Nancy E. Wight MD, FAAP, IBCLC

Once thought to be "no longer worth the bother"1, breastfeeding has been rediscovered by modern science as a means to save lives, reduce illness, and protect the environment. Policy makers are increasingly recognizing that breastfeeding promotion efforts can reduce healthcare costs and enhance maternal and infant well-being. Breastfeeding promotion and support has been recognized as a healthcare priority by the World Health Organization 2,3, the United States Department of Health and Human Services 4-7, the American Academy of Pediatrics 8,9, the American Dietetic Association 10, the American Public Health Association 11, the American College of Obstetricians and Gynecologists 8, the American Academy of Family Physicians and numerous other institutions and organizations concerned with preventive medicine and the healthcare of mothers and infants.

The current recommendation is that infants be exclusively breastfed for approximately the first six months of life and that breastfeeding be continued, complemented by appropriate introduction of other foods, well past the first year of life and as long as both mother and infant wish 9,12. The Healthy People 2000: National Health Promotion and Disease Prevention objectives call for an increase to at least 75% of the proportion of mothers who initiate breastfeeding and to increase to at least 50% the portion who continue to breastfeed until their infants are six months old 4. Breastfeeding promotion and support has now become a preventive medicine focus of the California Department of Health Services 13.

With the extensive research now available on the benefits of breastmilk and the risks of artificial milks, physicians need to be able to support their breastfeeding patients. Unfortunately most physicians currently in practice have had little to no education in breastfeeding physiology and clinical management. Well researched basic principles and guidelines exist, in addition to well educated lactation professionals and mother-to mother resources, to help the physician help his or her patients. Where are the resources we need to support our patients?

Why is Breastfeeding so Important for Infants?

Human milk is uniquely suited for human infants

  • Human milk is easy to digest and contains all the nutrients that babies need in the early months of life. 14,15
  • Human milk contains special enzymes to optimally digest and absorb the nutrients in the milk before infants are capable of producing these enzymes themselves. 16
  • Breastmilk contains multiple growth and maturation factors. 16-18
  • Factors in breastmilk protect infants from a wide variety of illnesses. 13,19,20
  • Breastmilk contains antibodies specific to illnesses encountered by each mother and baby. 16,21,22
  • Research suggests that fatty acids, unique to human milk, play a role in optimal infant brain and visual development. 23-25
  • In several large studies, children who had been breastfed had a small advantage over those who had been artificially fed when given a variety of cognitive and neurologic tests, including measures of IQ. 26-29

Breastfeeding saves lives

  • Lack of breastfeeding is a risk factor for sudden infant death syndrome (SIDS). 30-34
  • Human milk seems to protect the premature infants from life-threatening gastrointestinaldisease and other illnesses. 16,35-42

Breastfed infants are healthier

  • Infants who are exclusively breastfed for at least four months are half as likely as artificially fed infants to have ear infections in the first year of life. 43-47
  • Breastfeeding reduces the incidence and lessens the severity of bacterial infections such as meningitis, lower respiratory infections, bacteremia and urinary tract infections in infants. 45-58
  • Breastfeeding is protective against infant botulism. 59
  • Breastfeeding reduces the risk of "baby-bottle tooth decay" in infants. 60,61
  • Breastfed infants are less likely to have diarrhea. 45,47,62-71
  • Evidence suggests that exclusive breastfeeding for at least two months protects susceptible children from Type I insulin dependent diabetes mellitus (IDDM). 72-74
  • Breastfeeding may reduce the risk of subsequent inflammatory bowel disease and childhood lymphoma. 75-81
  • Breastfeeding confers some protection against allergy. 82-84
  • New research suggests that older children and adults who were breastfed as infants, arelikely to have less adult illnesses such as heart disease, stroke, hypertension and auto-immune diseases. 85
Why is Breastfeeding so Important to Mothers?

