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  • August 31, 2016 12:27 PM | Deleted user

    The Inside Knowledge campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. Inside Knowledge encourages women to pay attention to their bodies, so they can recognize any warning signs and seek medical care.

    New television and radio public service announcements in English and Spanish feature actress Cote de Pablo, talking about her own cervical cancer scare, and sharing advice for other women. And check out the new posters telling Cote’s story, as well as our Behind-the-Scenes videos from filming!

    Inside Knowledge also has new TV and radio PSAs that highlight gynecologic cancer symptoms. The PSAs encourage women to learn the symptoms, and pay attention to what their bodies are telling them.


  • August 31, 2016 12:26 PM | Deleted user


     Woman with doctorLesser-known conditions and diseases affect the health or safety of millions of women or girls each year. Learn about some of them and what you can do.

    1. Asthma occurs more often in women than men. Older adults, women, and African Americans are more likely to die due to asthma.

    • Women with asthma should always try to avoid asthma triggers.
    • Known asthma triggers include pollen, mold and tobacco smoke.
    • Know your triggers and learn how to avoid them.
    • Work with your doctor to develop an asthma action plan that will help you take your medications correctly and avoid your asthma triggers.

    2. Heavy menstrual bleeding, lasting more than seven days or very heavy, affects more than 10 million American womeneach year. That is about one out of every five women.

    • A bleeding disorder may be the cause of heavy menstrual bleeding.
    • Talk to your doctor or nurse if you have heavy menstrual bleeding to determine if you need testing.
    • Learn about possible causes, including the signs and symptoms of a bleeding disorder.

    3. About 27 million women in the U.S. have a disability , a condition of the body or mind that makes it more difficult to do certain activities and interact with the world around them.

    • More than 50% of women older than 65 are living with a disability. The most common cause of disability for women isarthritis or rheumatism.
    • Women with disabilities need the same general health care as women without disabilities, and they may also need additional care to address their specific needs. However, research shows that many women with disabilities may not receive regular health screenings, like mammograms or a Pap test, as recommended.

    • Learn about tools and health resources for women with disabilities.

    4. Infertility affects about 6% of married women ages 15-44. Also, about 12% of women 15 - 44 years of age in the U.S. have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status.

    • Infertility is defined as not being able to get pregnant after one year of unprotected sex.
    • Several things increase a woman's risk of infertility, including age, smoking, excessive alcohol use, extreme weight gain or loss, or excessive physical or emotional stress that results in the absence of a menstrual period.
    • Infertility may be treated medically, surgically, or using assisted reproductive technology depending on the underlying cause.
    • Assisted Reproductive Technology, also known as ART, includes all fertility treatments in which both eggs and sperm are handled.
    • Learn more about what you can do to be healthy before, during, and after ART treatment. Resources are available for patients preparing for infertility treatment and pregnancy.

    5. Bacterial vaginosis (BV) is the most common vaginal infection in women ages 15-44.

    • BV is an infection caused when too much of certain bacteria change the normal balance of bacteria in the vagina. In the United States an estimated 21.2 million (29.2%) women ages 14–49 have BV.
    • The cause of BV is unknown. BV is linked to an imbalance of "good" and "harmful" bacteria that are normally found in a woman's vagina.
    • Basic prevention steps that may help to lower your risk of developing BV include not having sex, limiting the number of sex partners you have, and not douching.

    6. Sex Trafficking is a serious public health problem that affects the well-being of individuals, families, and communities. The majority of victims are women and girls.

    7. About 19 women die every day as a result of drug overdoses involving prescription opioids.

    • Women are more likely to have chronic pain, be prescribed opioid pain relievers, and use them for longer time periods than men.
    • Addiction to prescription opioids is the strongest risk factor for heroin addiction, and heroin use has increased among women.
    • Women should discuss all medications they are taking with their doctor and use prescriptions only as directed. Get help for substance abuse problems (1-800- 662-HELP); call Poison Help (1-800-222-1222) for questions about medicines, or see your pharmacist.


