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Am Fam Physician. 2002;65(8):1522

to the editor: I appreciate the emphasis made on the importance of initiating breastfeeding as early as possible during the neonatal period. The article “Initial Management of Breastfeeding”1 by Dr. Sinusas and Ms. Gagliardi addressed important issues regarding this topic. However, I think more emphasis should be made on various methods of prenatal interventions to increase breastfeeding rates and issues surrounding possible social and cultural barriers to initiating breastfeeding.

Results of studies2 show that women in the United States encounter a variety of barriers to breastfeeding, including lack of social support, inadequate prenatal education, and the media's portrayal of formula feeding as the norm. It is important to address these common barriers as early as possible in the prenatal period because this might positively affect a woman's decision to breastfeed.

The long-term success of breastfeeding is based on active initial postnatal interventions and active, multifaceted prenatal interventions that are started early in the prenatal period. This intervention should include ongoing one-on-one counseling by health care providers, written materials, videos on breastfeeding techniques, and support groups. These early prenatal and postnatal interventions are essential to the success of long-term breastfeeding.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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