Annals of Family Medicine Publishes New U.S. Preventive Services Task Force Recommendations to Promote Breastfeeding

Contact:
Angela Lower
Annals of Family Medicine
(800) 274-2237 ext. 5224 or (913) 906-6253
alower@aafp.org

LEAWOOD, Kan. - The U.S. Preventive Services Task Force (USPSTF) today released new recommendations for measures primary care providers can take to support and encourage breastfeeding.  The new recommendations and the systematic evidence-based review on which the USPSTF statement is based are published in the July/August 2003 issue of Annals of Family Medicine.

The newly published USPSTF guidelines recommend structured breastfeeding education and behavioral counseling programs to improve breastfeeding.  In its review, the USPSTF found evidence that intervention programs combining educational classes with behaviorally oriented counseling are associated with increased rates of breastfeeding initiation and its continuation for up to three months.  The USPSTF also found evidence that providing ongoing support for patients, through in-person visits or telephone contacts with providers or counselors, increased the proportion of women continuing to breastfeed for up to six months.

The USPSTF found insufficient evidence to recommend for or against the following interventions to promote breastfeeding: brief education and prevention counseling by primary care providers during routine office visits, peer counseling when used alone, and written materials.

An overwhelming body of evidence suggests that breast milk provides the most complete form of nutrition for infants and offers a range of benefits for both infant and maternal health.  Despite this strong evidence, current U.S. breastfeeding rates, particularly among certain vulnerable populations, including low-income and minority populations, fall short of national goals. 

National data from 2001 indicate that 58 percent of low-income mothers and 53 percent of African-American mothers initiate breastfeeding. By six months only 21 percent of low-income and 22 percent of African-American mothers continued breastfeeding. These rates compare with overall rates of 69.5 percent of new mothers who initiated breastfeeding and 32.5 percent who were still breastfeeding at six months.

Recognizing the health benefits of breastfeeding, the Department of Health and Human Services' Healthy People 2010 initiative set a goal of having 75 percent of mothers breastfeeding immediately after having a baby, 50 percent at six months and 25 percent at one year. 

"We hope that these recommendations will help women and their clinicians understand which kinds of programs are most helpful, and will help ensure they become more widely available for pregnant women," said Task Force Chair, Alfred O. Berg, M.D., M.P.H., who is also Chair of the Department of Family Medicine at the University of Washington in Seattle. "In addition, there is a need for further studies about how clinicians and peer counselors can play a more significant role in encouraging women to breastfeed."

While the programs reviewed by the Task Force did not all take place in primary care clinics, the Task Force highlighted the important role primary care clinicians, such as family physicians, obstetricians and nurses in referring pregnant women to breastfeeding programs to ensure they begin and continue to breastfeed.

Also included in the July/August issue of Annals is the systematic evidence-based review by Jeanne-Marie Guise, M.D., M.P.H., and colleagues on which the USPSTF statement is based. The review, which analyzed the results of 35 related studies conducted between 1966 and 2001, found that educational programs, inclusive of individual instruction sessions or group classes with structured content, had the greatest positive effect of any single intervention on both initiation and short-term duration of breastfeeding.

"Our findings challenge hospitals and practices to make breastfeeding classes more accessible to patients," Guise said.  "To improve breastfeeding rates, we must first begin by identifying and removing any existing barriers that might prevent mothers from receiving breastfeeding education and support services."

In their review, Guise and colleagues also found that support programs, conducted in person or over the telephone by lactation consultants, nurses or peer counselors, significantly increased short- and long-term breastfeeding duration. 

In contrast, the researchers found that written materials, including informational pamphlets and booklets, were not effective in increasing initiation or duration of breastfeeding.  The use of commercial discharge packets, which often contain samples and coupons for formula, was shown to significantly reduce exclusive breastfeeding.

The recommendations and review can be accessed on the Annals of Family Medicine Web site at www.annfammed.org.  Access to these and other articles contained in the journal is free of charge.

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Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline.  Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians (AAFP), the American Board of Family Practice (ABFP), the Society of Teachers of Family Medicine (STFM), the Association of Departments of Family Medicine (ADFM), the Association of Family Practice Residency Directors (AFPRD) and the North American Primary Care Research Group (NAPCRG).  The journal is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials.  A board of directors with representatives from each of the sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups can be accessed free of charge on the journal's Web site, www.annfammed.org.