The American College of
Obstetricians and Gynecologists
WOMEN’S HEALTH CARE PHYSICIANS
Committee on Health Care for Underserved Women
This information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Breastfeeding in Underserved Women: Increasing
Initiation and Continuation of Breastfeeding
ABSTRACT: Maternal and infant benefits from breastfeeding are well documented and are especially impor-
tant to underserved women. Underserved women are disproportionately likely to experience adverse health
outcomes that may improve with breastfeeding. They face unique barriers and have low rates of initiation and
continuation of breastfeeding. Through a multidisciplinary approach that involves practitioners, family members,
and child care providers, obstetrician–gynecologists can help underserved women overcome obstacles and obtain
the benefits of breastfeeding for themselves and their infants.
The American College of Obstetricians and Gynecologists According to the 2012 Breastfeeding Report Card,
(the College) strongly supports breastfeeding as the pre- 76.9% of infants in the United States were ever breastfed.
ferred method of feeding for newborns and infants and However, 47.2% of infants were breastfed at 6 months,
recommends exclusive breastfeeding until the infant is which decreased to 25.5% at 12 months (1). Although
approximately 6 months of age. A longer breastfeeding breastfeeding rates have increased over the past several
experience, with gradual introduction of iron-enriched years, Healthy People 2020 goals include increasing the
solid foods in the second half of the first year of life, is rate of continued breastfeeding as well as improving the
beneficial. The College calls on its Fellows, other health rate of exclusive breastfeeding (seeBox 1).
care professionals who provide care for women and their Maternal and infant benefits from breastfeeding
infants, hospitals, and employers to support women in include protection from infections (2), biologic signals
choosing to breastfeed their infants. All should work to for promoting cellular growth and differentiation (2),
facilitate continuation of breastfeeding in the workplace decrease in maternal postpartum blood loss (3), and a
and public facilities, and advocate for changes to the reduction in the risk of ovarian and breast cancer (4–6).
public environment that support breastfeeding locally Despite the benefits of breastfeeding, cultural and societal
and nationally. Although most women can breastfeed, barriers to breastfeeding exist at all levels; from hospitals
some women will choose not to breastfeed or cannot to the workplace. Underserved women, those who are
breastfeed. Health care providers should be sensitive to unable to obtain quality health care by virtue of poverty,
the needs of women, regardless of whether or not they cultural differences, race and ethnicity, geographic region,
choose to breastfeed. Health care providers should aim or other factors that contribute to health care disparities,
to support women in the vulnerable postpartum period may face greater barriers in the initiation and continua-
and encourage and assist women who choose to breast- tion of breastfeeding.
feed and accept the decision of women who choose not Overall, national estimates for breastfeeding initia-
to breastfeed. Additionally, health care providers should tion meet the Healthy People 2010 target of 75%.
help women recognize when their newborns are getting However, significant disparities exist with breastfeeding
enough nutrition and hydration through breast milk so initiation among African American women and women
they can confidently continue exclusive breastfeeding or in the Special Supplemental Program for Women, Infants
seek assistance if there is a concern. and Children (WIC); 58.9% and 66.1% respectively (7,8).
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