A presentation with the following purposes: 1) describe the importance of breastfeeding from an individual health and public health perspective and 2) explore the reasons for a rapid rise in breastfeeding rates in the 1970's in order to inform future public health efforts.

1. THE RAPID RISE OF BREASTFEEDING IN
THE U.S. IN THE 1970’S: ANALYSIS OF A
TIPPING POINT IN PUBLIC HEALTH
Sonja Ray
December 1, 2010

2. BREAST MILK & HEALTH
Health Benefits of Breastfeeding (BF)
Baby Mom
Reduced Rate of: Reduced Rate of:
Acute otits media Postpartum depression
Gastroenteritis Type 2 diabetes
Atopic dermatitis Breast cancer
Severe lower respiratory infections Ovarian cancer
Necrotizing enterocolitis
Sudden infant death syndrome
Obesity
Type 1 and 2 diabetes
Asthma
Childhood leukemia
Note: Adapted from Ip, Chung, Raman, Chew, Magula, DeVine, Trikalinos, & Lau, 2007.
Bottle-fed infants are 14 times more likely to be hospitalized than breastfed
infants (Baumslag & Michels, 1995).

3. RECOMMENDATIONS
American Academy of Pediatrics (2005) recommends
exclusive breastfeeding for 6 months
Healthy People 2010, Goals (Objective 16-9)
75% will breastfeed at least once
50% will breastfeed at 6 months
25% will breastfeed at 12 months
40% will breastfeed exclusively through 3 months
17% will breastfeed exclusively through 6 months

4. BREASTFEEDING RATES
Current Breastfeeding Rates Fall Short of Goals
Actual Breastfeeding Rates in U.S.
Healthy People 2010 Goals
80
75 75
60
Problem
40 50
43 40
33
20 22.4 25
13.3 17
0
Ever BF BF at 6 mos BF at 12 mos Exlusively at 3 mos Exclusively at 6 mos
Source: Centers for Disease Control and Prevention National Immunization Survey, Provisional Data, 2007 births. http://www.cdc.gov/
breastfeeding/data/NIS_data/index.htm

5. EFFECT OF LOW BF ON PH
Low breastfeeding rates in the black community could
account for as much of the race difference between black
and white infant mortality as low birth weight (Forste,
Weiss, & Lippincott, 2001)
If 90% of U.S. families exclusively breastfed for 6 months,
the U.S. would save $13 billion in health care costs and 911
lives annually (Bartick & Reinhold, 2010)

6. BF RATES: THE EARLY YEARS
U.S. Breastfeeding Rates: 1931-1975
Long downward trend in
BF rates after WWII
Decline attributed to:
Woman’s movement
Increased number of
women in workforce
Changing roles of
women
Increased availability of
formula Adapted from: Hendershot, 1984

7. BF RATES: THE TIPPING
POINT
U.S. Breastfeeding Rates: 1965-1995
Between 1971 and 1981 BF Ross Mother’s Laboratory Survey (RMLS)
rates more than doubled
1971:
25% of infants BF in
hospital
8% BF at 3 months
1981:
58% of infants BF in
hospital
28% BF at 3 months Adapted from: Ryan, 1997

8. CONTEXT OF TIPPING POINT
1999 2010
Women allowed HHS Call to
to BF on action
Federal
2000 Employers
Percent Breastfeeding at 6 months property
HHS must provide
50 CDC starts Blueprint for break to
1990 tracking BF Action on express milk
Breastfeeding rates Breastfeeding
Promotion 2006
1984
37.5 Surgeon
Consortium 1st Nat’l BF
Formed Coalitions
General’s BF 2001 Conference
Workshop Healthy People USBC Strategic
1971 2000 BF goals Plan on BF
25 FDA publishes formed
1998
infant formula 1985 National BF Policy
standards First follow up Conference
report on Surgeon 1991
12.5 General’s workshop Second follow up US Breastfeeding
report on Committee
Surgeon General’s launched
workshop
0
1971 1976 1981 1986 1991 1996 2001 2006 2011
Adapted from Grummer-Strawn and Shealy, 2009

9. WHAT HAPPENED IN THE
SEVENTIES?
Were there fundamental changes in the demographics of the
women giving birth?
Did formula companies give up?
Did the government step up it’s public health efforts?
Did a non profit organization take up the mission of
breastfeeding promotion?

10. WHAT HAPPENED IN THE
SEVENTIES?
Second-wave feminism
Women encouraged to challenge medical power
(Rothman, 2008)
Science
Research began to define benefits of breast milk
Natural birth movement
De-medicalized birth
Lead to decrease in anesthesia use, allowing women to be
alert after giving birth (Pitcock & Clark, 1992; Starbird,
1991).

11. WHAT DOES IT MEAN?
Cultural beliefs (i.e. feelings about the underlying nature of
childbirth and womanhood) as well as knowledge were
integral to the adoption of breastfeeding practices in the
1970’s.
In the future, efforts focused entirely on developing
knowledge around breastfeeding will fall short of their goals
to improve breastfeeding rates.

12. QUESTIONS?
THANK YOU!

13. REFERENCES
American Academy of Pediatrics. 2005. Policy Statement: Breastfeeding and the use of human milk. Pediatrics,
115(2), 496-506. doi: 10.1542/peds.2004-2491
Bartick, M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: A pediatric
cost analysis. Pediatrics, 125(5), e1048-e1056. doi:10.1542/peds.2009-1616
Baumslag, N., & Michels, D.L. (1995). Milk, money, and madness: The culture and politics of breastfeeding.
Westport, CT: Bergin & Garvey.
Centers for Disease Control. (2010). Breastfeeding report card: United States, 2010.
Forste, R., Weiss, J., & Lippincott, E. (2001). The decision to breastfeed in the United States: Does race
matter? Pediatrics, 108(2), 291-296.
Grummer-Strawn, L.M., & Shealy, K.R. (2009). Progress in protecting, promoting, and supporting
breastfeeding: 1984-2009. Breastfeeding Medicine, 4, S31-S39. doi: 10.1089=bfm.2009.0049
Hendershot, G. E. (1984). Trends in breast-feeding. Pediatrics, 74(4), 591-602.
Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed
countries. Evidence Report/Technology Assessment No. 153. AHRQ Publication No. 07-E007.
Rockville, Md.: Agency for Healthcare Research and Quality, 2007.
Pitcock, C. D., & Clark, R. B. (1992). From fanny to fernand: The development of consumerism in pain
control during the birth process. American Journal of Obstetrics and Gynecology, 167(3), 581-587.
Rothman, B. K. (2008). New breast milk in old bottles. International Breastfeeding Journal, 3, 9. doi:
10.1186/1746-4358-3-9
Ryan, A. S. (1997). The resurgence of breastfeeding in the United States. Pediatrics, 99(4), E12.
Starbird, E. H. (1991). Comparison of influences on breastfeeding initiation of firstborn children, 1960-69 vs
1970-79. Social Science & Medicine (1982), 33(5), 627-634.