  • August 30, 2016 9:47 AM | Deleted user

    Soluble corn fiber (SCF) is a nondigestible carbohydrateused in foods and beverages such as cereals, baked goods, candy, dairy products, frozen foods, carbonated beverages, and flavored water.

    SCF helps create packaged food products that have lower sugar contents, while providing a valuable source of dietary fiber.

    Evidence suggests that SCF has many of the same health benefits associated with intact dietary fiber found in grains, vegetables, legumes, and fruit. SCF may improve intestinal regularity and has prebiotic properties. Moreover, SCF supports healthy blood glucose control and supports bone health by increasing calcium absorption.

    The daily recommended fiber intake for adults in the United States is 25 grams for women and 38 grams for men. However, most Americans consume around half of the recommended amount. Fiber-enriched foods help bridge the shortage of fiber in the diet without significantly increasing calorie content.

    In the new research, the team aimed to evaluate how the dose of SCF affected calcium absorption, bone properties, and gut microbiome in adolescent and postmenopausal women.

    "We are looking deeper in the gut to build healthy bone in girls and help older women retain strong bones during an age when they are susceptible to fractures," says Connie Weaver, distinguished professor and head of nutrition science.

    "Soluble corn fiber, a prebiotic, helps the body better utilize calcium during both adolescence and postmenopause. The gut microbiome is the new frontier in health," she adds.

    Tate & Lyle Ingredients America LLC funded the research, and they produce Promitor Dietary Fiber, which is a soluble prebiotic fiber made from corn that is labeled as "soluble corn fiber" or "maltodextrin" on the packaging.

    Findings from the study on postmenopausal women were published in American Journal of Clinical Nutrition, while the findings on adolescent women were published in Journal of Nutrition.

    Weaver and colleagues found that after prebiotic fiber passes through the gut for the microbes in the lower gut to digest, the SCF is broken down into short-chain fatty acids, which assist in the maintenance bone health.

    Supplementation helped build and preserve bone

    In the postmenopausal study, 14 healthy postmenopausal women consumed 0 grams, 10 grams, or 20 grams of SCF every day for 50 days. The women in the groups that received 10 grams and 20 grams - amounts that are found in supplement form - displayed bone calcium retention improvement by 4.8 percent and 7 percent, respectively.

    "If projected out for a year, this would equal and counter the average rate of bone loss in a post-menopausal woman," says Weaver, an expert in mineral bioavailability, calcium metabolism, botanicals and bone health.

    In the adolescent study, 28 girls aged between 11-14 years old consumed either 0 grams, 10 grams, or 20 grams of SCF every day for 4 weeks, while maintaining their regular diet. The females in both the 10 gram and 20 gram SCF groups saw an increase in calcium absorption by around 12 percent, which would build 1.8 percent more skeleton per year.

    Gastrointestinal symptoms were minimal in both studies and the same was seen in the control groups.

    "Most studies looking at benefits from soluble corn fiber are trying to solve digestion problems, and we are the first to determine that this relationship of feeding certain kind of fiber can alter the gut microbiome in ways that can enhance health," Weaver said. "We found this prebiotic can help healthy people use minerals better to support bone health."

    Few people meet the daily recommended intake of 1,200 milligrams of calcium for healthy bone mass.

    Weaver says that while SCF can help people better utilize calcium for bone health, this finding does not mean the recommendation to drink milk and follow a well-balanced diet should be ignored. SCF can, however, help individuals that are not consuming the whole recommended amount of dairy.

    "Calcium alone suppresses bone loss, but it doesn't enhance bone formation. These fibers enhance bone formation, so they are doing something more than enhancing calcium absorption."

    Connie Weaver

    Further studies by the team will examine the mechanisms behind how SCF boosts calcium absorption and retention, and if the prebiotic fiber benefits the body in other ways.

    Read about how a diet high in fiber alters bacteria to protect against food allergies.

    Written by Hannah Nichols


  • August 30, 2016 9:46 AM | Deleted user

    With concerns over a continued Zika outbreak growing, the Food and Drug Administration has given Roche Holdings emergency approval to use one of its Zika blood testing kits.

    The approval, which lasts as long as the emergency is ongoing, will allow for testing of the virus through Roche's LightMix Zika rRT-PCR test, which has not been approved by the FDA yet.