Breastfeeding helps mothers recover from childbirth

  • Breastfeeding helps the uterus to shrink to its pre-pregnancy state and reduces the amount of blood lost after delivery. 15,86,87
  • Breastfeeding mothers return to their prepregnant weight more rapidly than bottle-feeding mothers. 88,89
  • Breastfeeding mothers usually resume their menstrual cycles 20 to 30 weeks later than bottle-feeding women. 90

Breastfeeding keeps women healthier throughout their lives

  • Breastfeeding can be an important factor in child spacing among women who do not use contraceptives. 16,91,92
  • Breastfeeding reduces the risk of breast and ovarian cancer. 93-100
  • Women who breastfeed their infants are less likely to develop multiple sclerosis. 101
  • Breastfeeding may reduce the risk of osteoporosis. 102-108
  • During lactation, total cholesterol, LDL cholesterol, and triglyceride levels decline while the beneficial HDL level remains high. 109-112 Carbohydrate metabolism is also improved. 113,114
  • Breastfeeding promotes maternal confidence. 115-117

Why is Breastfeeding so Important for Society?

Breastfeeding is economical

  • The cost of artificial baby milk has increased 150% since the 1980's. 13
  • If no California infants were breastfed, the cost of artificial baby milk alone would exceed $400 million per year. 13,118
  • Breastfeeding reduces healthcare costs for infants with less gastrointestinal, respiratory and other infant illnesses and less hospital admissions. 119-126
  • Breastfeeding may reduce healthcare costs long-term via a healthier child, adolescent and adult population. 126
  • Employers benefit from breastfeeding via healthier infants and children and less parent absenteeism from work. 127,128

Breastfeeding is environmentally sound

  • Unlike artificial baby milk, breastfeeding requires no fossil fuels for its manufacture or preparation. 129,130
  • Breastfeeding reduces pollutants created as byproducts during the manufacture of plastics and artificial baby milk. 131,132
  • Breastfeeding reduces the burden on our landfills. 131,132
  • Breastfeeding represents the most efficient conversion of plant material into an ideal high-protein, high-energy food for infants. 133
  • Breastfeeding performs a critical global ecological function by averting nearly as many births as all other modern contraceptive methods combined. 134,135

Health costs to federal and state governments, and private healthcare systems because of not breastfeeding appear to run into billions of dollars. ( Estimates to date have been conservative as they usually include neither parent lost work time nor other costs that occur when children are ill). Given that breastfeeding is disease prevention in its purest form, it behooves healthcare providers, administrators and policy makers, under pressure to reduce medical costs, to promote and support breastfeeding. 136,137 If breastfeeding is to be accepted as the lifestyle choice for more women, our culture must support it. 138

Every mother has the right to decide how her infant will be fed. When asked, most breastfeeding women say they chose to breastfeed because of the health benefits for their babies. Yet, despite overwhelming evidence that breastfed babies are healthier, only 49% of new mothers are exclusively breastfeeding at one month after their baby's birth. If the healthcare dollar savings and health benefits of breastfeeding are to be realized, further education and support of our mothers, families, communities and health care professionals is imperative. Breastfeeding is not just a lifestyle choice, it is a health issue. Every baby has a right to the Best/Breast!

