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Letters to the Editor  |   October 2011
Support for Women in Osteopathic Medicine Who Breastfeed: A Call for Action
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Obstetrics and Gynecology / Pediatrics
Letters to the Editor   |   October 2011
Support for Women in Osteopathic Medicine Who Breastfeed: A Call for Action
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 566-568. doi:10.7556/jaoa.2011.111.10.566
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 566-568. doi:10.7556/jaoa.2011.111.10.566
To the Editor: 
It has been well established that breastfeeding is an unsurpassed method of feeding infants. Research shows that breastfed infants have reduced risks of asthma, childhood leukemia, diabetes mellitus, diarrhea, infections, obesity, and sudden infant death syndrome compared with infants who are not breastfed.1,2 In addition, women who have breastfed have lower risks of breast and ovarian cancers, cardiovascular disease, and diabetes mellitus compared with mothers who have not breastfed.1-2 Numerous medical authorities—including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Nurse-Midwives, American Congress of Obstetricians and Gynecologists, American Dietetic Association, American Public Health Association, Centers for Disease Control and Prevention, US Department of Health and Human Services, US Surgeon General, and World Health Organization—recommend that infants be exclusively breastfed for the first 6 months of life and continue to be breastfed until they are aged 1 to 2 years.3-9 
As leaders in preventive medicine and health promotion, osteopathic physicians should actively encourage such healthy behaviors as breastfeeding. However, female physicians themselves are becoming a high-risk group for low breastfeeding rates.10 Although female physicians with personal breastfeeding experience are more comfortable than other physicians in educating their patients about breastfeeding, and current literature suggests that female physicians initiate breastfeeding at a higher rate than women in the general population, they have lower rates of exclusive breastfeeding and abbreviated durations of breastfeeding compared with their age-, race-, and socioeconomic status-matched peers.10-15 The personal breastfeeding behaviors of physician mothers may impact the guidance on this matter that they provide to their patients.10,11 
Osteopathic medical institutions can play a key role in increasing breastfeeding rates by actively supporting female osteopathic medical students, residents, and physicians who are breastfeeding. According to the United States Breastfeeding Committee—an independent nonprofit coalition of more than 40 health-related organizations—employers that provide breastfeeding support programs report improved employee recruitment and retention, increased employee satisfaction, and reduced employee absenteeism.1 Employers have also reported financial benefits as great as a 3-to-1 return on investment in breastfeeding programs.1,16,17 
National health policies and recommendations to support breastfeeding in the workplace are improving. The Patient Protection and Affordable Care Act, which amended the Fair Labor Standards Act when signed into law in March 2010, includes a provision that requires all employers to provide reasonable unpaid break time and a private, nonbathroom location for nursing employees to express milk during the work day.18 In addition, Healthy People 2020 calls on the United States to increase the proportion of employers that have worksite lactation support programs from 25% (as reported in 2009) to 38%.19 
An increasing number of universities across the United States are demonstrating that successful and supportive breastfeeding environments can be developed for students, faculty, and staff. For example, Virginia Polytechnic Institute and State University requires new construction on campus to include space for a lactation room in each new building.20 The University of Iowa, University of Michigan, Columbia University, Duke University, and Oregon State University each has more than 10 lactation rooms available on campus, and Harvard University and the University of California, Davis, each has more than 20 lactation rooms on campus.21-27 A number of allopathic medical schools—such as the University of California, Los Angeles; University of Massachusetts; Emory University; and Virginia Commonwealth University—provide lactation rooms for students, faculty, and staff.28-31 Breastfeeding education during allopathic medical school and residencies is also improving.32-36 
However, improved breastfeeding support for students and faculty at osteopathic medical institutions is needed. Only 3 osteopathic medical schools currently provide lactation facilities or breastfeeding support services for women who are breastfeeding.37-39 
Dedicated space, adequate time for milk expression, and supportive health policies are needed to encourage breastfeeding continuation within workplaces and academic institutions.12 Osteopathic medical schools can play a key role in increasing breastfeeding among female osteopathic medical students, residents, and physicians by actively supporting arrangements of time and space for breast milk expression. The following online resources provide information on developing institutional lactation support programs: 
The provision of lactation support within osteopathic medical institutions would serve as an expression to the greater medical community of our commitment to the prevention of childhood illnesses and chronic disease and to the promotion of healthy lifestyles. Nearly one-third of practicing osteopathic physicians and nearly half of osteopathic medical students are women.40 Let us put our actions behind our beliefs in preventive medicine and the promotion of healthy behaviors by providing breastfeeding supportive services to osteopathic physicians, residents, and medical students. Such actions will have a beneficial impact on the health of our patients and our communities. 
