Breastfeeding for Two Years?

Have you read the June 2022 AAP policy about breastfeeding? It made some headlines. The issue was the AAP recommendation that babies receive breast milk for two years. Two years? Is this putting pressure on mothers/women to do more?

The current policy statement titled “Breastfeeding and the Use of Human Milk” promotes breastfeeding, pumping and providing donor human milk. Research continues to confirm the benefits of micronutrients for the gut microbiome, brain and body growth. It is beneficial for preterm, full term, medically fragile babies and for toddlers. That is not in dispute.

Providing human breast milk influences long term health. The longer a child receives breast milk, the longer the benefits last. That is why the AAP recommends providing breast milk for six months, even two years (“as is mutually comfortable for mother and child.” )

It’s the issue of two years. That’s a lot to recommend, or ask, if there is little support for lactation. When we recognize how important this is, the real question is:

How do we help families to start and continue to provide breast milk?

At all points in their care, families need accurate, consistent information. When giving birth, hospital policies may interfere with early breastfeeding. Back at home, follow up support is often difficult to receive. Returning to work presents more challenges. We need to enact proactive policies so families get what they need to start and continue.

More hospitals designated ‘Baby Friendly’ . These are hospitals that follow specific protocols, the Ten Steps to Baby Friendly. That begins with providing prenatal education, immediate skin-to-skin contact, rooming in,  informed support for breastfeeding at the hospital and resources within the community. A necessary approach to hopefully avoid gaps in care.

Paid Family Leave! That would make a significant difference to the whole family, not just for breastfeeding. Families need time to care and to adjust to changes (illness birth, adoption, etc. ) Currently, in Maine, there is only unpaid family leave, up to ten weeks. https://www.workingfamiliesme.org/

• Insurance coverage of IBCLC visits for all subscribers. Some private insurance will reimburse (Aetna covers IBCLC care). That is only some insurance and that is not Medicaid plans. That means low income families have less access to further IBCLC support. All families, high, medium and low income, need to have IBCLC care covered. And by coverage, that means no added cost for the family. Reimbursement means a family has to pay first then wait for reimbursement, another barrier to receiving care.

Workplace policies that require and provide clean, private pumping spaces and (unpaid) break time for pumping is another necessary policy change.  This is not a heavy lift for most companies. The current bill (S. 1658/H.R. 3110) makes employers responsibilities clear and fortifies the Break Time for Nursing Mothers law.

The question was, does this policy put the pressure on women and mothers? The pressure should be on our health care providers, legislators, insurance companies, administrators and employers. This AAP policy recommends that Pediatricians can play an important role in leading and advocating for the societal changes that permit continued exclusive and direct breastfeeding”  Each of us, in our varied roles, can promote better support families. As a start, check out the legislation for Paid Family Leave and the Pump Act.

Breastfeeding, providing human milk for human babies, is safe, nutritious, economical and sustainable. And with specific policy changes, it is more possible. That’s the issue worthy of headlines and more discussion.