References

  1. Hill LF. "A Salute to La Leche League International". J Pediatr 1968; 73: 161-162
  2. Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. A Joint WHO/UNICEF Statement. World Health Organization, 1211 Geneva 227, Switzerland, 1989
  3. Innocenti Declaration: On the Protection, Promotion and Support of Breastfeeding. WHO/UNICEF, UNICEF Nutrition Cluster (H-8F), 3 United Nations Plaza, New York, NY 10017, 1990
  4. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. U.S. Department of Health and Human Services Publications No. (DHS) 91-50213, 1991
  5. Follow-Up Report: The Surgeon Generals' Workshop on Breastfeeding and Human Lactation. USDHHS Publication No. HRS-D-MG 85-2, 1985
  6. Spisak S, Gross SS. Second Follow-Up Report: The Surgeon Genrerals' Workshop on Breastfeeding and Human Lactation. NCEMCH, Washington, D.C., 1991
  7. Title II - Breastfeeding Promotion and Improvement of Other Childhood Nutrition Programs. Public Law 102-342, Sec 201, Sec 21, Aug 14, 1992
  8. American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). Guidelines for Perinatal Care, 4th Ed AAP, Elk Grove Village, IL, 1997
  9. Work Group on Breastfeeding, American Academy of Pediatrics, Breastfeeding and the Use of Human Milk. Pediatrics 1997; 100 (6): 1035-1039
  10. American Dietetic Association. Position of the American Dietetic Association: Promotion and Support of Breast-Feeding. J Am Diet Assoc 1993; 93 (4): 467-469
  11. American Public Health Association. Policy Statements: Breastfeeding. Am J Public Health 1983; 73: 347-358
  12. The World Health Organization's Infant Feeding Recommendation. Saadeh R et al. Breastfeeding: The technical basis and recommendations for action. Geneva, World Health Organization (document WHO/NUT/MCH/93.1)
  13. Breastfeeding Promotion Committee Report. Breastfeeding: Investing in California's Future. California Department of Health Services, Primary Care and Family Health, Sacramento, CA, Jan 1997
  14. Committee on Nutrition, American Academy of Pediatrics. Pediatric Nutrition Handbook. American Academy of Pediatrics, Elk Grove Village, IL, 1993
  15. Institute of Medicine. Nutrition during lactation. Washington D.C. National Academy Press; 1991
  16. Lawrence RA: Breastfeeding: A Guide for the Medical Profession, 4th Ed, CV Mosby Co, St. Louis, MO, 1994
  17. Grosnenov DE, Piccaino MF, Baumricker CR. Hormones and growth factors in milk. Endocr Rev. 1993; 14: 710-728
  18. Yellis MD. Human breast milk and facilitation of gastrointestinal development and maturation. Gastroenterology Nursing 1995; 18: 11-15
  19. Cunningham AS, Jellife DB, Jellife EEP. "Breastfeeding and Health in the 1980's" A Global Epidemiologic Review. J Pediatr 1991; 118 (5): 656-666
  20. Cunningham AS. Brestfeeding: Adaptive Behavior for Child health and Longevity, in Breastfeeding: Biocultural Perspectives. Stuart-Macadam P , Dettwyler KA, eds, Aldine de Gruyter, New York, NY, 1995
  21. Newman J. How Breast Milk Protects Newborns. Scientific American, December 1995: p76-79
  22. Fitzsimmons SP. Immunoglobulin A subclasses in infants' saliva and in saliva and milk from their mothers. J Pediatr 1994; 124: 566-573
  23. Nettleton JA. Are n-3 fatty acids essential nutrients for fetal and infant development? J Am Diet Assoc 1993; 93: 53-64
  24. Bjerve KS, Brubakk AM, et al. Omega-3 fatty acids: essential fatty acids with important biological effects, and serum phospholipid fatty acids as makers of dietary omega-3 fatty acid intake. Am J Clin Nutr 1993; 57: 8015-8055
  25. Uauy R , DeAndraca I. Human milk and breastfeeding for optimal mental development. J Nutr 1995; 125: 22785-22805
  26. Lucas A, Morley R, et al. Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992; 339: 261-264
  27. Morrow-Tlucak M, Haude RA, Ernhart CB. Breastfeeding and cognitive development in the first two years of life. Soc Sci Med 1988; 26: 635-639
  28. Rodgers B. Feeding in infancy and later ability and attainment: a longitudinal study. Dev Med Child Neurol 1978; 20: 421-426