    The test uses the company's LightCycler 480 Instrument II or cobas z 480 Analyzer to search for Zika. The systems, found in specialist laboratories, can help detect the virus which can be more easily be found in blood samples. The disease can also be found in urine. On its site Roche says the cobas z 480 can process 384 samples per day.

    The Roche emergency approval is the latest in the FDA's search to more quickly identify and contain the virus. The agency had previously approved nine other systems for detecting Zika since February under similar emergency use authorizations. It approved two systems that help detect the disease, one from InBios International and another from Luminex Corporation, earlier this month.

    On Friday the FDA announced that all blood donations in the U.S. needed to be scanned for Zika, which over the last few weeks has spread into Florida and Puerto Rico.

    Since officials revealed its presence in the state earlier this month over 40 people in the Miami-Dade and Palm Beach counties in Florida have been diagnosed with the virus.

    The FDA updated its guidance due to the potential serious health consequences of Zika to pregnant women and children born to women exposed to the virus during pregnancy. The Zika virus is transmitted primarily by the Aedes mosquito but can also be spread by sexual contact. Although most people infected with the virus never develop symptoms, an infection during pregnancy can cause serious birth defects and is associated with other adverse pregnancy outcomes, the FDA warns.

    Contributing: Doyle Rice 


  • August 29, 2016 8:35 AM | Deleted user

    New CDC downloads available:

    ZIKA VIRUS TESTING FOR ANY PREGNANT WOMAN NOT LIVING IN AN AREA WITH ZIKA - Download

    When to test for Zika Virus - Download

  • August 29, 2016 8:06 AM | Deleted user

    August 26, 2016

    On August 11th NCCPA announced that effective immediately, self-assessment CME and PI-CME are no longer required. What does this mean for PAs?

    In 2014 NCCPA began transitioning PAs to a 10-year certification maintenance process that incorporated requirements for self-assessment and performance improvement (PI) CME credit. With the first PAs who transitioned to the new 10-year process facing a December 2016 logging deadline, NCCPA evaluated the self-assessment and PI-CME options currently available to PAs and determined they were insufficient to maintain self-assessment and PI-CME as requirements.

    For many PAs, self-assessment and PI-CME were only on the horizon, not demanding attention until they transitioned to the new 10-year process at some point in the next few years. Other PAs, however, have already expended resources participating in self-assessment and PI-CME activities.

    PAs who have already completed self-assessment or PI-CME activities will still be able to log these and will actually receive an additional benefit. Acknowledging the evidence of the positive impact of self-assessment and PI-CME on outcomes, NCCPA also announced new incentives for completing self-assessment and PI-CME activities: PAs will receive an additional 50% weighting for all self-assessment credits logged with NCCPA and the first 20 PI-CME credits logged during every two-year cycle will now be doubled.

    For those PAs who have already completed and logged self-assessment and PI-CME activities, the additional credit weighting will be applied retroactively. Changes will be reflected in the NCCPA’s logging system and individual PA dashboards at some point during the next few months.  

    PAs should be aware that the additional weighting for self-assessment and PI-CME activities applies only to NCCPA certification. States that require CME for license renewal purposes do not apply any additional weighting for self-assessment or PI-CME. For state license purposes, PAs must claim those credits exactly as awarded on their CME certificates.

    Many PAs have questions about these changes, how and when it will affect them, and how it relates to them and their own career path. You can find the answers to many common questions in our Certification Maintenance FAQ.

    AAPA will continue to provide and accredit high quality, affordable self-assessment and PI-CME activities to keep PAs ahead of the curve as healthcare moves toward a value-based system. With the new weighted logging system, PAs now have an additional incentive to participate in these interactive and impactful activities. 

    - See more at: https://www.aapa.org/twocolumn.aspx?id=6442451548#sthash.Ld6A1VVT.dpuf


  • August 25, 2016 9:04 AM | Deleted user

    Centers for Disease Control and Prevention 
    Everyone has a role to play in protecting their community from viruses spread by mosquitoes, like Zika. It is especially important to protect pregnant women from getting Zika because infection during pregnancy can cause microcephaly and other serious birth defects. Pregnant women can take certain steps to protect themselves and their pregnancy from Zika, such as avoiding travel to areas with Zika, protecting themselves from mosquito bites, and protecting against sexual transmission.

