Unpacking The New Breastfeeding Guidelines From The American Academy Of Pediatrics
For the first time in a decade, the American Academy of Pediatrics (AAP) released new policy guidelines that significantly extend the recommended duration for breastfeeding from 1 year to 2 years or longer. Citing the provision of human milk as a public health imperative, the announcement comes on the heels of a national infant nutrition crisis and a spike in inflation. Along with this updated guidance, AAP acknowledges that parents face barriers beyond their control when making choices around breastfeeding, and which can prevent or significantly limit the duration of successful breastfeeding. To help parents navigate their options, the medical body calls for more support from hospitals, pediatricians, government and workplaces. For mothers returning to work, the landscape is even more complicated, with 80% of moms wanting better breastfeeding support from employers.¹
What are the new AAP recommendations?
The updated guidelines call for exclusive breastfeeding until 6 months of age and then continued breastfeeding for up to 2 years of age and beyond – marking a one-year increase from previous guidelines. “Not everyone can breastfeed or continue breastfeeding for as long as desired for various reasons, including workplace barriers,” said lead author Joan Younger Meed, MD. “Families deserve nonjudgmental support, information and help to guide them in feeding their infant.”
The new guidelines are now in line with longstanding recommendations of feeding breast milk for 2 years and beyond from the World Health Organization (WHO). AAP also issued a technical report providing the evidence and basis for their recommendation.
How do the new guidelines compare to previous guidelines?
AAP’s last policy statement was published in 2012. The main difference in the guidelines is an increase from 1 year of age to 2 years and beyond for the recommended duration for providing breast milk. The new policy also calls for more support from public and private sectors for women who choose to breastfeed.
Why did the AAP change their guidelines?
AAP’s goal was to share new research and normalize longer term breastfeeding. The update was prompted by evidence that there are health benefits for both a mother and child to breastfeed past the 12-month mark. For mothers, extended breastfeeding is linked to a reduction in maternal type 2 diabetes, hypertension, breast cancer and ovarian cancer rates. The statement also cites research linking breast milk to several benefits for infants, including decreased rates of lower respiratory tract infections, severe diarrhea and ear infections.
What is AAP’s position on health inequities with breastfeeding?
AAP recommends that hospitals and maternity care practices improve breastfeeding initiation, duration and exclusivity for all mothers and infants no matter their race, ethnicity or gender. AAP points to CDC data that indicates lower initiation rates of about 75% for non-Hispanic Black mothers and infants, which is below the national average of 84%. AAP suggests continuing targeted interventions for groups with lower rates, noting that the WHO’s Ten Steps to Successful Breastfeeding initiative has decreased the initiation disparity by 9.6%.
What are AAP’s recommendations about supporting mothers who breastfeed in public or express milk in the workplace?
AAP highlights that a lack of support and workplace obstacles hinder a woman’s ability to provide breast milk to their child, especially for an extended duration. Specifically, the statement notes: Policies that protect breastfeeding, including universal paid maternity leave, the right of a woman to breastfeed in public, insurance coverage for lactation support and breast pumps, on-site child care, universal workplace break time with a clean, private location for expressing milk, the right to feed expressed milk, and the right to breastfeed in child care centers and lactation rooms in schools are all essential to supporting families in sustaining breastfeeding.
What’s been the response to the new guidelines?
The new guidelines go a long way in destigmatizing extended breastfeeding, but also present a challenge for mothers already struggling to balance breastfeeding goals with work and other responsibilities. Sixty percent of moms say they fall short of reaching their breastfeeding goals, according to the CDC. In another recent study, 63% of new moms believe access to more resources would have helped them breastfeed longer and 62% would consider changing jobs for a company that offered better lactation support.² For employers, that means the call for more lactation benefits intensifies.
How do the new guidelines align with current legislation on breastfeeding and pumping rights in the workplace?
The Break Time for Nursing Mothers provision of the federal Fair Labor Standards Act offers limited protection of up to one year, which leaves a gap for parents who’d like to continue pumping past the one-year mark. Some states offer additional protections, but the new AAP guidelines and current federal laws are not aligned. The federal Break Time law also excludes nearly 25% of women workers of childbearing age–leaving more than 9 million women unprotected.³ The PUMP Act, which passed in the House but not the Senate yet, would close that gap and expand protections to all employees—not just non-exempt—to include salaried, seasonal and agriculture workers. It would also extend protections from 1 to 2 years, clarify employers’ obligations and ensure breastfeeding employees have access to appropriate remedies.
How do the current breastfeeding rates in the United States align with AAP’s recommended guidelines?
AAP notes a disparity between breastfeeding recommendations and key breastfeeding milestones. CDC data shows that 83% of moms start off breastfeeding, but by 3 months, only 45% of moms are exclusively breastfeeding. By 6 months, just 25% of moms are exclusively breastfeeding.
OTHER HEALTH ORGANIZATIONS WEIGH IN ON BREASTFEEDING
Along with AAP’s new policy guidelines, other leading health organizations weigh in on supporting infant well-being and nursing mothers.
WHO and United Nations International Children’s Emergency Fund (UNICEF)
In a recently released joint statement, WHO and UNICEF called on governments and the private sector to allocate increased resources to protect and support breastfeeding programs. They called for stepped up efforts in several areas, including implementing more policies to help families with the time, space and support they need to provide breast milk.
U.S. Department of Health and Human Services (DHS)
To increase breastfeeding rates as part of its Healthy People 2030 initiative, DHS established a goal of increasing the proportion of infants who are exclusively breastfed through 6 months of age to 42.4% – as compared to 25% in 2018. To increase the proportion of infants who are breastfed at one year, DHS established a 2030 goal of 54.1%, as compared to 35% in 2018.
American Heart Association (AHA)
A Journal of the American Heart Association study published in 2022 details growing evidence that breastfeeding lowers cardiovascular disease risks for infants and parents. In an analysis of nearly 1.2 million women, researchers found that women who breastfed were 17% less likely to die from cardiovascular disease than women who did not breastfeed. In another study published in 2021, infants who consumed breast milk had lower blood pressure at 3 years of age than children who did not receive any breast milk.
¹ Survey of 2,000 Working Moms, Medela, Mamava and Milk Stork, January 2020
² Aeroflow Survey, July 2022
³ Congress Must Pass the Pump Act, A Better Balance, July 2022