References
United States Breastfeeding Committee. Workplace Breastfeeding Support [issue paper]. Raleigh, NC: United States Breastfeeding Committee; 2002. http://www.usbreastfeeding.org/Portals/0/Publications/Workplace-2002-USBC.pdf. Accessed September 6, 2011.
Breastfeeding among US children born 2000-2008, CDC National Immunization Survey. US Department of Health and Human Services, Centers for Disease Control and Prevention Web site. Available at: http://www.cdc.gov/breastfeeding/data/NIS_data/ Accessed September 6, 2011.
Breastfeeding (policy statement). American Academy of Family Physicians Web site. http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpolicy.html. Accessed September 6, 2011.
Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG committee opinion No. 361: breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 pt 1):479-480. [PubMed]
Position statement: breastfeeding. American College of Nurse-Midwives, Division of Women's Health Policy and Leadership Web site. http://www.midwife.org/siteFiles/position/Breastfeeding_05.pdf. Accessed September 6, 2011.
James DC, Lesson R; American Dietetic Association. Position of the American Dietetic Association: promoting and supporting breastfeeding. J Am Diet Assoc. 2009;109(11):1926-1942. [CrossRef] [PubMed]
American Public Health Association. A Call to Action on Breastfeeding: A Fundamental Public Health Issue. Washington, DC: American Public Health Association; November 6 , 2007. Policy No 200714. http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1360. Accessed September 6, 2011.
World Health Organization. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization; 2003.
US Department of Health and Human Services. The Surgeon General's Call to Action to Support Breastfeeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011. http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf. Accessed September 6, 2011.
Sattari M, Levine D, Serwint JR. Physician mothers: an unlikely high risk group—call for action. Breastfeed Med. 2010;5(1):35-39. [CrossRef] [PubMed]
Miller NH, Miller DJ, Chism M. Breastfeeding practices among resident physicians. Pediatrics. 1996;98(3 pt 1):434-437. [PubMed]
Sattari M, Levine D, Bertram A, Serwint JR. Breastfeeding intentions of female physicians [published online ahead of print June 24, 2010]. Breastfeed Med. 2010;5(6):297-302. [CrossRef] [PubMed]
Arthur CR, Saenz R, Replogle WH. Breastfeeding education, treatment, and referrals by female physicians. J Hum Lact. 2003;19(3):303-309. [CrossRef] [PubMed]
Arthur CR, Saenz RB, Replogle WH. Personal breast-feeding behaviors of female physicians in Mississippi. South Med J. 2003;96(2):130-135. [CrossRef] [PubMed]
Kacmar JE, Taylor JS, Nothnagle M, Stumpff J. Breastfeeding practices of resident physicians in Rhode Island. Med Health RI. 2006;89(7):230-231.
United States Breastfeeding Committee. Statement on Lactation Accommodations in the Workplace. Washington, DC: United States Breastfeeding Committee; 2011.
US Department of Health and Human Services. The Business Case for Breastfeeding. Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau; 2008.
Patient Protection and Affordable Care Act, HR 3590, 111th Cong ( 2009-2010).