    Using an Environmental Protection Agency-registered insect repellent, treating clothing and gear with permethrin, and controlling mosquitoes inside and outside the home can protect against mosquito bites. Condoms (and other barriers to protect against infection) can reduce the chance of getting Zika from sex. Pregnant women who have recently traveled or who have a partner who traveled to an area with Zika should talk to their healthcare provider about their travel even if they don't feel sick. Share information with other moms-to-be about how to protect your pregnancy from Zika virus infection!

  • August 23, 2016 8:13 AM | Deleted user

    Postmenopausal women with osteoporosis assigned once-daily abaloparatide injection experienced a lower rate of vertebral and nonvertebral fractures during 18 months vs. those assigned teriparatide or a placebo, according to results from a randomized controlled trial.

    “This new medication, abaloparatide, can build bone mass very quickly in both the spine and the hip which are the two most important sites for osteoporosis-related fractures,” Felicia Cosman, MD, medical director of the clinical research center at Helen Hayes Hospital, senior clinical director of the National Osteoporosis Foundation and professor of medicine at Columbia University, told Endocrine Today. “The result of this bone building is a rapid reduction in the occurrence of fractures in both the spine as well as the rest of the skeleton. This represents a great potential treatment for osteoporosis-afflicted patients for the future.”

    Cosman, Paul D. Miller, MD, FACP, medical director of the Colorado Center for Bone Research, and colleagues , and colleagues analyzed data from 2,463 menopausal women participating in the ACTIVE trial, a phase 3, double blind, randomized controlled study conducted at 28 sites in 10 countries (mean age, 69 years). Participants had a bone mineral density T-score of up to –2.5 and greater than –5 at the lumbar spine or femoral neck, together with evidence of at least two mild vertebral fractures or one moderate vertebral fracture, or a low-trauma fracture of the forearm, humerus, sacrum, pelvis, hip, femur or tibia within 5 years. Women older than 65 years without fracture history were included if BMD T-score was –3 or less and at least –5 at the lumbar spine or femoral neck (mean femoral neck T-score, –2.1). Researchers assigned women to daily injections of abaloparatide (Radius Health; 80 µg; n = 824); open-label teriparatide (Forteo, Eli Lilly; 20 µg; n = 818) or placebo (n = 821) for 18 months. The primary endpoint was the percentage of women with new vertebral fractures in the abaloparatide vs. placebo groups; secondary endpoints included BMD change at total hip, femoral neck and lumbar spine and time to first incident of vertebral fracture in the abaloparatide vs. placebo groups.

    Researchers found that participants in the abaloparatide group experienced fewer morphometric vertebral fractures during the study period (n = 4; 0.58%) vs. the teriparatide group (n = 6; 0.84%) and placebo group (n = 30; 4.22%). Comparing abaloparatide with placebo, the RR for new vertebral fracture was 0.14 (95% CI, 0.05-0.39); HR for nonvertebral fracture was 0.57 (95% CI, 0.32-1).

    When compared with placebo, participants assigned to abaloparatide also saw increases in BMD from baseline during the 18-month period at the total hip (4.18% vs. –0.1%), femoral neck (3.6% vs. –0.43%) and lumber spine (11.2% vs. 0.63%).

    Serious, treatment-emergent adverse events were similar between abaloparatide, teriparatide and placebo groups (9.7%, 10% and 11%, respectively). Overall incidence of hypercalcemia was lower in the abaloparatide group vs. teriparatide group (3.4% vs. 6.4%) at any time during the study. Researchers did not observe evidence of increased cardiovascular risk associated with hypercalcemia in the abaloparatide group.

    Cosman noted that the findings apply to women with a fracture history, as well as those with very low bone mass who have not had fractures; however, more research is needed on the drug’s effect on other groups.

