Breastfeeding and health outcomes.

Ihave the good fortune to work at the Agency for Health Care Research and Quality (AHRQ), where I have the opportunity to help translate numbers and evidence into meaningful action to improve health and health care. In my work I am privileged to support the U.S. Preventive Services Task Force and collaborate with and fund researchers in primary care. The mission of the Agency is to improve the quality, safety, effectiveness, and efficiency of health care for all Americans. Today, I’m going to talk about the effects of breastfeeding on the health of women and children. When we deconstruct breastfeeding to identify its effects on individual healthcare outcomes, we lose the bigger picture. Breastfeeding is a dynamic, complex, living practice—a multidimensional, relational system involving not only a mother and child, but their entire environment. I generally approach breastfeeding as a means of optimizing a child’s chances for reaching his or her full potential. This sometimes creates conflict, because breastfeeding is not the magic guarantee for well-being that physicians and policy makers sometimes want. It is also important to remember that an individual family, making a decision about helping the development of a child, has a perspective on breastfeeding that is very different from the viewpoint of the population at large and of the policy makers who monitor public concerns. To set a foundation for this summit, I am pleased to be able to summarize a report published in 2007 on outcomes of breastfeeding on maternal and infant health in developed countries that was prepared for AHRQ by the Evidence-Based Practice Center (EPC) of the Tufts–New England Medical Center, Boston, MA. The EPC program was established by AHRQ in 1997 to review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments. EPC evidence reports are based on rigorous, comprehensive syntheses and analyses of the scientific literature. There are currently 14 centers around the United States and Canada that are commissioned to systematically review the evidence surrounding a particular practice. The methodology used by the EPC is very explicit; its documentation is very detailed. The EPCs collaborate broadly with experts around the world in various fields to produce reports on aspects of healthcare practice and outcomes that policy makers as well as clinicians use to guide health care. The EPC’s 2007 report on breastfeeding in maternal and infant health summarized evidence through May 2006 from different types of studies in the English-language literature, including randomized controlled trials and controlled observational studies. Over 9,000 articles were considered for this report. Given the breath of literature, the EPC relied on previously conducted systematic reviews and meta-analysis and at times conducted new and updated meta-analysis as well. Every study was examined and graded for its methodologic quality, and some studies of poorer quality were discarded. The 2007 EPC report concluded that breastfeeding provided short-term benefits for infants in terms of a lower frequency of common illnesses, including ear infections and vomiting and diarrhea. The evidence suggests that for every six children who are breastfed exclusively for the first 6 months of life, one of them will not have an ear infection that he or she would otherwise have had. That means that of the approximately 4 million infants born in the United States every year, 2 million would be expected to have an ear infection in the first 6 months of life. If breastfeeding rates in America were increased to 80% of children, there would be 300,000 fewer ear infections than there now are. Among formula-fed infants the incidence of vomiting and diarrhea is nearly 100% in the first year of life, as compared with such illness in fewer than half of breastfed children. The report found that the benefits are not only for common illnesses that occur in infancy, but also for rarer but serious illnesses. The rates of hospitalizations for pneumonia and severe lower respiratory tract infection are lower among breastfed infants than among those not breastfed. A metaanalysis found a significant inverse association between breastfeeding and sudden infant death syndrome (SIDS). The benefits of breastfeeding are not limited to infancy; they extend into childhood and even into adulthood. A history