Hello All -

I apologize for cramming so much in to one post, I hope it can be
followed...

Definitions of Exclusive Breastfeeding & Data Comparability

Valerie makes an excellent point that the definition of 'exclusive bf'
used in the NIS survey differ(ed) from that used by Ross.  In fact,
there is no agreement *anywhere* about what the definition of exclusive
bf is/should be, and in fact finding some kind of consensus is a major
project CDC, USBC, UNICEF, and others have been working on for quite
some time.  The disparities between varying definitions of exclusive bf
is are a monumental problem and task, and the importance of this issue
is not lost on the researchers involved.

As Marsha pointed out, the definition of exclusive bf used by Ross is
"no formula" which is how they are able to report rates of 11.0% of all
infants exclusively breastfeeding at 12 months.

When the bf items used in the NIS (National Immunization Survey) were
initially constructed, the collective opinion of a variety of experts in
breastfeeding surveillance was that water should be included in the
item.  Since that time, that particular item has been changed, and as of
the first quarter of 2004 the item will no longer include water, and
instead will be consistent with the WHO definition of exclusive bf.

HP 2010 Breastfeeding Data

When the bf goals for HP2010 were being developed, no national system
for collecting ongoing bf data existed beyond the Ross survey.
Inclusion in HP2010 required availability of an ongoing system for
national data collection.  At the time, the options were to a) have no
bf goals for HP2010, or b) include bf goals and work toward creation of
a non-proprietary data source to replace the proprietary one as soon as
it became available.  A decision was reached to go for option b.  That
decision bolstered support for inclusion of bf items in the NIS, which
as of 2003 replaced Ross as the source for bf data related to the HP2010
bf goals.  Further work is being done to add a goal for exclusive bf at
6 months.

Value of Breastmilk at Older Ages

Someone recently posted in response to the ill-informed opinion that
breastmilk was useless for a 3 year old that humans are suggested to
drink cow milk throughout the lifespan despite a lack of necessity of it
past infancy.  I would humbly suggest that this argument not be one's
first line of defense in response to claims of the uselessness of
breastmilk because that very argument refutes the value of breastmilk
past infancy as well.  Instead, it might be more effective to point out
that mammals are designed to consume mother's milk, and point to the
dichotomy of claiming value of such milk for a 3 month old but
simultaneous uselessness for a 3 year old.  It could also be stated
quite simply that milk is milk, and while mother's milk indeed changes
over time, any milk that is species-specific is superior to milk from
any other mammal (or plant?).

Hospital Discharge Packs that Support Breastfeeding

Someone recently posted speaking with a hospital representative for a
formula manufacturer that their "bf friendly" discharge pack would be
more appropriate if it contained a breast pump than 4 single serve
bottles of RTF formula.  I must disagree with this, that in fact *any*
pack coming from a formula manufacturer is inherently bf un-friendly,
and inclusion of a breast pump could be more detrimental than other
items.

One (unnamed) formula manufacturer distributed a "bf success" discharge
pack that contained a manual pump which was loosely modeled on 2
different and not very similar effective retail manual pumps.
Superficially the included pump looked fine, however if one tried to use
the pump one discovered that it was physically impossible to operate
that pump with less than three hands.  An ingenious marketing move to
include such a device in a bf discharge pack, it clearly showed a new,
tired, exasperated mother that a) if she wants to bf she needs a very
strange looking contraption to help her do it, b) everyone else can
figure this pump out except her so she must be too stupid to bf and also
a failure as a mother, c) she is going to have to abandon all modesty
yet again so soon after labor and birth and ask her husband or other
person in the household (if she's lucky enough to have such a person) to
help her operate the pump on her breasts, but d) don't worry, if it
doesn't work out, there's a bottle of formula to get you through the
night and it will all work out in the end.  This is a much more
comprehensive strategy than simply including RTF formula.

Katherine Shealy, MPH, IBCLC, RLC
Atlanta, GA  
(who recently had the RN at the peds office gasp in shock and horror
that her 2.5 yo was going to nurse through a shot, she then squealed
"OMG I can't believe he didn't BITE you when I did that!"  Needless to
say, said 2.5 yo didn't even flinch or notice getting the shot, then
leapt down and pronounced "I'm SUPER tough!"  Clear evidence that the
value of breastmilk at older ages is well beyond simply nutritional.)


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