    “We need to continue evaluate abaloparatide in other clinical settings,” Cosman said. “We would like to see if this medication is just as efficatious in men, for example, and how efficatious it is in people who have been on other osteoporosis therapies.”

    Drug developer Radius Health submitted a new drug application to the FDA for abaloparatide on March 30. The company submitted a marketing authorization application in Europe on Nov. 17.

    “We are honored to have these findings published in JAMA, and are encouraged by the totality of data collected to date which demonstrate that abaloparatide, if approved, could have a significant impact in improving outcomes for women with postmenopausal osteoporosis,” Lorraine A. Fitzpatrick, MD, chief medical officer of Radius, said in a press release. “We look forward to presenting additional scientific information about abaloparatide as part of theAmerican Society for Bone Mineral Research (ASBMR) Annual Meeting in Atlanta, Georgia September 16-19, 2016.” – by Regina Schaffer

    Disclosure: The study was funded by Radius Health. Miller reports serving on scientific advisory boards for AgNovos, Amgen, Eli Lilly, Merck, Radius Health, Roche, and Ultragenyx; receiving research grants from Alexion, Amgen, Boehringer Ingelheim, Daiichi-Sankyo, Eli Lilly, Immunodiagnostics, Merck, Merck Serono, National Bone Health Alliance, Novartis, Radius Health, Regeneron, Roche Diagnostics and Ultragenyx; and serving on data safety committees for Allergan and the Grunenthal Group. Please see the full study for the other authors’ relevant financial disclosures.

    Source: Miller PD, et al. JAMA. 2016;doi:10.1001/jama.2016.11136.


  • August 09, 2016 8:38 AM | Deleted user

    by Diana Swift 
    Contributing Writer

    The European League Against Rheumatism (EULAR) has published comprehensive recommendations on reproductive health and family planning for women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) – conditions that largely affect women of childbearing age.

    "Reproductive issues are of paramount importance for women with systemic lupus erythematosus and/or antiphospholipid syndrome and should be addressed on a regular basis by healthcare providers," wrote Angela Tincani, MD, of the University of Brescia in Italy, and colleagues, in Annals of the Rheumatic Diseases.

    The new EULAR guidelines, initially presented last year at the organization's annual meeting in Rome,"recognize an implicit need for change in the mindset of health professionals, shifting from caution against pregnancy towards embracement of pregnancy," the authors stated. Research on the long-term health status of the offspring of affected mothers has been generally reassuring, although sparse, the authors noted, but potentially relatedneurodevelopmental disorders need to be confirmed.

    To optimize the care of these patients, a multidisciplinary international team developed guidelines using an evidence-based approach further refined by expert consensus. "Several 'unmet needsin the management of reproductive and other women's health issues may impact on personal relationships and the decision to have children," Tincani and her associates wrote. Among these concerns are pregnancy's effect on maternal disease, the impact of disease activity on fetal health, and the safety of medications during pregnancy and lactation.

    "I applaud these efforts – the guidelines are so comprehensive, going from prepregnancy to pregnancy and menopause – and they are generally in harmony with the way we practice medicine in the United States," said Jane E. Salmon, MD, from the Hospital for Special Surgery in New York City, in an interview with MedPage Today.

    "The issue of pregnancy and prepregnancy counseling should be front and center at the time of lupus diagnosis. From our work in the PROMISSE study it is clear that among women who have inactive disease – even with a history of renal disease – and are on low doses of prednisone and have very low proteinuria levels, 80%-plus can have uncomplicated pregnancies."

    Salmon noted that today's thinking is a far cry from earlier times when lupus was considered related exclusively to female hormones, and that in the hyper-feminizing state of pregnancy "the same bad players will be amplified at much higher levels and lupus will flare.

    "We've shown now that if lupus is in remission when you get pregnant, flares are uncommon and de novo renal disease will not occur in women who did not have it before," she said.

    The EULAR committee highlighted a variety of needs to be addressed in SLE/APS pregnancy, including preconception counseling and risk stratification to prevent unwanted complications. These needs included balancing the use of hormonal contraception or replacement therapy against the risks of thrombosis or teratogenesis; counseling patients about fertility preservation and the gestational effects of active disease, especially lupus nephritis; and the potential negative impact on fertility of immunosuppressive drugs and alkylating agents such as cyclophosphamide.

