Commentary

The World Health Organization (WHO) global nutrition targets for 2025 include increasing the rate of exclusive breastfeeding in the first 6 months to at least 50% (http://www.who.int/nutrition/global-target-2025/en/). From 2007 until 2014, only about 36% of infants globally were exclusively breastfed from birth to 6 months (http://who.int/mediacentre/factsheets/fs342/en/). In the United States, national rates of breastfeeding initiation are 79.2%, breastfeeding at 6 months is 49.4%, and exclusive breastfeeding to 3 months is 40%—all below the 2020 Healthy People targets (https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf). Although breastfeeding initiation rates are important, continuation and exclusive breastfeeding rates are also important. Many breastfeeding families need assistance once discharged from the hospital or birth center. Problems with engorgement, sore nipples, mastitis, and perceived insufficient milk supply tend to occur after discharge. Step 10 of the WHO/UNICEF Baby-Friendly Hospital Initiative requires designated facilities to “foster the establishment of breastfeeding support groups and refer mothers to them upon discharge from the hospital or clinic” (http://www.tensteps.org/ten-steps-successful-breastfeeding.shtml). Specifically, a breastfeeding family should receive information about community breastfeeding resources prior to hospital or birth center discharge. Access to breastfeeding support and assistance is necessary for continued breastfeeding. Early postpartum support is beneficial at a critical time when breastfeeding is being established. Skilled lactation care, directly targeting a mother’s concerns, will positively affect continued breastfeeding. Community breastfeeding support improves breastfeeding successes. ¹

Grubesic and Durbin explored place and geography to better understand initial breastfeeding in Kentucky using geospatial analysis. Geospatial analysis allows researchers to explore how human factors interact with the physical environment. In the 1960s, Canadians first used geospatial analysis to catalog natural resources. Cataloguing was accomplished using the first geographic information systems (GIS), which allow users to predict, learn, and manage information about the earth and its occupants. Geographic information includes both spatial and nonspatial data. ² Nonspatial data, like demographic data, may be identified by county or census tract. Spatial data pinpoint an exact geographic location, for example, the location of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic. Geographic information systems allow interested persons to look up features of interest using location-based information, for example, the location of WIC clinics, peer-to-peer support groups, and/or International Board Certified Lactation Consultants (IBCLCs).

The authors used GIS information to examine human factors like employment status, education, ethnicity, and environmental factors like rural/urban location and breastfeeding support resources. As these authors point out, lactation support in Kentucky is primarily located in metropolitan areas and available to advantaged families. Is this distribution of lactation support typical throughout the world? They also conclude that spatial analytics can help us better understand issues surrounding breastfeeding initiation.

There are 28 105 IBCLCs worldwide (http://iblce.org/about-iblce/current-statistics-on-worldwide-ibclcs/). Many countries have no IBCLCs, whereas the United States has the most at 15 144. In the United States, the number of IBCLCs continues to increase—3.5 IBCLCs per 1000 live births through 2013. Five states have at least 6 IBCLCs per 1000 live births; there are fewer than 3 IBCLCs in 11 states. Community level data are needed regarding where these IBCLCs are located.

Grubesic and Durbin’s article raised many questions for me. What is adequate community lactation support? How can we meet Step 10 requirements if we don’t know what type of community support is available? What happens when there is no community support? It is important that we identify available breastfeeding support services in our communities—our cities, counties, communities, and countries.

All mothers should have access to support after discharge. Geographic information systems are useful for targeting available lactation support services and those areas with no lactation support. Geographic information system tools can help lactation professionals assess community support and strategize appropriate interventions for areas lacking support. Breastfeeding families deserve equal access to services. The environment, including the presence or absence of breastfeeding support, can enhance breastfeeding duration. Let’s ensure we can increase exclusive breastfeeding rates to 50% and meet the Baby-Friendly Hospital Initiative Step 10. We need to identify areas lacking lactation services and target ways to provide that needed support to mothers and babies.

Breastfeeding initiation and continuation may be affected by where a family lives. Geographic information systems (GIS) are useful tools to identify areas with low breastfeeding rates and corresponding lactation support.