US Department of Health and Human Services, , Centers for Disease Control and Prevention, , National Center for Health Statistics. Healthy People 2020. Washington, DC: US Department of Health and Human Services; 2010.
Virginia Polytechnic Institute and State University. Virginia Tech Design and Construction Standards. Blacksburg; Virginia Polytechnic Institute and State University; 2006.
Lactation rooms. Child Care at Harvard University Web site. http://www.childcare.harvard.edu/childcare/lactation.shtml. Accessed September 6, 2011.
Breastfeeding support program. Columbia University Work-Life Web site. http://worklife.columbia.edu/breastfeeding-support#section2. Accessed September 6, 2011.
Breastfeeding/lactation rooms. Oregon State University Web site. http://oregonstate.edu/childcare/breastfeeding. Accessed September 6, 2011.
Breastfeeding Support Program—a partnership of Human Resources and the Foods for Health Institute. University of California, Davis, Web site. http://www.hr.ucdavis.edu/worklife-wellness/Life/breastfeeding-support-program-1. Accessed September 6, 2011.
Lactation rooms. Duke University Human Resources Web site. http://www.hr.duke.edu/benefits/family/newborn/lactation/. Accessed September 6, 2011.
Lactation room locations. University of Iowa Human Resources Web site. http://www.uiowa.edu/hr/famserv/lactation_location.html. Accessed September 6, 2011.
Parenting: lactation resources. University of Michigan Work/Life Resource Center Web site. http://www.hr.umich.edu/worklife/parenting/lactationrooms.html. Accessed September 6, 2011.
Prospective parents and nursing moms. University of California, Los Angeles, David Geffen School of Medicine, Office of Diversity Affairs Web site. http://dgsomdiversity.ucla.edu/body.cfm?id=33. Accessed September 6, 2011.
Nursing mothers. Emory University Center for Women at Emory Web site. http://www.womenscenter.emory.edu/services_resources/Nursing%20Nest/index.html. Accessed September 6, 2011.
Lactation rooms. Virginia Commonwealth University Medical Center Web site. http://www.medschool.vcu.edu/audience/lactationrooms.html. Accessed September 6, 2011.
Mothers' rooms. University of Massachusetts Medical School Human Resources Web site. http://www.umassmed.edu/hr/work-life/parenting.aspx. Accessed September 6, 2011.
Ogburn T, Espey E, Leeman L, Alvarez K. A breastfeeding curriculum for residents and medical students: a multidisciplinary approach. J Hum Lact. 2005;21(4):458-464. [CrossRef] [PubMed]
Roy R. Development of a breastfeeding curriculum. Acad Med. 1997;72(5):452-453. [CrossRef] [PubMed]
Bunik M, Gao D, Moore L. An investigation of the field trip model as a method for teaching breastfeeding to pediatric residents. J Hum Lact. 2006;22(2):195-202. [CrossRef] [PubMed]
Montgomery KS. Implementing breastfeeding education in the academic setting. J Hum Lact. 1999;15(2):145-147. [CrossRef] [PubMed]
Dykes F. The education of health practitioners supporting breastfeeding women: time for critical reflection. Matern Child Nutr. 2006;2(4):204-216. [CrossRef] [PubMed]
The FAC is happy to announce the opening of its new lactation room! University of North Texas Health Science Center Web site. http://www.hsc.unt.edu/departments/HealthPromotion/lactation room.cfm. Accessed September 6, 2011.
Welcome to the OSU Women's Resource Center. Oklahoma State University Web site. http://www.okstate.edu/osu_orgs/wrc/. Accessed September 6, 2011.
Welcome to ROUNDS! Ohio University College of Osteopathic Medicine Web site. http://www.oucom.ohio.edu/news/rounds/2010/may/05_10_10.htm. Accessed September 6, 2011.
American Osteopathic Association. 2010 Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 2010. http://www.osteopathic.org/inside-aoa/about/who-we-are/Documents/Osteopathic-Medical-Profession-Report-2010.pdf. Accessed September 6, 2011.