The researchers found that about 90% of hospitals report providing prenatal breastfeeding education teaching breastfeeding techniques, but fewer than half follow the other recommendations in the Ten Steps to Successful Breastfeeding, the list of required policies and actions for being a Baby-Friendly hospital or birth center. Only about 3.5% of hospitals have implemented at least 9 of the 10 practices, which are thought to increase breastfeeding rates by supporting mothers.

Among the least-followed of the ten steps were having a model breastfeeding policy (14.4% did so); limiting use of formula, water, or glucose supplements for healthy, full-term breastfed infants (21.5%); and providing adequate breastfeeding support to breastfeeding mothers at hospital discharge (26.8%).

For more information, see the CDC’s press release, Vital Signs report, more detail on the survey results in the MMWR publication, and advice for what state and local governments, hospitals, doctors and nurses, and mothers and their families can do to encourage hospital support of breastfeeding.

• well-woman visits
• screening for gestational diabetes
• HPV testing
• STI counseling
• HIV screening and counseling
• contraception methods and counseling
• breastfeeding support, supplies, and counseling
• screening and counseling for domestic and interpersonal violence

Coverage for these services is expected to begin Aug. 1, 2012.

There is one caveat for some women regarding access to contraception without a co-pay — a provision that “Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.”

An announcement at the HealthCare.gov site indicates that public comment is welcome on this provision. Although I haven’t yet been able to locate it on Regulations.gov, instructions for comment and more detail about the exemption is provided in this document.

It was not clear, however, whether birth control would be included as a preventive service. It seems obvious to us, but the Institute of Medicine was asked to make some recommendations about which preventive services for women should be included, and included birth control in those recommendations, released yesterday.

If they are adopted, preventive services including birth control could become much more affordable and accessible to women in the United States.

The Institute, after reviewing the rate and consequences of unintended pregnancy, effectiveness of birth control, and cost and access concerns, concluded:

The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

In addition to copay-free coverage of birth control, the Institute recommended:

• screening for gestational diabetes
• human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
• counseling on sexually transmitted infections
• counseling and screening for HIV
• lactation counseling and equipment to promote breast-feeding
• screening and counseling to detect and prevent interpersonal and domestic violence
• yearly well-woman preventive care visits to obtain recommended preventive services

You can view the Institute’s press release, recommendations, report brief, and full report, “Clinical Preventive Services for Women: Closing the Gap,” online. The Department of Health and Human Services will still need to adopt this list of recommendations for the care to be covered under the Affordable Care Act.

Some other coverage and discussion of this topic:

• NLIRH Applauds Panel’s Counsel to Cover Birth Control Under Health Reform – from the National Latina Institute for Reproductive Health
• Anti-Choicers Gear Up To Fight Guidelines on Preventive Care for Women – Jodi Jacobson at RHRealityCheck discusses the inevitable anti-choice backlash
• A Preventive Health Care Game-Changer for Women – at the Ms. Blog
• Statement from the March of Dimes commending the recommednations
• Doctors to HHS: Adopt Contraception Recommendations, Improve Women’s Health, Save Money – Press release from Physicians for Reproductive Choice and Health<
• Women’s Preventive Health Coverage Information Central – lots of news and resources on this topic from Raising Women’s Voices
• Women Should Get Free Birth Control, HHS-Backed Group Urges – at The Rundown, a PBS NewsHour blog

Seen other good links on this news? Leave ‘em in the comments!

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Yo no suelo tener la revista “Wired” en mente cuando busco interesantes historias de salud femenina; simplemente me encontré con su reciente artículo virtual sobre la leche materna humana.

En Oro Liquido: El Mercado Floreciente para la Leche Materna Humana (Liquid Gold: The Booming Market for Human Breast Milk), la autora Judy Dutton explora cómo y por qué las mujeres van a las páginas de la internet para comprar, vender y donar leche materna a otras mujeres (y algunos hombres), e investiga las preocupaciones de seguridad y los beneficios de la leche materna.  Ella también examina si se debe permitir que las personas vendan leche materna directamente a otros individuos sin el uso de un banco de leche materna.

Según el artículo, aparentemente la leche materna es considerada comida en los Estados Unidos y no es regulada como lo son los tejidos y la sangre; la compra y venta de la leche materna es aparentemente legal en la mayoría de estados.

