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US Surgeon General Blueprint on Breastfeeding

By Martha Hartney-Schatzle
Palos Verdes, CA USA
From: NEW BEGINNINGS, Vol. 18 No. 2, March-April 2001, pp. 74-75

December 2000

At the turn of the millennium, the United States is still not a breastfeeding friendly society. But one man hopes to change that. He is a scholarly looking gentleman, graying beard and spectacles, in a navy blue suit with brass buttons, the uniform of his office. He is the Surgeon General of the United States. And the first black man to hold that position.

On October 31, 2000, Surgeon General David Satcher and the US Department of Health and Human Services (HHS) released the "Blueprint for Action on Breastfeeding" making it an important policy-setting document issued by the federal government affirming the superiority and importance of breastfeeding.

Dr. Suzanne Haynes, chairperson for the Subcommittee on Breastfeeding and Senior Science Advisor at the Office on Women's Health, said the document was released to widespread media coverage. "This public policy document gives a new sense of credibility to breastfeeding and will allow more doors to be opened that may have been closed before."

The Blueprint was drafted by a committee of governmental agencies and reviewed by liaisons from a variety of professional organizations. The committee examined scientific data both in favor of and cautious about breastfeeding and the document concludes with a list of broad changes in the health care system, workplace, and community needed to make breastfeeding easier for all mothers.

Breastfeeding advocates around the country have given the Blueprint mixed reviews. On one hand, the document is unabashedly pro-breastfeeding. As a scaffold upon which HHS policy makers intend for the country to build upon, their position is backed up by deeply scrutinized evidence. It recognizes immunological, nutritional, developmental, maternal, and socioeconomic benefits of breastfeeding.

On the other hand, members of the committee and breastfeeding advocates acknowledge that the document is a compromise, like all public policy documents.

Workplace Environment

The Blueprint states, "a large proportion of employed mothers who have children under three years of age work full time." The plan asks that employers institute programs to facilitate breastfeeding or breast milk expression and includes a list of recommended practices for corporations to consider when developing mother friendly policies.

However, the plan does not make specific recommendations about legislation that would support a mother's plans to breastfeed. Most employers do not perceive breastfeeding to be an issue warranting their attention. In the United States, in comparison to many other industrialized nations, there are no federal statutes with specific provisions and protections for nursing mothers.

The Blueprint may serve nursing mothers seeking understanding and change in their workplaces. By presenting a federally approved document detailing their needs in so credible a manner, mothers may find more receptive audiences.

The International Code of Marketing of Breast Milk Substitutes

The Committee included a short paragraph about the International Code of Marketing of Breast Milk Substitutes. The International Code was drafted in 1981 by the World Health Organization to protect breastfeeding from the undue influence of formula manufacturers' marketing schemes. Most specifically, it prohibits marketing and advertising to mothers and health care professionals and proscribes sample distribution under all circumstances.

While the plan does not specifically obligate infant formula manufacturers or distributors to act in accordance with the Code, many hail the brief mention as a monumental step in American policy. The Code has been virtually ignored in the US until the Subcommittee saw fit to include it in the Blueprint which brings with it the opportunity to pursue it legislatively and socially.

Baby Friendly Hospital Initiative

While the Blueprint uses a form of the Baby Friendly Hospital Initiative guidelines as the standard to which hospitals in the US should aspire, it does not specifically endorse the BFHI or recommend that hospitals seek the designation 'Baby Friendly." There are currently only 27 hospitals in the US with the 'Baby Friendly" designation, the most recent being the prestigious Boston Medical Center in 1999. Baby Friendly USA states that there are over 15,000 hospitals carrying the "Baby Friendly" seal worldwide.

Environmental Chemicals in Human Milk

The plan contains a warning about environmental pollutants that have been found in human milk without known exposure. An appendix lists the names of those found over the last 30 years. It notes, however, "effects on

the nursing child have been seen primarily in poisonings where the mother herself was clinically ill."

While the document cautions about possible contaminants in human milk, no mention is made about contaminants in artificial baby milk (ABM), a criticism echoed by several sources. "If they are going to tell mothers that their milk might be contaminated, then they should tell about contaminants present in formula so parents can make a more informed choice," stated one participant who spoke on condition of anonymity.

Breastfeeding with HIV/AIDS

The Blueprint states that HIV-infected mothers in the US should not breastfeed or give their babies expressed human milk due to the risk of transmission of the virus to the child. However, "In countries with populations at increased risk for other infectious diseases and nutritional deficiencies resulting in infant death, the mortality risks associated with not breastfeecting may outweigh the possible risk of transmission of HIV infection."

