Best Start Breastfeeding Promotion Campaign

To the Editor—Breastfeeding is the method of infant feeding supported by many professional organizations, including the American Academy of Pediatrics,1 the American College of Obstetrics and Gynecology,2 and the American Academy of Family Physicians.3 In the United States, Healthy People 2010 has set the goal of 75% of mothers breastfeeding at birth and 50% at 6 months,4 and the Best Start Breastfeeding Promotion Campaign has been developed to increase breastfeeding awareness.5The provision of information and support to expectant mothers has been shown to increase the incidence and duration of breastfeeding,6 and during the past 2 decades a number of physician surveys that assess physicians’ breastfeeding attitudes and knowledge have been published.7 A national survey of fellows of the American Academy of Pediatrics, published in 1999, reported that only 65% recommended breastfeeding as the exclusive mode of feeding for the first month of life,8 and a recent study of obstetricians found that only 57% routinely provided breastfeeding supportive practices in their prenatal and postnatal care.9 In 1995 an article based on data from a national random sample of pediatricians, obstetricians, and family physicians (both residents and practitioners) found inadequate physician training in the areas of breastfeeding counseling, but strong endorsements by the respondents that physicians should be involved in breastfeeding promotion.10In fall 1998 a 2-page questionnaire was mailed to all physicians in Wisconsin who were members of the American Academy of Pediatrics Wisconsin Chapter, American College of Obstetrics and Gynecology Wisconsin Section, or the Wisconsin Academy of Family Physicians. Before mailing, the survey was reviewed by members of the American College of Obstetrics and Gynecology Wisconsin Section and the Wisconsin Academy of Family Physicians. The goal of the survey was to assess physicians’ current practices and level of comfort providing breastfeeding mothers with counseling and support as well as physicians’ favorite modes of learning for breastfeeding CME. The survey was piloted by faculty from the Division of General Pediatrics and Adolescent Medicine, University of Wisconsin-Madison. The survey was mailed within each organization’s newsletter with a letter from the chapter/section president that encouraged participation in the survey. The response rate for each organization was 15%; 428 physicians participated—family physicians (N = 259), pediatricians (N = 109), and obstetrician/gynecologists (N = 60). Most respondents (75%) had graduated from medical school before 1990, 59% were male, and three quarters reported either having breastfed an infant or having a spouse who breastfed. About two thirds of respondents who graduated after 1990 were women, compared to one third of respondents who graduated before 1990.Although almost all physicians agreed that breast milk was the best source of infant nutrition, only 78% of men physicians and 87% of women physicians (P < .01) reported that they actively support breastfeeding in their practices. Pediatricians (17%) and family physicians (18%) were more likely than obstetricians were (7%, P = .004) to report they learned a lot about breastfeeding during their residency. More recent medical school graduates (after 1990) were no more likely than less recent graduates (before 1990) to report they learned a lot about breastfeeding during residency (P > .2). Pediatricians and family physicians were more likely to report encouraging breastfeeding in their practices compared with obstetricians (P = .04), and women physicians with personal breastfeeding experience reported the most confidence in their ability to provide breastfeeding counseling to their patients (P < .05, analysis of variance, Scheffé method for multiple comparisons). When queried in a forced-choice manner concerning their favorite mode of breastfeeding learning, the majority selected handouts/articles (55%), then website (14%), lecture at academy meeting (12%), all-day lecture on breastfeeding (11%), and no opinion (8%).Despite strong support for breastfeeding from some of the world’s most respected health organizations, the majority of men and women physicians who participated in this survey reported they learned less than a lot about breastfeeding in their residency, and 40% of pediatricians, 57% of family physicians, and 63% of obstetricians did not feel knowledgeable about breastfeeding. Physicians with a higher level of interest in breastfeeding issues were probably more likely to respond to the survey compared to colleagues with lower levels of interest. Strategies to attain the breastfeeding goals included in Healthy People 2010 must include a renewed effort to develop, implement, and evaluate the most effective CME methods to improve physicians’ breastfeeding knowledge and increase their confidence to support breastfeeding mothers and their infants.