Dutto explica algunas razones por la cual las mujeres podrían querer usar la internet para este fin.  Algunas mujeres prefieren donar leche directamente a otra mujer en lugar de que esta sea revendida por un banco de leche.  Otras razones incluyen la posibilidad de solventar dificultades financieras por la venta de leche sobrante, los chequeos y las restricciones propios de una donación a bancos, los altos costos asociados a la compra de leche a un banco de leche, la falta de cobertura de seguro para obtener leche donada, y el actualizado atractivo, en el siglo 21, de esta antigua practica de dar de lactar a los bebes de otras mujeres.

¿Qué piensa usted? ¿Deben los individuos poder comprar y vender leche materna? ¿Cómo se siente en cuanto a los riesgos de contaminación y la falta de control en las ventas o donaciones personales? ¿Es esto algo que usted consideraría hacer? ¡Háganoslo saber en los comentarios!

In Liquid Gold: The Booming Market for Human Breast Milk, author Judy Dutton explores how and why women come to online sites to buy, sell and donate breast milk to other women (and a few men) as well as safety concerns and the benefits of breast milk. She also examines the question of whether individuals should be allowed to sell breast milk directly to other individuals, without going through a breast milk bank.

According to the piece, breast milk is apparently considered a food in the U.S. and so is not as regulated as tissues and blood are; buying and selling breast milk is apparently legal in most states.

Dutton explains a few reasons why women might want to go online for this need. Some women prefer to donate milk directly to another woman rather than have it be resold by a milk bank. Other reasons include the ability to alleviate financial difficulties by selling extra milk, screening and restrictions involved in donating to banks, the high costs associated with purchasing milk through a milk bank, lack of insurance coverage for obtaining donor milk, and the appeal of this simple 21st century update of the age old practice of women feeding each other’s babies.

What do you think? Should individuals be able to buy and sell breast milk? How do you feel about the risk of contamination and the lack of screening in person-to-person sales or donations? Is this something you would consider? Let us know in the comments!

The American Academy of Pediatrics had previously requested that the IRS rule that these supplies be added to the list of qualifying FSA items, but received a denial stating that breastfeeding did not constitute medical care. The new ruling does not decide that breastfeeding is medical care of an infant, but rules that the supplies are medical because “they are for the purpose of affecting a structure or function of the body of the lactating woman.” The AAP has applauded the change as “an important victory for the health of women and children across the country by making breastfeeding a more practical option for new and working mothers.”

In other news, the Associated Press has covered the issue of access to nitrous oxide for women in labor. The piece explains that some institutions (including my own) are currently working to make nitrous oxide an option; it’s commonly available to laboring women in some other countries. The item notes at the end that “the federal Agency for Healthcare Research and Quality is reviewing the effectiveness and safety of nitrous oxide compared to other pain relief methods” – I’m on the team for this project at work, so we’ll be sure to let you know as soon as that report is available.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La semana pasada la Dra. Regina M. Benjamín, Cirujana General de los Estados Unidos, expidió “Llamado a la acción en apoyo a la lactancia materna de la cirujana general” (The Surgeon General’s Call to Action to Support Breastfeeding). El informe describe los obstáculos y las tasas de lactancia materna en los Estados Unidos y los beneficios de salud, los beneficios económicos, sicológicos y ambientales de la lactancia materna. El informe es un llamado de acción a toda persona para tomar medidas que faciliten las opciones disponibles a madres para amamantar a sus bebés.

En lugar de únicamente invitar a las mujeres a amamantar a sus hijos(as), el informe hace un llamado a que los padres y las abuelas sean educados sobre la lactancia materna, a que se fortalezca el apoyo comunitario entre madres, a que las madres aborden cómo  está mercadeando la leche de fórmula, asegurar que guarderías que cuidan infantes apoyen la lactancia, que haya consultores(as) de lactancia accesible para madres y que se continúen haciendo estudios de investigación.