  29. Lanting C, et al. Neurological differences between 9-year-old children fed breast milk and formula-milk as babies. Lancet 1994; 344: 1319-1322
  30. Watson E, Gardner A, Carpenter G. An epidemiological and sociological study of unexpected death in infancy in nine areas of Southern England. Med Sci Law 1981; 21: 78-88
  31. Carpenter RG, et al. Prevention of unexpected infant death: evaluation of the first seven years of the Sheffield Intervention Programme. Lancet 1983; 1: 725-727
  32. Murphy JF, Newcombe RJ, Sibert JR. The epidemiology of sudden infant death syndrome. J Epidemiol Comm Hlth 1982; 36: 17-21
  33. Ford RPK, et al. Breastfeeding and the risk of sudden infant death syndrome. Int J Epid 1993; 22: 885-890
  34. McKenna JJ, Bernshaw NJ. Breastfeeding and Infant-Parent Co-Sleeping as Adaptive Strategies: Are They Protective against SID? in Breastfeeding: Biocultural Perspectives, Stuart-Macadam P and Dettwyler KA, eds, Aldine de Gruyter, New York, NY 1995
  35. Grass SJ, Slagle TA. Feeding the low birth weight infant. Clin Perinatol 1993; 20: 193
  36. Murphy JF, Neale ML, Matthew N. Antimicrobial properties of preterm breast milk cells. Arch Dis Child 1983; 58: 198-200
  37. Goldman AS. Effects of prematurity on the immunologic system in human milk. J Pediatr 1982; 101: 901-905
  38. Bartlaw B, et al. An experimental study of acute neonatal enterocolitis - the importance of breast milk. J Pediatr Surg 1974; 9: 587-594
  39. Pitt J, Barlow B, Heird WC. Protection against experimental necrotizing enterocolitis by maternal Milk I. Role of milk leukocytes. Pediatr Res 1977; 11: 906-909
  40. Lucas A, Cole TJ. Breastmilk and neonatal necrotizing enterocolitis. Lancet 1990; 336: 1519-1523
  41. Bleuscher ES. Host defense mechanisms of human milk and their relations to enterio infections and necrotizing enterocolitis. Clin Perinatol 1994; 21: 247-262
  42. El-Mohandes AE, et al. Use of Human Milk in the Intensive Care Nursery Decreases the Incidence of Nosocomial Sepsis. J Perinatol 1997; 17 (2): 130-134
  43. Facione N. Otitis media: an overview of acute and chronic disease. Nurse Practitioner 1990; 15: 11-22
  44. Duncan B, et al. Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics 1993; 91: 867-872
  45. Dewey KG, Hinig MJ, Nommsen-Rivers LA. Differences in morbidity between breastfed and formula-fed infants. J Pediatr 1995; 126: 696-702
  46. Duffy LC, et al. Exclusive Breastfeeding Protects Against Bacterial Colonization and Day Care Exposure to Otitis Media. Pediatrics 1997; 100 (4): p. e7
  47. Scariati PD, Grummer-Strawn LM, Fein SB. A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States. Pediatrics 1997; 99 (6); p. e5
  48. Howie, et al. Protective effect of breastfeeding against infection. Br Med J 1990; 300: 11-16
  49. Forman MR, et al. The Pima infant feeding study: breastfeeding and respiratory infections during the first year of life. Int J of Epid 1984; 13: 447-453
  50. Wright AL, et al. Breastfeeding and lower respiratory tract illness in the first year of life. Br Med J 1989b; 299: 945-949
  51. Pullan CR, et al. Breastfeeding and respiratory syncytial virus infection. Br Med J 1980; 281: 1034-1036
  52. Cochi SL, et al. Primary invasive Hemophilus influenza type b disease: a population-based assessment of risk factors. J Pediatr 1986; 108: 887-896
  53. Istre GR, Conner JS, Broome CV. Risk factors fro primary invasive Haemophilus influnzae disease: increased risk from day care attendance and school-aged household members. J Pediatr 1985; 106: 190-195
  54. Andersson B, et al. Inhibition of attachment of Streptococcus pneumoniae and Haemophilus infuenzae by human milk and receptor oligosaccharides. J Infect Dis 1986; 153: 232-237
  55. Lum MD, Ward JL, Bender TR. Protective influence of breastfeeding on the risk of developing H. influenzae type b disease (Abstract No. 436). Pediatr Res 1982; 16: 151A
  56. Fallot Me, Boyd JL, Oski FA. Breastfeeding reduces incidence of hospital admissions for infection in infants. Pediatrics 1980; 65: 1121-1124