    The committee members recommended a discussion about family planning to be held as early as possible after SLE/APS diagnosis. Planning includes risk stratification for potential adverse obstetrical outcomes, with consideration of disease activity, the autoantibody profile, previous vascular and pregnancy morbidity, hypertension, and drug use.

    The guidelines also emphasize the benefits of hydroxychloroquine to reduce the risk of flares and minimize the likelihood of poor obstetrical outcomes, as well as the use of antiplatelets or anticoagulants.

    Salmon noted that some of the EULAR data on risk stratification are not very strong, although there are compelling data to suggest that hydroxychloroquine taken before and during pregnancy is safe and results in better outcomes. "In a U.S. woman with inactive disease who is not on hydroxychloroquine, a physician would be hard-pressed to justify adding another drug to her regimen," she said. In addition, the data for giving aspirin to patients at preeclampsia risk are also not very strong, but the toxicity is low and it could be of significant benefit.

    Patients with stable or inactive disease who are at low risk of thrombosis can safely use hormonal contraception and hormone-replacement therapy for menopausal symptoms, and can safely undergo assisted reproduction.

    The authors recommended validating protocols for assisted reproduction techniques in SLE/APS patients, who have assisted reproductive technology success rates similar to those of women in the general population.

    The guidelines also called for expanding predictive biomarkers for maternal disease activity during SLE pregnancy, with a focus on predicting preeclampsia, and gestational monitoring for placental insufficiency with fetal growth restriction to determine the best time for delivery and to reduce perinatal morbidity and mortality.

    In addition, the authors noted that data are needed to establish the cost effectiveness of intensive surveillance with fetal echocardiography in patients with positive anti-Ro/Sjögren's-syndrome-related antigen A (SSA) and anti-La/SSB antinuclear autoantibodies and who had no previous child with congenital heart block.

    For fetal monitoring, Doppler ultrasonography and fetal biometry can be considered, particularly in the third trimester, to screen for placental insufficiency and fetuses small for gestational age.

    "I am not sure all physicians in the U.S. have the ability to do Doppler ultrasound and biometric parameters, so it's important to stratify by risk and balance resources in an equitable way," Salmon said.

    In terms of general prenatal care, as with women in the general population, the guidelines advise supplementation with calcium, vitamin D, and folic acid for patients with SLE and/or APS -- in particular, for those showing low circulating levels of 25-OH vitamin D in trimester one and receiving glucocorticoids and/or heparin, which have detrimental effects on bone mass.

    "These recommendations are an opportunity to change attitudes, provide guidance on intervention, and perhaps stimulate rheumatologists to stratify patients by risk and make sure high-risk patients are monitored by someone with expertise in this area," Salmon said.

    The authors reported no conflicts of interest.

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

    LAST UPDATED 08.08.2016

    • Primary Source

    Annals of the Rheumatic Diseases

    Source Reference: Andreoli L, et al "EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome" Ann Rheum Dis 2016; DOI: 10.1136/annrheumdis-2016-209770.


  • August 05, 2016 11:22 AM | Deleted user

    August is National Breastfeeding Month, hosted by the United States Breastfeeding Committee to advocate for the policy and practice changes needed to build a “landscape of breastfeeding support.” Breastfeeding has numerous health benefits for infants, children and mothers, yet only 27 percent of U.S. babies meet the American Academy of Pediatrics recommendation of breastfeeding for the first 12 months of their lives.

    Briana J. Jegier, PhD, of APHA’s Breastfeeding Forum, spoke to Public Health Newswire on why breastfeeding is such a critical public health issue and what all Americans can do to promote it.

    Q: Simply put, why is breastfeeding so important for public health?

