breastfeeding essay conclusion

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Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991.

Nutrition During Lactation.

• Hardcopy Version at National Academies Press

1 Summary, Conclusions, and Recommendations

During the past decade, the benefits of breastfeeding have been emphasized by many authorities and organizations in the United States. Federal agencies have set specific objectives to increase the incidence and duration of breastfeeding (DHHS, 1980, 1990), and the Surgeon General has held workshops on breastfeeding and human lactation (DHHS, 1984, 1985). At the federal and state levels, the Special Supplemental Food Program for Women, Infants, and Children (WIC) has produced materials designed to promote breastfeeding (e.g., Malone, 1980; USDA, 1988). Furthermore, the Office of Maternal and Child Health has sponsored breastfeeding projects (e.g., The Steering Committee to Promote Breastfeeding in New York City, 1986), as have state health departments and others. However, less attention has been given to two general topics: (1) the effects of breastfeeding on the nutritional status and long-term health of the mother and (2) the effects of the mother's nutritional status on the volume and composition of her milk and on the potential subsequent effects of those changes on infant health. The present report was designed to address these topics.

This summary briefly describes the origin of this effort and the process; provides key definitions; reviews what was learned about who is breastfeeding in the United States and if those women are well nourished; discusses nutritional influences on milk volume or composition; and describes how breastfeeding may affect infant growth, nutrition, and health, as well as maternal health. It then presents major conclusions, clinical recommendations, and the research recommendations most directly related to the nutrition of lactating women in the United States.

• Origin Of This Study

This study was undertaken at the request of the Maternal and Child Health Program (Title V, Social Security Act) of the Health Resources and Services Administration, U.S. Department of Health and Human Services. In response to that request, the Food and Nutrition Board's Committee on Nutritional Status During Pregnancy and Lactation and its Subcommittee on Nutrition During Lactation were asked to evaluate current scientific evidence and formulate recommendations pertaining to the nutritional needs of lactating women, giving special attention to the needs of lactating adolescents; women over age 35; and women of black, Hispanic, or Southeast Asian origin. Part of this task included consideration of the effects of maternal dietary intake and nutritional status on the volume and composition of human milk, the appropriateness of various anthropometric methods for assessing nutritional status during lactation, and the effects of lactation both on maternal and infant health and on the nutritional status of both the mother and the infant.

• Approach To The Study

The study was limited to consideration of healthy U.S. women and their healthy, full-term infants. The Subcommittee on Nutrition During Lactation conducted an extensive literature review, consulted with a variety of experts, and met as a group seven times to discuss the data and draw conclusions from them. The Committee on Nutritional Status During Pregnancy and Lactation (the advisory committee) reviewed and commented on the work of the subcommittee and helped establish appropriate linkages between this report and the reports on weight gain and nutrient supplements during pregnancy contained in Nutrition During Pregnancy —a report prepared by two other subcommittees of this advisory committee (IOM, 1990). Compared with earlier reports from the National Research Council, Nutrition During Pregnancy recommended a higher range of weight gain (11.5 to 16 kg, or 25 to 35 lb, for women of normal prepregnancy weight for height). In addition, it advised routine low-dose iron supplementation during pregnancy, but supplements of other vitamins or minerals were recommended only under special circumstances.

In examining the nutritional needs of lactating women, priority was given to energy and to those nutrients believed to be consumed in amounts lower than Recommended Dietary Allowances (RDAs) by many women in the United States. These nutrients include calcium, magnesium, iron, zinc, folate, and vitamin B 6 . Careful attention was given to the effects of lactation on various indicators of nutritional status, such as measurements of levels of biochemical compounds; functions related to specific nutrients; nutrient levels in specific body compartments; and height, weight, or other indicators of body size or adiposity. The subcommittee took into consideration that weight gain recommendations for pregnant women have been raised (see Nutrition During Pregnancy [IOM, 1990]) and that average weight gains of U.S. women during pregnancy have risen over the past two decades.

When possible, a distinction was made between exclusive breastfeeding, defined as the consumption of human milk as the sole source of energy, and partial breastfeeding, defined as the consumption of human milk in combination with formula or other foods, or both.

The nutritional demands imposed by lactation were estimated from data on volume and composition of milk produced by healthy, successfully lactating women, as done in Recommended Dietary Allowances (NRC, 1989). When it was feasible, evidence relating to possible depletion of maternal stores or to a decrease in the specific nutrient content of milk resulting from low maternal intake of the nutrient was also addressed. Because of the complex relationships between the nutrition of the mother and infant, the subcommittee examined the nutrition and growth of the breastfed infant.

The terms maternal health and infant health were interpreted in a broad sense. Consideration was given to both beneficial and adverse consequences for the health of the mother and her offspring, both during lactation and long after breastfeeding has been discontinued. For the mother, there was a search for evidence of differences in outcome related to whether or not she had breastfed. For the infant, evidence was sought for differences in outcome related to the method of feeding (breast compared with bottle). The possible influences of breastfeeding on prevention or promotion of chronic disease were addressed.

To the extent possible, this report includes detailed coverage of published evidence linking maternal nutrition, breastfeeding, and maternal and infant health. Because breastfeeding is encouraged primarily as a method for promoting the health of infants, considerable attention is also directed toward infant health even when there is no established relationship to maternal nutritional status. Recognizing the serious gaps in knowledge of nutrition during lactation, the subcommittee gave much thought to establishing directions for research.

The members of the subcommittee realized that nutrition is not the sole determinant of successful breastfeeding. A network of overlapping social factors including access to maternal leave, instructions concerning breastfeeding, availability of prenatal care, the length of hospital stay following delivery, infant care in the workplace, and the public attitudes toward breastfeeding are important. Given the goals of this report, the subcommittee did not specifically address those factors, but it recognizes that they should be considered in depth by public health groups that are attempting to improve rates of breastfeeding in this and other countries.

• What Was Learned

Who Is Breastfeeding

The incidence and duration of breastfeeding changed markedly during the twentieth century—first declining, then rising, and, from the early 1980s, declining once again. Currently, women who choose to breastfeed tend to be well educated, older, and white. Data on the incidence and duration of breastfeeding in the United States are especially limited for mothers who are economically disadvantaged and for those who are members of ethnic minority groups. The best data for any minority groups are for black women. Their rates of breastfeeding are substantially lower than those for white women, but factors that distinguish breastfeeding from nonbreastfeeding women tend to be similar among black and white women. Social, cultural, economic, and psychological factors that influence infant feeding choices by adolescent mothers are not well understood. In the United States, where few employers provide paid maternity leave, return to work outside the home is associated with a shorter duration of breastfeeding, but little else is known about when mothers discontinue either exclusive or partial breastfeeding. Such data are needed to estimate the total nutrient demands of lactation.

How Can It Be Determined Whether Lactating Women Are Well Nourished

The few lactating women who have been studied in the United States have been characterized as well nourished, but this observation cannot be generalized since these subjects were principally white women with some college education. Women from less advantaged, less well studied populations may be at higher risk of nutritional problems but tend not to breastfeed.

To determine whether women are adequately nourished, investigators use biochemical or anthropometric methods, or both. For lactating women, however, there are serious gaps and limitations in the data collected with these methods. Consequently, there is no scientific basis for determining whether poor nutritional status is a problem among certain groups of these women. To identify the nutrients likely to be consumed in inadequate amounts by lactating women, the subcommittee used an approach involving nutrient densities (nutrient intakes per 1,000 kcal) calculated from typical diets of nonlactating U.S. women. That is, they made the assumption that the average nutrient densities of the diets of lactating women would be the same as those of nonlactating women but that lactating women would have higher total energy intake (and therefore higher nutrient intake). Using this approach, the nutrients most likely to be consumed in amounts lower than the RDAs for lactating women are calcium, zinc, magnesium, vitamin B 6 , and folate.

Data for U.S. women indicate that successful lactation occurs regardless of whether a woman is thin, of normal weight, or obese. Anthropometric measurements (such as weight, weight for height, and skinfold thickness) have not been useful for predicting the success of lactation among the few U.S. women who have been studied. The predictive ability is not known for anthropometric measurements that fall outside the ranges observed in these limited samples.

Lactating women eating self-selected diets typically lose weight at the rate of 0.5 to 1.0 kg (˜1 to 2 lb) per month in the first 4 to 6 months of lactation. Such weight loss is probably physiologic. During the same period, values for subscapular and suprailiac skinfold thickness also decrease; triceps skinfold thickness does not. Not all women lose weight during lactation; studies suggest that approximately 20% may maintain or gain weight.

Biochemical data for lactating women have been obtained only from small, select samples. Such data are of limited use in the clinical situation because there are no norms for lactating women, and the norms for nonpregnant, nonlactating women may not be applicable to breastfeeding women. For example, there appear to be changes in plasma volume post partum, and there are changes in blood nutrient values over the course of lactation that are unrelated to changes in plasma volume.

Does Maternal Nutritional Status or Dietary Intake Influence Milk Volume

The mean volume of milk secreted by healthy U.S. women whose infants are exclusively breastfed during the first 4 to 6 months is approximately 750 to 800 ml/day, but there is considerable variability from woman to woman and in the same woman at different times. The standard deviation of daily milk intake by infants is about 165 ml; thus, 5% of women secrete less than 550 ml or more than 1,200 ml on a given day. The major determinant of milk production is the infant's demand for milk, which in turn may be influenced by the size, age, health, and other characteristics of the infant as well as by his or her intake of supplemental foods. The potential for milk production may be considerably higher than that actually produced, as evidenced by findings that the milk volumes produced by women nursing twins or triplets are much higher than those produced by women nursing a single infant.

Studies of healthy women in industrialized countries demonstrate that milk volume is not related to maternal weight or height or indices of fatness. In developing countries, there is conflicting evidence about whether thin women produce less milk than do women with higher weight for height.

Increased maternal energy intake has not been linked with increased milk production, at least among well-nourished women in industrialized countries. Nutritional supplementation of lactating women in developing countries where undernutrition may be a problem has generally been reported to have little or no impact on milk volume, but most studies have been too small to test the hypothesis adequately and lacked the design needed for causal inference. Studies of animals indicate that there may be a threshold below which energy intake is insufficient to support normal milk production, but it is likely that most studies in humans have been conducted on women with intakes well above this postulated threshold.

The weight loss ordinarily experienced by lactating women has no apparent deleterious effects on milk production. Although lactating women typically lose 0.5 to 1 kg (˜1 to 2 lb) per month, some women lose as much as 2 kg (˜4 lb) per month and successfully maintain milk volume. Regular exercise appears to be compatible with production of an adequate volume of milk.

The influence of maternal intake of specific nutrients on milk volume has not been investigated satisfactorily. Early studies in developing countries suggest a positive association of protein intake with milk volume, but those studies remain inconclusive. Fluids consumed in excess of thirst do not increase milk volume.

Does Maternal Nutritional Status Influence Milk Composition

The composition of human milk is distinct from the milk of other mammals and from infant formulas ordinarily derived from them. Human milk is unique in its physical structure, types and concentrations of macronutrients (protein, fat, and carbohydrate), micronutrients (vitamins and minerals), enzymes, hormones, growth factors, host resistance factors, inducers/modulators of the immune system, and anti-inflammatory agents.

A number of generalizations can be made about the effects of maternal nutrition on the composition of milk (see also Table 1-1 ):

Possible Influences of Maternal Intake on the Nutrient Composition of Human Milk and Nutrients for Which Clinical Deficiency Is Recognizable in Infants.

• Even if the usual dietary intake of a macronutrient is less than that recommended in Recommended Dietary Allowances (NRC, 1989), there will be little or no effect on the total amount of that nutrient in the milk. However, the proportions of the different fatty acids in human milk vary with maternal dietary intake.
• The concentrations of major minerals (calcium, phosphorus, magnesium, sodium, and potassium) in human milk are not affected by the diet. Maternal intakes of selenium and iodine are positively related to their concentrations in human milk, but there is no convincing evidence that the concentrations of other trace elements in human milk are affected by maternal diet.
• The vitamin content of human milk is dependent upon the mother's current vitamin intake and her vitamin stores, but the strength of the relationships varies with the vitamin. Chronically low maternal intake of vitamins may result in milk that contains low amounts of these essential nutrients.
• The content of at least some nutrients in human milk may be maintained at a satisfactory level at the expense of maternal stores. This applies particularly to folate and calcium.
• Increasing the mother's intake of a nutrient to levels above the RDA ordinarily does not result in unusually high levels of the nutrient in her milk; vitamins B 6 and D, iodine, and selenium are exceptions. Studies have not been conducted to evaluate the possibility that high levels of nutrients in milk are toxic to the infant.
• Some studies suggest that poor maternal nutrition is associated with decreased concentrations of certain host resistance factors in human milk, whereas other studies do not suggest this association.

In What Ways May Breastfeeding Affect Infant Growth and Health

Infant nutrition.

Several factors influence the nutritional status of the breastfed infant: the infant's nutrient stores (which are largely determined by the length of gestation and maternal nutrition during pregnancy), the total amount of nutrients supplied by human milk (which is influenced by the extent and duration of breastfeeding), and certain genetic and environmental factors that affect the way nutrients are absorbed and used.

Human milk is ordinarily a complete source of nutrients for the exclusively breastfed infant. However, if the infant or mother is not exposed regularly to sunlight or if the mother's intake of vitamin D is low, breastfed infants may be at risk of vitamin D deficiency. Breastfed infants are susceptible to deficiency of vitamin B 12 if the mother is a complete vegetarian—even when the mother has no symptoms of that vitamin deficiency.

The risk of hemorrhagic disease of the newborn is relatively low. Nonetheless, all infants (regardless of feeding mode or of maternal nutritional status) are at some risk for this serious disease unless they are supplemented with a single dose of vitamin K at birth.

Full-term, exclusively breastfed infants ordinarily maintain a normal iron status for their first 6 months of life, regardless of maternal iron intake. Providing solid foods may reduce the percentage of iron absorbed by the partially breastfed infant, making it important in such cases to ensure that adequate iron is provided in the diet.

Growth and Development

Breastfed infants gain weight at about the same rate as formula-fed infants during the first 2 to 3 months post partum, although breastfed infants usually ingest less milk and thus have a lower energy intake. After the first few months post partum, healthy breastfed infants gain weight more slowly than those who are formula fed. In general, this pattern is not altered by the introduction of solid foods. Differences in linear growth between breastfed and formula-fed infants are small if statistical techniques are used to control differences in size at birth.

Infant Morbidity and Mortality

Several types of health problems occur less often or appear to have less serious consequences in breastfed than in formula-fed infants. These include certain infectious diseases (especially ones involving the intestinal and respiratory tracts), food allergies, and, perhaps, certain chronic diseases. There is suggestive evidence that severe maternal malnutrition might reduce the degree of immune protection afforded by human milk, but further studies will be required to address that issue.

Few infectious agents are commonly transmitted to the infant via human milk. The most prominent ones are cytomegalovirus in all populations that have been studied and human T lymphocytotropic virus type 1 (HTLV-1) in certain Asian populations. The transmission of cytomegalovirus by breastfeeding does not result in disease; the consequences of the transmission of HTLV-1 by breastfeeding are unknown. There are some case reports that indicate that human immunodeficiency virus (HIV) can be transmitted by breastfeeding as a result of the transfusion of HIV-contaminated blood during the immediate postpartum period. The likelihood of transmitting HIV via breastfeeding by women who tested seropositive for the agent during pregnancy has not been determined. Public policy on this issue has ranged from the Centers for Disease Control's recommendation not to breastfeed under these circumstances to the World Health Organization's encouragement to breastfeed, especially among women in developing countries.

In developing countries, mortality rates are lower among breastfed infants than among those who are formula fed. It is not known whether this advantage also holds in industrialized countries, in which death rates are lower in general. It is reasonable to believe that breastfeeding will lead to lower mortality among disadvantaged groups in industrialized countries if they have higher than usual infant and child mortality rates, but this issue has not been studied.

Medications, Drugs, and Environmental Contaminants

The few prescription drugs that are contraindicated during lactation because of potential harm to the infant can usually be avoided and replaced with safer acceptable ones. For example, there are a number of safe and effective substitutes for the antibiotic chloramphenicol, which is contraindicated for lactating women. If treatment with antimetabolites or radiotherapeutics is required by the mother, breastfeeding is contraindicated.

Cigarette smoking and alcohol consumption by lactating women in excess of 0.5 g/kg of maternal weight may be harmful to the infant, partly because of potential reduction in milk volume. Furthermore, a single report (Little et al., 1989) associates heavy alcohol use by the mother with retarded psychomotor development of the infant at 1 year of age. Infrequent cigarette smoking, occasional consumption of small amounts of alcohol, and moderate ingestion of caffeine-containing products are not considered to be contraindicated during breastfeeding. Use of illicit drugs is contraindicated because of the potential for drug transfer through the milk as well as hazards to the mother. Since the limited information on the impact of these habits upon the nutrition of women in the childbearing years is reviewed in Nutrition During Pregnancy (IOM, 1990), they were not considered further by this subcommittee.

In the uncommon situation of a high risk of exposure to such environmental contaminants as organochlorinated compounds (such as dichlorodiphenyl-trichloroethane [DDT] or polychlorinated biphenyls [PCBs]) or toxic metals (such as mercury), risks must be weighed against the benefits of breastfeeding for both mother and infant on a case-by-case basis. In areas of unusually high exposure, levels of the contaminant should be measured in the mother's blood and milk.

How Does Breastfeeding Affect Maternal Nutrition and Health

Breastfeeding substantially increases the mother's requirements for most nutrients. The magnitude of the total increase is most strongly affected by the extent and duration of lactation. Adequacy of intakes of calcium, magnesium, zinc, folate, and vitamin B 6 merits special attention since average intakes may be below those recommended. The net long-term effect of lactation on bone mass is uncertain. Some data associate lactation with short-term bone loss, whereas most recent studies suggest a protective long-term effect. Those data are provocative but of such preliminary nature that no definitive conclusions may be drawn from them.

Although most lactating women lose weight gradually during lactation, some do not. The influence of lactation on long-term postpartum weight retention and maternal risk of adult-onset obesity has not been determined.

A well-documented effect of lactation is delayed return to ovulation. In addition, some recent epidemiologic evidence indicates that breastfeeding may lessen the risk that the mother will develop breast cancer, but the data are not consistent across all studies.

• Conclusions And Recommendations

The major conclusions of the report are as follows.

Women living under a wide variety of circumstances in the United States and elsewhere are capable of fully nourishing their infants by breastfeeding them. Throughout its deliberations, the subcommittee was impressed by evidence that mothers are able to produce milk of sufficient quantity and quality to support growth and promote the health of infants—even when the mother's supply of nutrients and energy is limited. With few exceptions (identified later in the summary under "Infant Growth and Nutrition"), the full-term exclusively breastfed infant will be well nourished during the first 4 to 6 months after birth.

In contrast, the lactating woman is vulnerable to depletion of nutrient stores through her milk. Measures should be taken to promote food intake during lactation that will prevent net maternal losses of nutrients, especially of calcium, magnesium, zinc, folate, and vitamin B 6 .

Breastfeeding is recommended for all infants in the United States under ordinary circumstances. Exclusive breastfeeding is the preferred method of feeding for normal full-term infants from birth to age 4 to 6 months. Breastfeeding complemented by the appropriate introduction of other foods is recommended for the remainder of the first year, or longer if desired. The subcommittee and advisory committee recognize that it is difficult for some women to follow these recommendations for social or occupational reasons. In these situations, appropriate formula feeding is an acceptable alternative.

Data are lacking for use in developing strategies to identify lactating women who are at risk of depleting their own nutrient stores. Although nutrient intake appears adequate for the small number of lactating women who have been studied in the United States, evidence from U.S. surveys of nonpregnant, nonlactating women suggests that usual dietary intake of certain nutrients by disadvantaged women is likely to be somewhat lower than that by women of higher socioeconomic status. Thus, if breastfeeding rates increase among less advantaged women as a result of efforts to promote breastfeeding, it will be important to examine more completely the nutrient intake of these women during lactation.

If lactating women follow eating patterns similar to those of the average U.S. woman in sufficient quantity to meet their energy requirements, they are likely to meet the recommended intakes of all nutrients except perhaps calcium and zinc. However, if they curb their energy intakes, their intakes of several nutrients are likely to be less than the RDA.

Recommendations for Women Who Wish To Breastfeed and for Their Care Providers

Because of serious gaps in information about nutrition assessment and nutrient requirements during lactation and about effects of maternal nutrition on the wide array of components in the milk, the following recommendations should be considered preliminary. Although they reflect the best judgment of the subcommittee and advisory committee, these recommendations are open to reconsideration as the knowledge base grows.

Diet and Vitamin-Mineral Supplementation

Lactating women should be encouraged to obtain their nutrients from a well-balanced, varied diet rather than from vitamin-mineral supplements.

• Provide women who plan to breastfeed or who are already doing so with nutrition information that is culturally appropriate (that is, information that is sensitive to the foodways, eating practices, and health beliefs and attitudes of the cultural group). To facilitate the acquisition of this information, health care providers are encouraged to make effective use of teaching opportunities during prenatal visits, hospitalization following delivery, and routine postpartum visits for maternal or pediatric care.
• Encourage lactating women to follow dietary guidelines that promote a generous intake of nutrients from fruits and vegetables, whole-grain breads and cereals, calcium-rich dairy products, and protein-rich foods such as meats, fish, and legumes. Such a diet would ordinarily supply a sufficient quantity of essential nutrients. The individual recommendations should be compatible with the woman's economic situation and food preferences. The evidence does not warrant routine vitamin-mineral supplementation of lactating women.
• If dietary evaluation suggests that the diet does not provide the recommended amounts of one or more nutrients, encourage the woman to select and consume foods that are rich in those nutrients.
• For women whose eating patterns lead to a very low intake of one or more nutrients, provide individualized diet counseling (preferred) or recommend nutrient supplementation (as described in Table 1-2 ).
• Encourage sufficient intake of fluids—especially water, juice, and milk—to alleviate natural thirst. It is not necessary to encourage fluid intakes above this level.
• The elimination of major nutrient sources (e.g., all dairy products) from the maternal diet to treat allergy or colic in the breastfed infant is not recommended unless there is evidence from oral elimination-challenge studies to determine whether the mother is sensitive or intolerant to the food or that the breastfed infant reacts to the foods ingested by the mother. If a key nutrient source is eliminated from the maternal diet, the mother should be counseled on how to achieve adequate nutrient intake by substituting other foods.

Suggested Measures for Improving Nutrient Intake of Women with Restrictive Eating Patterns.

A Defined Health Care Plan for Lactating Women

There should be a well-defined plan for the health care of the lactating woman that includes screening for nutritional problems and providing dietary guidance. Since preparation for lactation should begin during the prenatal period, the physician, midwife, nutritionist, or other member of the obstetric team should introduce general information about nutrition during lactation and should screen for possible problems related to nutrition. Ideally, more extensive evaluation and counseling should take place during hospitalization for childbirth. If that is precluded by the brevity of the hospital stay, an early visit to an appropriate health care professional by the mother or a visit to the mother's home is advisable.

To implement routine screening economically and practically, the subcommittee considers it sufficient to continue the practice of weighing women (using standard procedures as described in Nutrition During Pregnancy [IOM, 1990]) at scheduled visits and to ask a few simple questions to determine the following:

• Are calcium-rich foods eaten regularly?
• Does the diet include vitamin D-fortified milk or cereal or is there adequate exposure to ultraviolet light?
• Are fruits and vegetables eaten regularly?
• Is the mother a complete vegetarian?
• Is the mother restricting her food intake severely in an attempt to lose weight or to treat certain medical conditions?
• Are there life circumstances (e.g., poverty, or abuse of drugs or alcohol) that might interfere with an adequate diet?

It is not necessary to obtain measurements of skinfold thickness or to conduct laboratory tests as a part of the routine assessment of the nutritional status of lactating women.

The subcommittee recognizes that establishing standard health care procedures for lactating women requires expanded training of health care providers. Activities to achieve this expanded training are being initiated by the Surgeon General's workshop committee comprising representatives from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and other professional organizations.

Breastfeeding Practices

Efforts to support lactation must consider breastfeeding practices.

• Because the early management of lactation has a strong influence on the establishment of an adequate milk supply, breastfeeding guidance should be provided prenatally and continued in the hospital after delivery and during the early postpartum period.
• All hospitals providing obstetric care should provide knowledgeable staff in the immediate postpartum period who have responsibility for providing support and guidance in initiating breastfeeding and measures to promote establishment of an ample supply of milk.
• Breastfeeding practices that are responsive to the infant's natural appetite should be promoted. In the first few weeks, infants should nurse at least 8 times per day, and some may nurse as often as 15 or more times per day. After the first month, infants fed on demand usually nurse 5 to 12 times per day.

Maternal Weight

Women who plan to breastfeed or who are breastfeeding should be given realistic, health-promoting advice about weight change during lactation.

• Advise women that it is normal to lose weight during the first 6 months of lactation. The average rate of weight loss is 0.5 to 1.0 kg (˜ 1 to 2 lb)/month after the first month post partum. However, not all women who breastfeed lose weight; some women gain weight post partum, whether or not they breastfeed. If a lactating woman is overweight, a weight loss of up to 2 kg (˜4.5 lb) per month is unlikely to adversely affect milk volume, but such women should be alert for any indications that the infant's appetite is not being satisfied. Rapid weight loss (>2 kg/month after the first month post partum) is not advisable for breastfeeding women.
• Advise women who choose to curb their energy intake to pay special attention to eating a balanced, varied diet and to including foods rich in calcium, zinc, magnesium, vitamin B 6 , and folate. Encourage energy intake of at least 1,800 kcal/day. Calcium, multivitamin-mineral supplements, or both may be advised when dietary sources are marginal and it is unlikely that appropriate dietary practices will or can be followed. Intakes below 1,500 kcal/day are not recommended at any time during lactation, although fasts lasting less than 1 day have not been shown to decrease milk volume. Liquid diets and weight loss medications are not recommended. Since the impact of curtailing maternal energy intake during the first 2 to 3 weeks post partum is unknown, dieting during this period is not recommended.

Maternal Substance Use and Abuse

The use of illicit drugs should be actively discouraged, and affected women (regardless of their mode of feeding) should be assisted to enter a rehabilitative program that makes provision for the infant. The use of certain legal substances by lactating women is also of concern, including the potential for alcohol abuse.

• There is no scientific evidence that consumption of alcoholic beverages has a beneficial impact on any aspect of lactation performance. If alcohol is used, advise the lactating woman to limit her intake to no more than 0.5 g of alcohol per kg of maternal body weight per day. Intake over this level may impair the milk ejection reflex. For a 60-kg (132-lb) woman, 0.5 g of alcohol per kg of body weight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer.
• Actively discourage smoking among lactating women, not only because it may reduce milk volume but because of its other harmful effects on the mother and her infant.
• Discourage intake of large quantities of coffee, other caffeine-containing beverages and medications, and decaffeinated coffee. The equivalent of 1 to 2 cups of regular coffee daily is unlikely to have a deleterious effect on the nursling, although preliminary evidence suggests that maternal coffee intake may adversely influence the iron content of milk and the iron status of the infant.

Infant Growth and Nutrition

The subcommittee recommends that health care providers be informed about the differences in growth between healthy breastfed and formula-fed infants. On average, breastfed infants gain weight more slowly than those fed formula after the first 2 to 3 months. Slower weight gain, by itself, does not justify the use of supplemental formula. When in doubt, clinicians should evaluate adequacy of growth according to the guidelines described by Lawrence (1989).

Regardless of what the mother eats, the following steps should be taken to ensure adequate nutrition of breastfed infants.

• All newborns should receive a 0.5- to 1.0-mg injection or a 1.0-to 2.0-mg oral dose of vitamin K immediately after birth regardless of the type of feeding that will be offered the infant.
• If the infant's exposure to sunlight appears to be inadequate, the infant should be given a 5- to 7.5-µg supplement of vitamin D per day.
• Fluoride supplements should be provided to breastfed infants if the fluoride content of the household drinking-water supply is low (<0.3 ppm)
• When breastfeeding is complemented by other foods, and by 6 months of age in any case, the infant should be given food rich in bioavailable iron or a daily low-dose oral iron supplement.

Infant Health

Health care providers should recognize that breastfeeding is recommended to reduce the incidence and severity of certain infectious gastrointestinal and respiratory diseases and other disorders in infancy. Breastfeeding ordinarily confers health benefits to the infant, but in certain rare cases it may pose some health risks, as indicated below.

• For mothers requiring medication and desiring to breastfeed, the clinician should select the medication least likely to pass into the milk and to the infant.
• Although medications rarely pose a problem during lactation, breastfeeding is contraindicated in the case of a few. Such drugs include antineoplastic agents, therapeutic radiopharmaceuticals, some but not all antithyroid agents, and antiprotozoan agents.
• In those rare cases when there is heavy exposure to pesticides, heavy metals, or other contaminants that may pass into the milk, breastfeeding is not recommended if maternal levels are high.

Recommendations for Nutrition Monitoring

The committee recommends that the U.S. government provide a mechanism for periodically monitoring trends in lactation and developing normative indicators of nutritional status during lactation.

• Monitoring of trends . Data are needed on the incidence and duration of breastfeeding among the population as a whole, and among some particularly vulnerable subpopulations. Exclusive, partial, and minimal breastfeeding should be distinguished; and data should be collected at several ages during infancy. Current or planned surveys by such agencies as the National Center for Health Statistics or the Nutrition Monitoring Division of the U.S. Department of Agriculture could be modified to serve these goals.
• Developing normative indicators of nutritional status . There is a need for data on dietary intakes by, and nutritional status among, lactating women and their relationship to lactation performance. Identification of groups of lactating women who are at nutritional risk is a problem of public health importance.

Research Recommendations

In its deliberations, the subcommittee was well aware that many factors (such as hospital practices, social attitudes, governmental policies, and exposure to infectious agents) may have a great influence on breastfeeding rates and lactation performance and that there is a need for studies to examine approaches that hold the most promise for improving both of these. Similarly, the subcommittee recognized the great need for studies to examine the short- and long-term benefits of breastfeeding in the United States among mothers and infants in all segments of the population, but especially among disadvantaged groups, which currently have the lowest rates of breastfeeding. Research recommendations concerning several of these issues (infant mortality, growth charts for breastfed infants, possible transmission of HIV, indicators of infant nutritional status) are contained in Chapter 10 . They have been excluded from this summary, not because they are unimportant, but rather because they relate only indirectly to the nutrition of healthy U.S. women during lactation.

• Research is needed to develop indicators of nutritional status for lactating women. First, the identification of normative values for nutritional status should be based on observations of representative, healthy, lactating women in the United States. In addition, indicators are needed of both (1) risks of adverse outcomes related to the mother's dietary intake and (2) the potential of the mother or her nursing infant to benefit from interventions designed to improve their nutritional status or health.
• Research is needed to identify groups of lactating women in the United States who are at nutritional risk or who could benefit from nutrition intervention programs. In general, it has been difficult to identify groups of mothers and infants in the United States with nutritional deficits that are severe enough to have measurable functional consequences. Priority should be given to the study of lactating women in subpopulations believed to be at risk of inadequate intake of certain nutrients, such as calcium by blacks and vitamin A by low-income women. The potential influence of culture-specific food beliefs on nutrient intake of lactating women should be included in any such investigations.
• Intervention studies of improved design and technical sophistication are needed to investigate the effects of maternal diet and nutritional status on milk volume; milk composition; infant nutritional status, growth, and health; and maternal health. The nursing dyad (the mother and her infant) has seldom been the focus of studies. Thus, a key aspect of this recommendation is concurrent examination of the mother, the volume and composition of the milk, and the infant. The design of such research needs to be adequate for causal inference; thus, if possible, it should include random assignment of lactating subjects to treatment groups. Appropriate sampling and handling of milk for the valid assessment of energy density, nutrient concentration, and total milk volume are essential, as is accurate measurement of nutrient concentrations.

With regard to the energy balance of lactating women, the threshold below which energy intake is insufficient to support adequate milk production has not yet been identified. Resolution of this question will probably require supplementation studies of women in developing countries whose diets are chronically energy deficient. Although such deficient diets are not common in the United States, identification of the level of energy intake that is too low to support lactation will be useful in establishing guidelines for women who want to breastfeed but who also want to restrict their energy intake to lose weight. Although chronically low energy intakes by women in disadvantaged populations may not be completely analogous to acute energy restriction among otherwise well-nourished women, ethical considerations limit the kinds of investigations that could directly address the influence of energy restriction. In supplementation studies, measurements should be made of lactation performance and of any impact on the mother's nutritional status and health, including the period of lactation amenorrhea.

With regard to specific nutrients, the impact of relatively low intakes of folate, vitamin B 6 , calcium, zinc, and magnesium during lactation on the mother's nutritional status and health needs to be assessed in more detail. As a part of this assessment, studies of the absorption of calcium, zinc, and magnesium during lactation will be useful. There is also a need to identify a reliable indicator of vitamin B 6 status of infants and to document the relationships between this indicator, maternal vitamin B 6 intake, and vitamin B 6 content in milk. Finally, resolution of the conflicting findings concerning the impact of maternal protein intake on milk volume would be desirable.

• DHHS (Department of Health and Human Services). 1980. Promoting Health/Preventing Disease: Objectives for the Nation . Public Health Service, U.S. Department of Health and Human Services, U.S. Government Printing Office, Washington, D.C. 102 pp.
• DHHS (Department of Health and Human Services). 1984. Report of the Surgeon General's Workshop on Breastfeeding and Human Lactation . DHHS Publ. No. HRS-D-MC 84-2. Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, Rockville, Md. 93 pp.
• DHHS (Department of Health and Human Services). 1985. Followup Report: The Surgeon General's Workshop on Breastfeeding & Human Lactation . DHHS Publ. No. HRS-D-MC 85-2. Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, Rockville, Md. 46 pp.
• DHHS (Department of Health and Human Services). 1990. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Conference Edition . U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary of Health, Washington, D.C. 672 pp.
• IOM (Institute of Medicine). 1990. Nutrition During Pregnancy: Weight Gain and Nutrient Supplements . Report of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy, Subcommittee on Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board. National Academy Press, Washington, D.C. 468 pp.
• Lawrence, R.A. 1989. Breastfeeding: A Guide for the Medical Profession , 3rd ed. C.V. Mosby, St. Louis. 652 pp.
• Little, R.E., K.W. Anderson, C.H. Ervin, B. Worthington-Roberts, and S.K. Clarren. 1989. Maternal alcohol use during breastfeeding and infant mental and motor development at one year . N. Engl. J. Med. 321:425-430. [ PubMed : 2761576 ]
• Malone, C. 1980. Breast-Feeding. Cumberland County WIC Program, People's Regional Opportunity Program, Portland, Maine . 13 pp.
• NRC (National Research Council). 1989. Recommended Dietary Allowances , 10 th ed. Report of the Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 284 pp.
• The Steering Committee to Promote Breastfeeding in New York City. 1986. The Art and Science of Breastfeeding . Division of Maternal and Child Health, Bureau of Health Care Delivery and Assistance, Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, D.C. 74 pp.
• USDA (U.S. Department of Agriculture). 1988. Promoting Breastfeeding in WIC: A Compendium of Practical Approaches . FNS-256. Food and Nutrition Service, U.S. Department of Agriculture, Alexandria, Va. 171 pp.
• Cite this Page Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. 1, Summary, Conclusions, and Recommendations.
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Essay on Breastfeeding

Students are often asked to write an essay on Breastfeeding in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Breastfeeding

What is breastfeeding.

Breastfeeding is a natural way of feeding a baby. It involves a mother giving her milk to her baby directly from her breasts. This milk is produced in the mother’s body and is rich in nutrients that are perfect for the baby’s growth and development.

Benefits of Breastfeeding

Breastfeeding has many benefits. It helps the baby grow strong and healthy. It also helps the mother and baby bond. The mother’s milk has antibodies that protect the baby from illnesses. It’s also free and always available, making it convenient.

Challenges in Breastfeeding

Some mothers may face challenges in breastfeeding. These can include pain, difficulty in the baby latching on, or not producing enough milk. It’s important to seek help from a doctor or a lactation consultant if these problems occur.

Support for Breastfeeding

Support for breastfeeding mothers is very important. Family members, friends, and healthcare providers can provide this support. They can help by offering encouragement, providing comfortable spaces for breastfeeding, and giving helpful advice.

Breastfeeding is a natural and beneficial way of feeding a baby. While it can present challenges, with the right support, these can be overcome. It’s a beautiful way to bond with the baby and provide the best nutrition.

250 Words Essay on Breastfeeding

Breastfeeding is the process of feeding a baby with milk directly from the mother’s breast. It is a natural act that has been practiced since the beginning of human existence. Breast milk is the best food source for newborns and infants.

The Importance of Breastfeeding

Breastfeeding is very important for both the baby and the mother. For the baby, breast milk provides all the necessary nutrients. It is easy to digest and helps protect the baby from illnesses. For the mother, breastfeeding can help her body recover faster after giving birth. It also creates a strong bond between the mother and the baby.

The Benefits of Breastfeeding

Breastfeeding offers many benefits. It helps the baby grow and develop properly. It also reduces the risk of the baby getting sick. For mothers, breastfeeding can help them lose weight after pregnancy. It can also lower their risk of certain health problems like breast cancer.

Breastfeeding Challenges

Even though breastfeeding is natural, it can be challenging for some mothers. Some common problems include pain, difficulty getting the baby to latch, and concerns about producing enough milk. But with support and practice, most of these challenges can be overcome.

There are many resources available to support breastfeeding mothers. These include lactation consultants, breastfeeding classes, and support groups. Remember, it’s okay to ask for help if you’re having trouble with breastfeeding.

500 Words Essay on Breastfeeding

Understanding breastfeeding.

Breastfeeding is a natural process where a mother feeds her baby with milk produced from her breasts. It’s the first food a baby eats after they are born. This milk is rich in nutrients, which helps the baby grow strong and healthy. It’s the best food for newborns and infants.

Benefits of Breastfeeding for Babies

Breastfeeding offers many benefits to babies. First, breast milk has all the necessary nutrients that a baby needs for the first six months of life. It has proteins, fats, vitamins, and minerals in the right amounts. It also has antibodies, which are like soldiers in our bodies. They fight off harmful germs and keep the baby healthy.

Benefits of Breastfeeding for Mothers

Not only babies, but mothers also gain from breastfeeding. It helps the mother’s body recover from childbirth more quickly. It can also help the mother lose the weight she gained during pregnancy.

Breastfeeding can also lower the mother’s risk of getting certain diseases later in life. These include breast cancer, ovarian cancer, and type 2 diabetes. Besides health benefits, breastfeeding also helps to build a strong emotional bond between the mother and the baby.

Challenges of Breastfeeding

But don’t worry, help is available. Doctors, nurses, and lactation consultants can provide support and advice to make breastfeeding easier. They can teach mothers how to position the baby correctly and how to handle common breastfeeding problems.

In conclusion, breastfeeding is a wonderful gift that mothers can give to their babies. It provides the best nutrition for the baby and offers many health benefits for both the mother and the baby. Despite the challenges, with the right support and guidance, most mothers can successfully breastfeed their babies. Remember, every drop of breast milk counts, and every breastfeeding journey is unique and special.

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• Open access
• Published: 26 November 2021

Women’s Perceptions and Experiences of Breastfeeding: a scoping review of the literature

• Bridget Beggs 1 ,
• Liza Koshy 1 &
• Elena Neiterman 1  

BMC Public Health volume  21 , Article number:  2169 ( 2021 ) Cite this article

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Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization. While the literature exploring breastfeeding beliefs and practices is growing, it offers various and sometimes conflicting explanations regarding women’s attitudes towards and experiences of breastfeeding. This research explores existing empirical literature regarding women’s perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices.

This paper uses a scoping review methodology developed by Arksey and O’Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of keywords. After removing duplicates, papers published in 2010–2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data.

In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it difficult to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women’s decision to breastfeed.

While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. It is important to acknowledge that breastfeeding is associated with challenges and provide adequate supports for mothers so that their experiences can be improved, and breastfeeding rates can reach those identified by the World Health Organization.

Peer Review reports

Public health efforts to educate parents about the importance of breastfeeding can be dated back to the early twentieth century [ 1 ]. The World Health Organization is aiming to have at least half of all the mothers worldwide exclusively breastfeeding their infants in the first 6 months of life by the year 2025 [ 2 ], but it is unlikely that this goal will be achieved. Only 38% of the global infant population is exclusively breastfed between 0 and 6 months of life [ 2 ], even though breastfeeding initiation rates have shown steady growth globally [ 3 ]. The literature suggests that while many mothers intend to breastfeed and even make an attempt at initiation, they do not always maintain exclusive breastfeeding for the first 6 months of life [ 4 , 5 ]. The literature identifies various barriers, including return to paid employment [ 6 , 7 ], lack of support from health care providers and significant others [ 8 , 9 ], and physical challenges [ 9 ] as potential factors that can explain premature cessation of breastfeeding.

From a public health perspective, the health benefits of breastfeeding are paramount for both mother and infant [ 10 , 11 ]. Globally, new mothers following breastfeeding recommendations could prevent 974,956 cases of childhood obesity, 27,069 cases of mortality from breast cancer, and 13,644 deaths from ovarian cancer per year [ 11 ]. Global economic loss due to cognitive deficiencies resulting from cessation of breastfeeding has been calculated to be approximately USD $285.39 billion dollars annually [ 11 ]. Evidently, increasing exclusive breastfeeding rates is an important task for improving population health outcomes. While public health campaigns targeting pregnant women and new mothers have been successful in promoting breastfeeding, they also have been perceived as too aggressive [ 12 ] and failing to consider various structural and personal barriers that may impact women’s ability to breastfeed [ 1 ]. In some cases, public health messaging itself has been identified as a barrier due to its rigid nature and its lack of flexibility in guidelines [ 13 ]. Hence, while the literature on women’s perceptions regarding breastfeeding and their experiences with breastfeeding has been growing [ 14 , 15 , 16 ], it offers various, and sometimes contradictory, explanations on how and why women initiate and maintain breastfeeding and what role public health messaging plays in women’s decision to breastfeed.

The complex array of the barriers shaping women’s experiences of breastfeeding can be broadly categorized utilizing the socioecological model, which suggests that individuals’ health is a result of the interplay between micro (individual), meso (institutional), and macro (social) factors [ 17 ]. Although previous studies have explored barriers and supports to breastfeeding, the majority of articles focus on specific geographic areas (e.g. United States or United Kingdom), workplaces, or communities. In addition, very few articles focus on the analysis of the interplay between various micro, meso, and macro-level factors in shaping women’s experiences of breastfeeding. Synthesizing the growing literature on the experiences of breastfeeding and the factors shaping these experiences, offers researchers and public health professionals an opportunity to examine how various personal and institutional factors shape mothers’ breastfeeding decision-making. This knowledge is needed to identify what can be done to improve breastfeeding rates and make breastfeeding a more positive and meaningful experience for new mothers.

The aim of this scoping review is to synthesize evidence gathered from empirical literature on women’s perceptions about and experiences of breastfeeding. Specifically, the following questions are examined:

What does empirical literature report on women’s perceptions on breastfeeding?

What barriers do women face when they attempt to initiate or maintain breastfeeding?

What supports do women need in order to initiate and/or maintain breastfeeding?

Focusing on women’s experiences, this paper aims to contribute to our understanding of women’s decision-making and behaviours pertaining to breastfeeding. The overarching aim of this review is to translate these findings into actionable strategies that can streamline public health messaging and improve breastfeeding education and supports offered by health care providers working with new mothers.

This research utilized Arksey & O’Malley’s [ 18 ] framework to guide the scoping review process. The scoping review methodology was chosen to explore a breadth of literature on women’s perceptions about and experiences of breastfeeding. A broad research question, “What does empirical literature tell us about women’s experiences of breastfeeding?” was set to guide the literature search process.

Search methods

The review was undertaken in five steps: (1) identifying the research question, (2) identifying relevant literature, (3) iterative selection of data, (4) charting data, and (5) collating, summarizing, and reporting results. The inclusion criteria were set to empirical articles published between 2010 and 2020 in peer-reviewed journals with a specific focus on women’s self-reported experiences of breastfeeding, as well as how others see women’s experiences of breastfeeding. The focus on women’s perceptions of breastfeeding was used to capture the papers that specifically addressed their experiences and the barriers that they may encounter while breastfeeding. Only articles written in English were included in the review. The keywords utilized in the search strategy were developed in collaboration with a librarian (Table  1 ). PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched for the empirical literature, yielding a total of 2885 results.

Search outcome

The articles deemed to fit the inclusion criteria ( n  = 213) were imported into RefWorks, an online reference manager tool and further screened for eligibility (Fig.  1 ). After the removal of 61 duplicates and title/abstract screening, 152 articles were kept for full-text review. Two independent reviewers assessed the papers to evaluate if they met the inclusion criteria of having an explicit analytic focus on women’s experiences of breastfeeding.

Prisma Flow Diagram

Quality appraisal

Consistent with scoping review methodology [ 18 ], the quality of the papers included in the review was not assessed.

Data abstraction

A literature extraction tool was created in MS Excel 2016. The data extracted from each paper included: (a) authors names, (b) title of the paper, (c) year of publication, (d) study objectives, (e) method used, (f) participant demographics, (g) country where the study was conducted, and (h) key findings from the paper.

Thematic analysis was utilized to identify key topics covered by the literature. Two reviewers independently read five papers to inductively generate key themes. This process was repeated until the two reviewers reached a consensus on the coding scheme, which was subsequently applied to the remainder of the articles. Key themes were added to the literature extraction tool and each paper was assigned a key theme and sub-themes, if relevant. The themes derived from the analysis were reviewed once again by all three authors when all the papers were coded. In the results section below, the synthesized literature is summarized alongside the key themes identified during the analysis.

In total, 59 peer-reviewed articles were included in the review. Since the review focused on women’s experiences of breastfeeding, as would be expected based on the search criteria, the majority of articles ( n  = 42) included in the sample were qualitative studies, with ten utilizing a mixed method approach (Fig.  2 ). Figure  3 summarizes the distribution of articles by year of publication and Fig.  4 summarizes the geographic location of the study.

Types of Articles

Years of Publication

Countries of Focus Examined in Literature Review

Perceptions about breastfeeding

Women’s perceptions about breastfeeding were covered in 83% ( n  = 49) of the papers. Most articles ( n  = 31) suggested that women perceived breastfeeding as a positive experience and believed that breastfeeding had many benefits [ 19 , 20 ]. The phrases “breast is best” and “breastmilk is best” were repeatedly used by the participants of studies included in the reviewed literature [ 21 ]. Breastfeeding was seen as improving the emotional bond between the mother and the child [ 20 , 22 , 23 ], strengthening the child’s immune system [ 24 , 25 ], and providing a booster to the mother’s sense of self [ 1 , 26 ]. Convenience of breastfeeding (e.g., its availability and low cost) [ 19 , 27 ] and the role of breastfeeding in weight loss during the postpartum period were mentioned in the literature as other factors that positively shape mothers’ perceptions about breastfeeding [ 28 , 29 ].

The literature suggested that women’s perceptions of breastfeeding and feeding choices were also shaped by the advice of healthcare providers [ 30 , 31 ]. Paradoxically, messages about the importance and relative simplicity of breastfeeding may also contribute to misalignment between women’s expectations and the actual experiences of breastfeeding [ 32 ]. For instance, studies published in Canada and Sweden reported that women expected breastfeeding to occur “naturally”, to be easy and enjoyable [ 23 ]. Consequently, some women felt unprepared for the challenges associated with initiation or maintenance of breastfeeding [ 31 , 33 ]. The literature pointed out that mothers may feel overwhelmed by the frequency of infant feedings [ 26 ] and the amount as well as intensity of physical difficulties associated with breastfeeding initiation [ 33 ]. Researchers suggested that since many women see breastfeeding as a sign of being a “good” mother, their inability to breastfeed may trigger feelings of personal failure [ 22 , 34 ].

Women’s personal experiences with and perceptions about breastfeeding were also influenced by the cultural pressure to breastfeed. Welsh mothers interviewed in the UK, for instance, revealed that they were faced with judgement and disapproval when people around them discovered they opted out of breastfeeding [ 35 ]. Women recalled the experiences of being questioned by others, including strangers, when they were bottle feeding their infants [ 9 , 35 , 36 ].

Barriers to breastfeeding

The vast majority ( n  = 50) of the reviewed literature identified various barriers for successful breastfeeding. A sizeable proportion of literature (41%, n  = 24) explored women’s experiences with the physical aspects of breastfeeding [ 23 , 33 ]. In particular, problems with latching and the pain associated with breastfeeding were commonly cited as barriers for women to initiate breastfeeding [ 23 , 28 , 37 ]. Inadequate milk supply, both actual and perceived, was mentioned as another barrier for initiation and maintenance of breastfeeding [ 33 , 37 ]. Breastfeeding mothers were sometimes unable to determine how much milk their infants consumed (as opposed to seeing how much milk the infant had when bottle feeding), which caused them to feel anxious and uncertain about scheduling infant feedings [ 28 , 37 ]. Women’s inability to overcome these barriers was linked by some researchers to low self-efficacy among mothers, as well as feeling overwhelmed or suffering from postpartum depression [ 38 , 39 ].

In addition to personal and physical challenges experienced by mothers who were planning to breastfeed, the literature also highlighted the importance of social environment as a potential barrier to breastfeeding. Mothers’ personal networks were identified as a key factor in shaping their breastfeeding behaviours in 43 (73%) articles included in this review. In a study published in the UK, lack of role models – mothers, other female relatives, and friends who breastfeed – was cited as one of the potential barriers for breastfeeding [ 36 ]. Some family members and friends also actively discouraged breastfeeding, while openly questioning the benefits of this practice over bottle feeding [ 1 , 17 , 40 ]. Breastfeeding during family gatherings or in the presence of others was also reported as a challenge for some women from ethnic minority groups in the United Kingdom and for Black women in the United States [ 41 , 42 ].

The literature reported occasional instances where breastfeeding-related decisions created conflict in women’s relationships with significant others [ 26 ]. Some women noted they were pressured by their loved one to cease breastfeeding [ 22 ], especially when women continued to breastfeed 6 months postpartum [ 43 ]. Overall, the literature suggested that partners play a central role in women’s breastfeeding practices [ 8 ], although there was no consistency in the reviewed papers regarding the partners’ expressed level of support for breastfeeding.

Knowledge, especially practical knowledge about breastfeeding, was mentioned as a barrier in 17% ( n  = 10) of the papers included in this review. While health care providers were perceived as a primary source of information on breastfeeding, some studies reported that mothers felt the information provided was not useful and occasionally contained conflicting advice [ 1 , 17 ]. This finding was reported across various jurisdictions, including the United States, Sweden, the United Kingdom and Netherlands, where mothers reported they had no support at all from their health care providers which made it challenging to address breastfeeding problems [ 26 , 38 , 44 ].

Breastfeeding in public emerged as a key barrier from the reviewed literature and was cited in 56% ( n  = 33) of the papers. Examining the experiences of breastfeeding mothers in the United States, Spencer, Wambach, & Domain [ 45 ] suggested that some participants reported feeling “erased” from conversations while breastfeeding in public, rendering their bodies symbolically invisible. Lack of designated public spaces for breastfeeding forced many women to alter their feeding in public and to retreat to a private or a more secluded space, such as one’s personal car [ 25 ]. The oversexualization of women’s breasts was repeatedly noted as a core reason for the United States women’s negative experiences and feelings of self-consciousness about breastfeeding in front of others [ 45 ]. Studies reported women’s accounts of feeling the disapproval or disgust of others when breastfeeding in public [ 46 , 47 ], and some reported that women opted out of breastfeeding in public because they did not want to make those around them feel uncomfortable [ 25 , 40 , 48 ].

Finally, return to paid employment was noted in the literature as a significant challenge for continuation of breastfeeding [ 48 ]. Lack of supportive workplace environments [ 39 ] or inability to express milk were cited by women as barriers for continuing breastfeeding in the United States and New Zealand [ 39 , 49 ].

Supports needed to maintain breastfeeding

Due to the central role family members played in women’s experiences of breastfeeding, support from partners as well as female relatives was cited in the literature as key factors  shaping women’s breastfeeding decisions [ 1 , 9 , 48 ]. In the articles published in Canada, Australia, and the United Kingdom, supportive family members allowed women to share the responsibility of feeding and other childcare activities, which reduced the pressures associated with being a new mother [ 19 , 20 ]. Similarly, encouragement, breastfeeding advice, and validation from healthcare professionals were identified as positively impacting women’s experiences with breastfeeding [ 1 , 22 , 28 ].

Community resources, such as peer support groups, helplines, and in-home breastfeeding support provided mothers with the opportunity to access help when they need it, and hence were reported to be facilitators for breastfeeding [ 19 , 22 , 33 , 44 ]. An increase in the usage of social media platforms, such as Facebook, among breastfeeding mothers for peer support were reported in some studies [ 47 ]. Public health breastfeeding clinics, lactation specialists, antenatal and prenatal classes, as well as education groups for mothers were identified as central support structures for the initiation and maintenance of breastfeeding [ 23 , 24 , 28 , 33 , 39 , 50 ]. Based on the analysis of the reviewed literature, however, access to these services varied greatly geographically and by socio-economic status [ 33 , 51 ]. It is also important to note that local and cultural context played a significant role in shaping women’s perceptions of breastfeeding. For example, a study that explored women’s breastfeeding experiences in Iceland highlighted the importance of breastfeeding in Icelandic society [ 52 ]. Women are expected to breastfeed and the decision to forgo breastfeeding is met with disproval [ 52 ]. Cultural beliefs regarding breastfeeding were also deemed important in the study of  Szafrankska and Gallagher (2016), who noted that Polish women living in Ireland had a much higher rate of initiating breastfeeding compared to Irish women [ 53 ]. They attributed these differences to familial and societal expectations regarding breastfeeding in Poland [ 53 ].

Overall, the reviewed literature suggested that women faced socio-cultural pressure to breastfeed their infants [ 36 , 40 , 54 ]. Women reported initiating breastfeeding due to recognition of the many benefits it brings to the health of the child, even when they were reluctant to do it for personal reasons [ 8 ]. This hints at the success of public health education campaigns on the benefits of breastfeeding, which situates breastfeeding as a new cultural norm [ 24 ].

This scoping review examined the existing empirical literature on women’s perceptions about and experiences of breastfeeding to identify how public health messaging can be tailored to improve breastfeeding rates. The literature suggests that, overall, mothers are aware of the positive impacts of breastfeeding and have strong motivation to breastfeed [ 37 ]. However, women who chose to breastfeed also experience many barriers related to their social interactions with significant others and their unique socio-cultural contexts [ 25 ]. These different factors, summarized in Fig.  5 , should be considered in developing public health activities that promote breastfeeding. Breastfeeding experiences for women were very similar across the United Kingdom, United States, