The U.S. Preventive Services Task Force has updated its statement on breastfeeding promotion following a review of the evidence, and recommends that “health care settings use strategies that work with women and families both before and after delivery to encourage and support breastfeeding.” The previous review, published in 2003, did not address prenatal support and had found insufficient evidence for interventions such as counseling by primary care providers.
The Task Force is part of a government agency and focuses on better informing healthcare providers by reviewing evidence of effectiveness and developing recommendations for clinical services. Its recommendation in this case is Grade B, meaning that “There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
In the recommendation, the reviewers note that there is evidence that breastfeeding may have health benefits for women and children, and that interventions to support breastfeeding have been found to increase the rates of initiation, duration, and exclusivity of breastfeeding, while the harms of such interventions are thought to be minimal.
The commentary on these potential harms specifically addresses the empowerment of women to make informed choices. The reviewers explain (emphasis added):
“No studies identified for the USPSTF reported harms from interventions to promote and support breastfeeding. Nonetheless, there are potential harms, such as making women feel guilty. Breastfeeding interventions, like all other health care interventions designed to encourage healthy behaviors, should aim to empower individuals to make informed choices supported by the best available evidence. As with interventions to achieve a healthy weight or to quit smoking, breastfeeding interventions should be designed and implemented in ways that do not make women feel guilty when they make an informed choice not to breastfeed.”
The reviewers also note that additional research is needed on issues such as exclusive vs. partial breastfeeding, costs and cost benefits of interventions to promote breastfeeding, the effectiveness of compliance with the World Health Organization’s Baby-Friendly Hospital Initiative in the United States, the effects of individual components of breastfeeding support, and “to allow the tailoring of interventions to the needs of individual women and families.”