On the other hand, the section on HN/AIDS makes no mention of the feasibility of using mother's own pasteurized milk, an option gaining more attention among lactation specialists and health care professionals abroad.

The document's statement on HIVIAIDS represents current understanding of the disease, but it may not be the last word from the government. More knowledge is amassed every day on how the virus is transmitted and what factors give rise to increased risk to infants. In the future, researchers may discover how to lower the risk of transmission, making the dream of healthy nursing come true for many more mothers living with HIV/AIDS.

Making Use of the Blueprint

Despite the few shortcomings that naturally arise out of compromise, the Blueprint is an essential first step in affecting broad cultural change in the Unites States. Dr. Haynes urges all mothers wishing to get involved in creating change to, "Bring a copy of the Blueprint to every pediatrician, obstetrician, health department, state and local legislator you can find." (See below for information on how to obtain copies of the Blueprint.)

A Call for Social Action

In his opening message, Dr. Satcher sums up what he hopes for the Blueprint, "Each of us, whether we play a role at the Federal, State, local or private level, must turn these recommendations into programs best suited for our own communities. Together we can shape a future in which mothers can feel comfortable and free to breastfeed their children without societal hindrances."



  • Department of Health and Human Services/Office on Women's Health
  • To obtain copies of the Blueprint for Action on Breastfeeding, call the Department of Health and Human Services Hotline at I800-994-9662 or TDD 1-888-220-5446. The Blueprint is also available on the HHS/OWH webside at
  • Introductory packets, videos and other publications are available through Baby Friendly USA, 8 Jan Sebastian Way, Unit 22, Sandwich, MA 02563, 1-508-8888092(phone),, info at (email).
  • National Alliance for Breastfeeding Advocacy (NABA) has created Advocacy Kits to help jump start advocacy efforts. Contact Barbara Heiser, 9684 Oak Hill Drive, Elliott City, MD 21042-6321 USA 1-410-995-3726 (phone), 1-410-992-1977 (fax), BarbB13 at (email)
  • Available from LLLI catalogue: Ten Steps to Successful Breastfeeding Poster (277-16, 60¢), Baby-Friendly Hospital Initiative-2000, WABA Action Folder (843-17, $1.50), AAP Statement (288-17, $2.50), Becoming a La Leche League Leader (I 66-13, 60@t), LLLI Peer Counselor Training Information Packet (357-18, free), Breastfeeding Peer Counselor Program (340-20, free), Corporate Lactation Support
    (957-20 free).


  • Form local (state or national level) advocacy groups, perhaps under the banner of a larger group such as the National Alliance for Breastfeeding Advocacy (US).
  • Contact Baby Friendly USA for information on working to certify local hospitals "Baby Friendly."
  • Formulate plans to obtain Title V funding from State Appropriations Committees for breastfeeding promotion activities. Title V funds are federal MateirnaUChild health funds that are granted to each state. State legislators can help identify the right departments and committees to approach for funding.
  • Contact local service organizations such as the Mwanis Clubs to form strong community alliances and make use of their reach.
  • Organize fundraisers such as LLUs World Walk for Breastfeeding to promote and fund your efforts.
  • Consider becoming a Peer Counselor through LLLI's Peer Counselor Program.
  • Consider becoming a La Leche League Leader to provide the mother-to-mother
    support so important in successful breastfeeding.
  • Provide copies of the Blueprint to employers to begin educating companies on the need for their support of breastfeeding families.
  • Send copies of the Blueprint to all media (television, newspapers) involved in portrayals of breastfeeding. Follow up with phone calls and letters.


Armstrong, H. C. and Sokol, E. The International Code of Marketing of Breast Milk Substitutes: What It Means for Mothers and Babies World-wide. A Special Publication of the International Lactation Consultant Association, 1994.

Baumsiag, N. and Michels, D. Milk, Money and Madness. Westport, CT. Bergin & Garvey, 1995.

HHS Blueprint for Action on Breastfeeding. Department of Health and Human Services, Office on Women's Health, 2000.

HIV and Infant Feeding: Guidelines for Decision-Makers; 1997 Policy Statement on HIV and Infant Feeding. UNICEF Brochure, 1998.

LLLI, THE WOMANLY ART OF BREASTFEEDING, 6th Edition. Schaumburg, IL: La Leche League International, 1997.

Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK, rev. ed. Schaumburg, IL: La Leche League International, 1997.

NOTE: For more information on this document, see the LLLI Press Releases: "US Surgeon General Joins Other World-Renowned Breastfeeding and Parenting Experts at La Leche League International Conference" and "Surgeon General to Address La Leche League International Conference". There is also a report on our 2001 conference pages about the US Surgeon General's presentation about this document.

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