  57. Pisacane A, et al. Breastfeeding and urinary tract infection. J Pediatr 1992. 120: 87-89
  58. Marild S, Jodal U, Hanson LA. Breastfeeding and urinary tract infection (letter). Lancet 1990; 336: 942
  59. Arnon SS, et al. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982; 100: 568-573
  60. Tsubouchi J, et al. A study of baby bottle tooth decay and risk factors for 18-month old infants in rural Japan. Asdc J of Dentistry for Children 1994; 61: 293-298
  61. Degano MP, Degano RA. Breastfeeding and oral health. A primer for the dental practitioner. New York State Dental Journal 1993; 59: 30-32
  62. Huffman SL, Combest C. Role of breastfeeding in the prevention and treatment of diarrhea. Diar Dis Res 1990; 8: 68-81
  63. Popkin BM, et al. Breastfeeding and Diarrhea morbidity. Pediatrics 1990; 86: 874-882
  64. McFarlane PI, Miller V. Human milk in the management of protracted diarrhea of infancy. Arch Dis Child 1984; 59: 260-265
  65. Yolken RH, et al. Human milk mucin inhibits rotavirus replication and prevents experimental gastroenteritis. J Clin Invest 1992; 90: 1984-1991
  66. Walterspiel JN, et al. Secretory anti-Giardia lamblia antibodies in human milk: protective effect against diarrhea. Pediatrics 1994; 93: 28-31
  67. Morrow AL, et al. Protection against infections with Giardia lamblia by breastfeeding in a cohort of Mexican infants. J Pediatr 1992; 121: 363-370
  68. Clems JD. Breastfeeding as a determinant of severity in shigellosis. Evidence for protection throughout the first three years of life in Bangladeshi children. Am J Epidemiol 1986; 123: 710-720
  69. Ahmed F, et al. Community-based evaluation of the effect of breastfeeding on the risk of microbiologically confirmed or clinically presumptive Shigellosis in Bangladeshi children. Pediatrics 1992; 90: 406-411
  70. Brown KH, et al. Effects of common illnesses on infants= energy intakes from breast milk and other foods during longitudinal community-based studies in Huascar (Lima), Peru. Am J Clin Nutr 1990; 52: 1005-1013
  71. Hoyle B, Yunus M, Chen LC. Breastfeeding and food intake among children with acute diarrheal disease. Am J Clin Nutr 1980; 33: 2365-2371
  72. Virtanen SM, et al. Early introduction of dairy products associated with increased risk of IDDM in Finnish children. The childhood Diabetes in Finland Study Group. Diabetes 1993; 42: 1786-1790
  73. Gerstein HC. Cow's milk exposure and type I diabetes mellitus. Diabetes Care 1994; 17: 13-19
  74. Karjalainen J, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med 1992; 327: 302-307
  75. Rigas A, et al. Breastfeeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood. Am Epidemiol 1993; 3: 387-392
  76. Koletzko S, et al. Role of infant feeding practices in development of Crohn's disease in childhood. Br Med J 1989; 298: 1617-1618
  77. Acheson ED, Truelove SC. Early weaning in the aetiology of ulcerative colitis: a study of feeding the infancy in cases and controls. Br Med J 1991; 2: 929-933
  78. Whorwell PJ, et al. Bottle-feeding, early gastroenteritis, and inflammatory bowel disease. Br Med J 1979; 1: 382
  79. Davis MK, Savitz DA, Graubard BI. Infant feeding and childhood cancer. Lancet 1988; 365-368
  80. Mathur GP, et al. Breastfeeding and childhood cancer. Ind Pediatr 1993; 30: 651-657
  81. Shu XO, et al. Infant breastfeeding and the risk of childhood lymphoma and leukaemia. Int J Epidem 1995; 24: 27-32
  82. Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 1995; 346: 1065-1069
  83. Bahna SL. Breast milk and special formulas in prevention of milk allergy. In: Mestecky, J eds. Immunol Milk Neo New York: Plenum Press, 1991: 445-451
  84. Dramer MS. Does breastfeeding help protect against atopic disease? Biology, methodology, and a golden jubilee of controversy. J Pediatr 1988; 112: 181-190
  85. Lucas A. Role of nutritional programming in determining adult morbidity. Arch Dis Child 1994; 71 (4): 288-290
  86. Riordan J. Anatomy and Psychophysiology of Lactation in J Riordan and KG Auerback, eds. Breastfeeding and Human Lactation, Jones and Bartlett, Boston, MA 1993: 81-104
