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Adolescent mothers not receiving recommended breastfeeding support

Despite the U.S. Surgeon General’s recommendation that providers align their maternity care with the Baby-Friendly Hospital Initiative, including the Ten Steps to Successful Breastfeeding, new data suggest that from 2009 through 2011, self-reported prevalence of adolescent mothers receiving such guidance varied widely.

CDC researchers reported in Morbidity and Mortality Weekly Report that the American Academy of Pediatrics recommends infants be breastfed exclusively for the first 6 months of life; however, only 19.3% of U.S. mothers aged 20 years and younger in 2011 were exclusively breastfeeding their child at 3 months.

“Given the substantial health advantages conferred to mothers and children through breastfeeding, and the particular vulnerability of adolescent mothers to lower breastfeeding rates, it is important for hospitals to provide evidence-based maternity practices related to breastfeeding as part of their routine care to all mothers, including adolescent mothers,” Oluwatosin Olaiya, MBChB, of the CDC’s Epidemic Intelligence Service and Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote.

To examine associations between Baby-Friendly Hospital Initiative (BFHI)-aligned maternity care and breastfeeding outcomes in mothers aged 12 to 19 years, the CDC researchers analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2009 through 2011. They focused on data representing mothers from New York City and the states of Alaska, Arkansas, Colorado, Maine, Minnesota, New Jersey, New York, Oregon, Texas and Vermont.

The researchers analyzed nine questions that assessed BFHI-aligned maternity practices: Eight corresponding to the Ten Steps to Successful Breastfeeding (Ten Steps), and one regarding the distribution of hospital gift packs containing formula, a practice that many health organizations recommend against. Of the nine BFHI-aligned practices, five were significantly associated with breastfeeding outcomes. The CDC estimated the prevalence of any and exclusive breastfeeding for ≥4 weeks and ≥8 weeks. The final sample size included 1,325 adolescent mothers aged 12 to 19 years.

According to the researchers, the prevalence of adolescent mothers experiencing BFHI-aligned maternity practices during delivery hospitalization varied greatly across the nine selected guidelines. Although 95.4% of adolescent mothers reported receiving information about breastfeeding, only 29.2% said they were not given a gift pack that contained formula. In addition, only four maternity practices — receiving information about breastfeeding, assistance with breastfeeding, the newborn staying in the same hospital room as the mother and phone support following hospital discharge — were experienced by more than 80% of the mothers. Only 7% reported experiencing all five of the practices significantly associated with breastfeeding outcomes — breastfeeding in the first hour after delivery, feeding the infant only breast milk at the hospital, hospital staff encouragement to breastfeed on demand, not using a pacifier in the hospital and not receiving formula in a gift pack. In addition, 9.6% report not experiencing any of the five practices.

Among the adolescent mothers who initiated breastfeeding, 64.4% reported that they continued for 4 or more weeks, and 40.9% reported exclusively breastfeeding 4 or more weeks. The prevalence of any and exclusive breastfeeding for 8 or more weeks was 44.6% and 30.9% respectively.

“This study demonstrates that adolescent mothers are not receiving care that is consistent with evidence-based guidelines,” Olaiya and colleagues wrote. “The Ten Steps are evidence-based maternity practices that support breastfeeding and that are meant to be delivered to mothers as a comprehensive package.” – by Jason Laday

Disclosure: The authors report no relevant financial disclosures.