El continuo apoyo de madres en lugares de trabajo y en la comunidad es importante porque los factores por los cuales mujeres dejan de amamantar más temprano de lo que ellas quisieran se debe a factores externos tales como la falta de descansos para empleados durante horas laborables y la falta de instalaciones para extraer la leche materna en los lugares de trabajo. Al presente tres cuartas partes de las mujeres estadounidenses que intentan continuar lactando pero menos de la mitad, han continuado amamantando por un mínimo de seis meses. La Dra. Benjamín indicó lo siguiente:

Existen muchas barreras para madres que quisieran lactar por lo que estas madres no deberían confrontar estos desafíos a solas. Así usted sea un/a médico/a, un miembro de familia, amigo/a, o empleado/a, uno puede colaborar en ayudar a las madres que desean dar de pecho a sus bebés.

En la medida en que nos mantenemos vigilantes con respecto al retroceso de provisiones para la reforma de salud, hemos de mantener los ojos abiertos con respecto a la lactancia materna ya que la legislación aprobada el año pasado incluyó para enmendar la Ley de Normas Razonables de Trabajo (Fair Labor Standards Act)  para asegurar que los empleadores provean descansos razonables para madres lactantes y en áreas privadas que no sean los baños.

A notice in the December 21, 2010 Federal Register indicates that employers have asked for further guidance on this measure, and asks for public comment on aspects such as what is “reasonable” break time. The National Partnership for Women and Families translates the key questions for public comment into the following terms, less technical than wading through the Federal Register document.

1. Have you ever had to use a room connected to a bathroom to pump breast milk at work? Was it completely closed off or private? Was it a good or bad environment — and why?

2. Have you ever had to pump breast milk in a room normally used for something else — like a locker room, storage room or closet, or a manager’s office? Was it a good or bad environment — and why?

3. Have you ever had to pump breast milk in a shared space — one shared by other employees or employees from other nearby employers, like in a shopping mall or airport? What provisions for privacy worked or didn’t work?

4. Have you tried to keep breastfeeding/pumping in a job that requires you to be on the move—like driving a vehicle, visiting clients off-site, or patrolling a neighborhood? How did you make this work and how did your employer help (or fail to) support you?

The organization also provides a way to submit comments directly through their website. You may also submit your comments individually by going directly through Regulations.gov, where the link to a PDF of the Federal Register document detailing questions and issues related to the provision is available for download.

Comments are due by February 22, 2011.

Rather than simply exhorting women to breastfeed, the report calls for educating fathers and grandmothers about breastfeeding; strengthening of community-based mother-to-mother and peer support; addressing the way infant formula is marketed; ensuring that maternity care providers and systems are supportive of breastfeeding and lactation consultants are accessible; improving maternity leave and workplace support for lactating mothers; and conducting further research.

The inclusion of workplace and community supports is important, because the factors that lead many women not to breastfeed or to stop breastfeeding earlier than they would like are often external ones, such as a lack of sufficient breaks and facilities for pumping milk in the workplace. Three quarters of U.S. women currently attempt breastfeeding, but fewer than half have kept it up by six months. As Dr. Benjamin stated for the press release:

Many barriers exist for mothers who want to breastfeed. They shouldn’t have to go it alone. Whether you’re a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed.

As we keep watch on efforts to roll back provisions of health care reform, this is yet another issue to keep an eye on, as the legislation passed last year included a provision to amend the Fair Labor Standards Act to ensure that employers provide reasonable break time for nursing mothers in a private place other than a bathroom.

Additional resources for mothers and employers are provided at http://www.surgeongeneral.gov/topics/breastfeeding/index.html.

However, rates of breastfeeding at other time points remain lower than the HP2010 objectives and have been stagnant for the past three years.  The target rates are 50% at 6 months (currently 43%), 25% at 12 months (now 22.4%), 40% exclusively breastfed through 3 months (now 33.0%), and 17% exclusively breastfed at 6 months (now 13.3%).

Rates vary widely by state – for example, the percent of women who initiated breastfeeding was >80% in several Western states (California, Utah, and Washington, for example), but only 52.5% in Mississippi.

A CDC press release on the report emphasizes the role of hospitals in increasing the rate, with a CDC representative stating that, “High initiation rates tell us that a lot of moms plan to breastfeed, but these rates do not indicate that a birth facility is doing what it needs to support them in their effort.”

The release also notes that <4% of U.S. births occur at facilities designated as Baby-Friendly, a designation indicating that the facility takes steps to encourage breastfeeding initiation. Another CDC rep notes the importance of support in workplaces and communities; see these previous posts for our past discussions related to workplace and economic pressures and breastfeeding.