  87. Chue S, et al. Influence of breastfeeding and nipple stimulation on postpartum uterine activity. Br J Ob Gyn 1994; 1010: 804-805
  88. Ohlin A, Rossner S. Maternal body weight development after pregnancy. Int J Obes 1990; 15: 159-173
  89. Dewey KG, Heinig MJ, Nommsen LA. Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr 1993; 58: 162-166
  90. McNeilly AS, Tay CC, Glasier A. Physiological mechanisms underlying lactational amenorrhea. Ann NY Acad Sci 1994
  91. Kennedy KI, Rivera R, McNeilly AS. Consensus statement on the use of breastfeeding as a family planning method. Contraception 1989; 39: 477-496
  92. Short RV, et al. Contraceptive effects of extended lactational amenorrhea: beyond the Bellagio consensus. Lancet 1991; 337: 715
  93. Byers TS, et al. Lactation and breast cancer: evidence for a negative association in premenopausal women. Am J Epidemiol 1985; 121: 664-674
  94. McTiernan A, Thomas DB. Evidence for a protective effect of lactation on risk of breast cancer in young women: results from a case control study. Am J Epidemiol 1986; 124: 353-358
  95. Newcomb PA, et al. Lactation and a reduced risk of premenopausal breast cancer. New Eng J Med 1994; 330: 81-87
  96. Whittemore AS, Harris R, Itnyre J, Group COC. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Am J Epidemiol 1992; 136: 1184-1203
  97. John EM, et al. Characteristics relating to ovarian cancer risk: collaborative analysis of seven U.S. case-control studies. Epithelial ovarian cancer in black women. J National Cancer Institute 1993; 85: 142-147
  98. Rosenblatt KA, Thomas DB. Lactation and the risk of epithelial ovarian cancer. Int J Epid 1993; 22: 192-197
  99. Risch HA, et al. Events of reproductive life and the incidence of epithelial ovarian cancer. Am J Epidemiol 1983; 117:128-139
  100. Gwinn ML, et al. Pregnancy, breastfeeding and oral contraceptives and the risk of epithelial ovarian cancer. J Clin Epidemiol 1990; 43: 559-568
  101. Piscance A, et al. Breastfeeding and multiple sclerosis. BMJ 1994; 308: 1411-1412
  102. Aloia JF, et al. Determinants of bone mass in postmenopausal women. Arch Intern med 1983; 143: 1700-1704
  103. Feldblum PJ, et al. Lactation history and bone mineral density among perimenopausal women. Epidemiol 1992; 3: 527-531
  104. Stevenson JC, et al. Determinants of bone density in normal women: Risk factors for future osteoporosis? Br Med J 1989; 298: 924-928
  105. Hreshchyshyn MM, Hopkins a, Zylstra S, Anbar M. Associations of parity, Brestfeeding, and birth control pills with lumbar spine and femoral neck bone densities. Am J Obstet Gynecol 1988; 159: 318-322
  106. Kent GN, et al. Human Lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. J Bone Min Res 1990; 5: 361-369
  107. Blaauw R, et al. Risk factors for development of osteoporosis in a South African Population. SAMJ 1994; 84: 328-332
  108. Aloia, JF, et al. Risk factors for postmenopausal osteoporosis. Am J Med 1985; 78: 95-100
  109. Kallio MT, Simmes MA, Perheentupa J. Cholesterol and its precursors in human milk during prolonged exclusive breastfeeding. Am J Clin Nutr 1989; 50: 782-785
  110. Kallio MT, et al. Serum cholesterol and lipoprotein concentrations in mothers during and after prolonged exclusive lactation. Metabolism 1992; 41:1327-1330
  111. Knopp HR, Bergelin RO, Wahl PW. Population based lipoprotein lipid reference values for pregnant women compared to nonpregnant women classified by sex hormone usage. Am J Obstet Gynecol 1982; 143: 626-637
  112. Knopp HR, Bergelin RO, Wahl PW. Effects of pregnancy, postpartum lactation and oral contraceptives use on the lipoprotein cholesterol/triglyceride ratio. Metab 1985. 34: 893-899
  113. Kjos SL, et al. The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol 1993; 34: 893-899
  114. Lenz S, et al. Influence of lactation on oral glucose in the puerperium. Acta Endocrinologica 1981; 98: 428-431
  115. Weisenfeld AR, et al. Psychophysiological response of breast and bottle-feeding mothers to their infants' signals. Psychophysiology 1985; 22: 79
  116. Virden SE. The relationship between infant feeding method and maternal role adjustment. J Nurse Midwifery 1988; 33: 31-35
  117. Laufer AB. Breastfeeding. Toward resolution of the unsatisfying birth experience. J of Nurse-Midwifery 1990; 35: 42-45
  118. Jarosz LA, Breastfeeding versus formula: cost comparison. Hawaii Med J 1993; 52: 14-17
  119. Labbok MH. Breastfeeding as a women's issue: conclusions and consensus, complementary concerns, and next actions. International J of Gynecology and Obstetrics 1994; 47 (suppl): S55-S61
  120. Labbock, MH. Costs and Savings of Breastfeeding in the U.S. Presented at 1995 ILCA Conference, 7/14/95, Scottsdale, AZ
  121. Bhatnager, S, Jain NP, Tiwari VK. Cost of Infant Feeding in Exclusive and Partially Breastfed Infants. Indian Pediatrics 1996; 33: 655-658
  122. Montgomery DL, Splett PL. Economic benefit of breast-feeding infants enrolled in WIC. J Am Diet Assoc 1997; 97: 379-385
  123. Tuttle CR, Dewey KG. Potential cost savings for Medi-Cal, AFDC, Food Stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong Women in California. J Am Diet Assoc 1996; 96: 885-890
  124. Heiser B. Affordable Health Care Begins with Breastfeeding. La Leche League International Breastfeeding Abstracts Nov1994; 14(2): 11-12
  125. Ware JL, Hoey C. A Tale of Two Abstracts: Economic Advantages of Breastfeeding in an HMO Setting. ABM News and Views 1997; 3 (1): 3
  126. Riordan JM. The Cost of Not Breastfeeding: A Commentary. J Hum Lact 1997; 13 (2): 93-97
  127. Cohen R, Mrtek, MB. The impact of two corporate lactation programs on the incidence and duration of breastfeeding by employed mothers. Am J Hlth Prom 1994; 8: 436-441
  128. Cohen R, Mrtek, MB, Mrtek RG. Comparison of Maternal Absenteeism and Infant Illness Rates Among Breast-feeding and Formula-feeding Women in Two Corporations. Am J Hlth Prom 1995; 10 (2): 148-154
  129. Gilman R, Skillicorn P. Boiling of drinking-water: Can a fuel-scarce community afford it? Bull World Health Organ 1985; 63 (1): 157-163
  130. Eckholm E, et al. Fuelwood: The Energy Crisis That Won't Go Away. London: Earthscan 1984
  131. Radford A. The Ecological Impact of Breastfeeding. Baby Milk Action Coalition. XIII 10cu World Congress, Hong Kong, July 1991
  132.   Wellstart International. Breastfeeding and the Environment. Expanded Promotion of Breastfeeding Program, Wellstart International, San Diego, CA 6/26/97
  133. International Baby Food Action Network. Bottle feeding: a waste of money, a waste of natural resources, a waste of time? In: Fighting for Infant Survival, IBFAN Information Kit Malasia: IBFAN, 1989
  134. Berg A, Berms S. The Case for Promoting Breastfeeding in Projects to Limit Fertility 1990. World Bank Technical Paper No. 102. Washington, D.C. The World Bank
  135. Thapa S, Short RV, Potts M. Breastfeeding, birthspacing and their effects on child survival. Nature 1989; 335 (20): 679-683
  136. Fredrickson DD. Breastfeeding research priorities, opportunities, and study criteria: what we learn from the smoking trail [editorial]. J Hum Lact 1993; 9 (3): 124
  137. Committee on Child Health Financing, American Academy of Pediatrics. Scope of Health Care Benefits for Newborns, Infants, Children, Adolescents and Young Adults. Pediatr 1997; 100 (6): 1040-1041
  138. Baumslag N, Michels D. Milk, Money, and Madness: The Culture and Politics of Breastfeeding 1995. Bergin and Garvey, Westport, CT

Nancy E. Wight MD, FAAP, IBCLC
Attending Neonatologist
Medical Director, Lactation Services
SharpMary Birch Hospital for Women
San Diego, California

Oct 1997

Back to Breastfeeding Articles.

I Home I About Us I Contact Us I Education/Events I Newsletter I BF Resource Guide (English) I BF Resource Guide (Spanish) I
I Articles I Links I California Coalitions I Donor Human Milk I Advocacy/Legislation I Breastfeeding & Drugs I
I Statistics/Research I Search the Site I Fun Facts I FAQ's I Breastfeeding Promotion Phrases I

Created by Creative Impacts