    A: Breastfeeding, including breast milk feeding, is a fundamental public health strategy because of its ability to improve the well-being of families, communities, and society. When compared with alternatives, breast milk is widely available, inexpensive, and is associated with improved short- and long-term health outcomes, economic savings, and environmental benefits. Emerging research demonstrates that breast milk plays a fundamental role in programming the gut microbiome’s ability to respond to diseases ranging from infectious (e.g. gastroenteritis) to chronic (e.g diabetes). In fact, breast milk is the only source of human milk oligosaccharides (HMOs) which laboratory studies demonstrate act as both a protective and decoy agent when we fight disease. Collectively, breastfeeding and breast milk are core to public health as increasing exposure to both provide an opportunity to improve all facets of health and to provide families and communities with an optimal start.

    Q: Nationally, nearly 80 percent of mothers have breastfed their babies, but only 50 percent are breastfeeding at six months. What are the barriers to sustained breastfeeding?

    A: Breastfeeding barriers are multifaceted but generally fall into three interconnected categories: inadequate education, insufficient support, and systemic undervaluing of breastfeeding. Families encounter these barriers throughout the prenatal period and birth hospital stay: they do not receive information and support necessary to make fully informed decisions about breastfeeding, they experience practices that obstructs breastfeeding intentions, and healthcare systems undermine the value of breastfeeding by exposing families to commercial formula advertisements. Barriers to breastfeed become all-the-more stark after hospital discharge. Although 80 percent of families initiate breastfeeding, only 60 percent are still exclusively breastfeeding after just 7 days. This dramatic drop continues through the first 6 months. At 6 months, only 20 percent of families are still exclusively breastfeeding in spite of professional recommendations that exclusive breastfeeding be supported and protected throughout this period.

    Inadequate education begins in elementary school and continues through university. Evidence-based infant feeding and lactation education is not systematically provided at any level, including in undergraduate, graduate, and postgraduate health professions programs. Without adequate education and training, under-informed families seek help from under-prepared providers; this creates a perfect storm for the perpetuation of myths, inadvertent breastfeeding sabotage, and over recommendation of breast milk alternatives as a blanket solution to any challenge. Moreover, this lack of education and training means that healthcare systems provide insufficient breastfeeding support. Shortages of trained, qualified lactation support professionals and communities devoid of policies, practices, and places that support breastfeeding leave too many families without resources they need to fulfill their breastfeeding intentions. Finally, and perhaps most important, breastfeeding is systemically undervalued. National conversations continue to characterize breastfeeding as a lifestyle choice rather than the life-saving, evidence-based intervention it is. Without appropriate value, requiring adequate education and developing comprehensive breastfeeding support – particularly paid family leave and adoption of the WHO code – will continue to face uphill battles.

    Q: This is the fifth anniversary of The Surgeon General’s Call to Action to Support Breastfeeding. What progress have we seen since then, and how is our Breastfeeding Forum advocating for more?

    A: Significant strides have been made on each of the 20 action items included in the Surgeon General’s Call. Breastfeeding rates continue to rise and the number of children born in facilities that are designated as Baby-Friendly has risen from roughly 3 percent in 2007 to 17.9 percent in 2016. This rise is in part due to programs supported by public health entities, including CDC and NACCHO, and led by our Breastfeeding Forum members that have enabled facilities to receive the support they need to receive Baby-Friendly designation.  Breastfeeding coalitions and public health departments across the US have also created state specific designations that recognize businesses, childcare facilities, and healthcare providers that adopt baby and breastfeeding friendly practices. We also see a bigger and more vibrant USBC that has built coalitions with partners, including APHA, to form work groups that address each of the 20 areas and other emerging breastfeeding issues. Finally, we have seen increases in funding initiatives and organizations dedicated to increasing lactation professional diversity and availability.

    The Breastfeeding Forum in partnership with other APHA sections has worked to promote the Surgeon General’s Call. We have revised APHA policy to incorporate the call and we have worked with our colleagues to ensure that new policies consider the impact of breastfeeding on the issues they address. We have also worked with APHA leaders to revise disaster preparedness fact sheets to ensure they reflect evidence-based information for breastfeeding families. Currently, we are developing a public health policy to address the growing practice of milk sharing.  We are also utilizing technology to increase collaboration (e.g. webinars, twitter chats) throughout the year. Finally, we have prioritized developing diversity in our membership so that all voices are at the table as we address the challenges faced in breastfeeding and public health.


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