. Director of Marketing Research Ross~Labomtorics Nutrition Break vi 955 a.m. IO:25 a.m. The Cultural Context of Breastfeeding in the United States Nutrition Break 1050 a.m. Successful Approaches to Promote Breastfeeding State-wide Approach City-wide Approach Hospital-based Approach 1 I A0 a.m. Guidelines for Work Groups 12:15 p.m. - 1:45 p.m, Audiovisual Presentation "Outside My Mom" `I& Lay Volunteer in the Mother-to-Mother Program of La Leche League 23Xl p.m. - 430 p.m. Susan Scrimshaw, Ph.D. Asaociite Professor of Public Health Divlalon of Population, Family and International Health University of Caliiomip. Los Angeles Henry A. Thiede, M.D., Moderator Jerianne Heimendinger, D.Sc., M.P.H. Director of Nutrition Services Rhode Island Department of Health Linda Randolph, M.D., M.P.H. Director, Oftke of Public Health New York State Department of Health John E. Alden, M.S., C.N.M. Indian Health Service Poplar, Montana Audrey Naylor, M.D., Dr.P.H. Co-Director, San Diego Lactation Program Mercy Hospital and Medical Center Martin Nacman. D.S.W. Director, Social Work Divison, Strong Memorial Hospital Professor, Department of Health Services University of Rochester Luncheon Bridge Lounge and May Room Wilson Commons Vince L. Hutchins, M.D.. M.P.H. Director, Division of Maternal and Child Health United States Department 4 Health and Human Services Rabbi Judea B. Miller Temple B'rith Kodesh March of Dimes Birth Defects Foundation Viola Lumon Founding Member, La Leche League International Work Groups Medical Education Building vii 7:oO p.m. Master of Ceremonies Invocation Speaker Breastfeeding: New York State's Infant Health Strategy June 12, lwlrl 7~45 a.m. 8:30 a.m. - It:45 a.m. 12:oO noon - 1:45 p.m, Invocation Speaker Breastfeeding and the Medii 2:W p.m. - 4~00 p.m, Presiding Reports from Work Groups 3a4lO p.m. 3:15 p.m. Summary of Recommendations and Presentation to the Surgmn General Response of the Surgeon General Closing Remarks Reception and Dinner Memorial Art Gallery and Cutler Union Prince Street Campus Richard Collins, M.D. Avon, New York Charles T. Lavery. C.S.B. Chancellor, St. John Fisher College David Axelrod, M.D. Commissioner, New York State Department of Health Continental Breakfast Medical Education Wing Work Groups Luncheon Helen Wood Hall Robert E. Hoekelman, M.D. Chairman, Department of Pediatrics University of Rochester Chaplain Thomas Herb& M.Div., M.Ed. Strong Memorial Hospital Robert Bazell NBC Network Closing Plenary Session First Floor Auditorium Medical Education Wing Vince L. Hutchins, M.D., M.P.H. Open Discussion Ruth A. Lawrence, M.D. C. Everett Koop, M.D., Sc.D. Frank Young, M.D., Ph.D. . . . Vlll CONTENTS INTRODUCTION .................................................................................. SURGEON GENERALS KEYNOTE ADDRESS.. ........................ EXCERPTS FROM PRESENTATIONS Human Lactation as a Physiologic Process.. ............................. The Unique Values of Human Milk ........................................... Trends in Breastfeeding in the United States ............................ The Cultural Context of Breastfeeding in the United States .... Successful Approaches to Promote Breastfeeding State-wide Approach ........................................................ City-wide Approach ......................................................... Rural-community Approach ............................................ Hospital-based Approach ................................................. Breastfeeding: New York State's Infant Health Strategy ......... The Lay Volunteer in the Mother-to-Mother Program of La Leche League ................................................................. Breastfeeding and the Media ................................. ..+ .................. Reflection on Breastfeeding ........................................................ WORK GROUP RECOMMENDATIONS ........................................ SUMMARY OF WORKSHOP RECOMMENDATIONS.. .............. RESPONSE OF THE SURGEON GENERAL ................................ CLOSING REMARKS .......................................................................... APPENDICES A-Participants.. ........................................................................... B-Facilitators and Recorders .................................................... C-Key Elements for Promotion of Breastfeeding in the Continuum of Maternal and Infant Health Care.. .......... D-Selected Readings ................................................................. 1 3 9 14 18 23 30 36 39 41 52 55 58 61 63 75 77 81 82 89 90 92 ix 447-700 0 - 84 - 2 1 Doctor Beverly Winikoff feeds her daughter, Lindsay.