System-level pathways to overcoming barriers to optimal infant feeding practices in maternity care

Infant feeding practices establish the foundation for lifelong health through physiological and behavioral pathways. Even though breastfeeding is “the preferred choice of feeding for all infants,” only 11.3% of infants are breastfed exclusively for six months—the AAP recommendation. Breastfeeding is not more widely adopted because of the lack of support at a fundamental level. The health care system and the formula industry, and not just individual mothers' choices, have contributed to suboptimal infant nutrition.

Results of the 2007 CDC national survey, Maternity Practices in Infant Nutrition and Care (mPINC), indicated that a substantial proportion of facilities used maternity practices that are not evidence-based and are known to interfere with breastfeeding. The inadequate uptake of the Baby-Friendly Hospital Initiative in the US suggests also that we will need to be more assertive in incentivizing behavior change. The question is how?

Applications of continuous quality improvement (CQI) approaches offer practical pathways to changing infant feeding practices at birth. System-level analyses are needed to consider the predisposing, enabling, and reinforcing factors that encourage formula feeding and inhibit breastfeeding. The existence of the AAP Safe and Healthy Beginnings Project Toolkit suggests that hospitals have resources to implement changes if we can, as a society, provide the policy and operating contexts that encourage change. National Quality Foundation's recent adoption of a standard calling for exclusive breastfeeding at hospital discharge as part of its 17 perinatal standards offers an important new incentive for changing maternity practices that influence infant feeding; however, more are needed.