Hi Jenna
I have interspersed my comments into your email



>According to the American Academy of Pediatrics, breastfeeding is
recommended for at least 6 months after birth but it ideally should last for
the first year of the infant's life or longer.< 

[NB] I think you have misread the AAP Section on Breastfeeding's position
statement.  It says, "Pediatricians and parents should be aware that
exclusive breastfeeding is sufficient to support optimal growth and
development for approximately the first 6 months of life and provides
continuing protection against diarrhea and respiratory tract infection.
Breastfeeding should be continued for at least the first year of life and
beyond for as long as mutually desired by mother and child."  

>Breastfeeding not only improves the growth, development, and health of the
infant but it also decreases the frequency of lower respiratory infections,
ear infections, diarrhea, and urinary tract infections while providing the
infant protection against other chronic diseases.<  

[NB] The AAP Policy Statement says "Exclusive breastfeeding is the reference
or normative model against which all alternative feeding methods must be
measured with regard to growth, health, development, and all other short-
and long-term outcomes."  This means that there are no benefits of
breastfeeding only risks associated with not breastfeeding. Breastfed
infants are physiologically normal.  Their health is normal. However infants
who are not breastfed are at increased risk of several acute and chronic
illnesses and tend to score lower on tests of visual acuity and cognitive
development.  This is a difficult concept.  Even the AAP is not consistent
and later in this document there are a number of references to the benefits
of breastfeeding.  I have attached an article that discussed this for you
but it will be stripped for the list.

>The mother benefits too.  She will experience less lochia, amenorrhea, and
faster return to prepregnancy weight along with long term health benefits
(Witters, 2003).  With all of these benefits for both the baby and mother,
one would think that breastfeeding rates would be stable at least through 6
months.< 

[NB] Have a look at Li and Colleagues latest article in Journal of the
American dietetic association 107(1). 25% of Americans believe that formula
'is as good as breastmilk'. And the authors suspect that this is
attributable to advertising messages that make this claim.  I also suspect
that many many people are told this by health professionals.
Also it is one thing to know that breastfeeding is important.  It is quite
another to be provided with enough accurate information and social support
to actually do it.  In a society where breastfeeding in public is frowned
upon, mothers are not provided with lactation breaks or statutory maternity
leave and health care providers are frequently provided with infant feeding
education by an industry with a commercial interest in undermining
breastfeeding, it is not at all suprising that so few women do it.  What is
surprising is that so many do.

	In one study 50% of the mothers breastfeeding stopped after 3 months
and 75% after 6 months (Kimbro, 2006).  I believe that part of this problem
is that women return to work, do not have adequate support, and do not have
enough information. 

[NB] Check the literature.  The most frequent reasons that mothers give for
weaning in the early weeks are 'insufficient milk' and 'chose not to'.
Working runs a distant third.

>I think that employers need to be accepting of the mother breastfeeding and
continue to encourage the mother to breastfeed once she has returned to work
especially those who work in service jobs, such as waitressing, because they
are the least likely to continue breastfeeding when they return to work
(Kimbro, 2006).  They can do this by providing paid breaks for the mother to
pump.  Family and friends also need to be supportive.  Some studies have
shown that mothers are more likely to continue breastfeeding if they have an
adequate support system, especially from their families (Witters, 2003).
[NB]Of course these things all help.  Have a look at Bailey et al in
Midwifery 2004 v20.  Women expect to fail at breastfeeding.  They believe
that the process is unreliable.  This is a self fulfilling prophecy that
leads quickly to 'perceived insufficient milk syndrome'.

  inally, I think that governmental programs such as WIC (women, infants, &
children) need to stress the importance of breastfeeding.
[NB] There are many people involved with WIC that are on this list and who
do encourage WIC mothres to breastfeed.  However, if I understand correctly
WIC is the largest purchaser of infant formula in the world.  This leads to
the understandable perception that WIC is where you get free formula - and
if the government is giving it out, it must be good for the baby,right?
Have a look at George Kent's article in International breastfeeding journal
on this.  
 
>One study showed that WIC clients do not initiate breastfeeding.  This
could be due to lack of education because of their socioeconomic status
(Ahluwalia, Morrow, & Hsia, 2005).<

[NB] or a lack of support, or an expectation of artificial feeding - because
that is all the mother has ever seen

>Breastfeeding would be beneficial for those of a lower socioeconomic
status.  It would not only save a lot of money but it could also decrease
any health problems the baby or the mom could have.<  

[NB] Again, breastfeeding is not beneficial.  It is physiological.
Artificial feeding is risky, detrimental to the health and well-being of
mothers and their infants, whatever their socio-economic status.

What have you found that encourages mothers to continue breastfeeding?  
Should employers be required to give paid breaks so breastfeeding mothers
can pump?

[NB] Of course, but this is only part of the picture.  What encourages
mothers to breastfeed is seeing other mothers breastfeed sucessfully and
being apprenticed by a woman who had BTDT.  (Referrals to LLLI or similar)
See Hoddinott P, Pill R. Qualitative study of decisions about infant feeding
among women in east end of London. BMJ 1999;318(7175):30-34.

Hope that helps
Nina Berry BA/Bed(Hons) Dip Arts(Phil)
Breastfeeding Counsellor
PhD Candidate - "Ethical Issues in the marketing of 'Toddler Milks'"

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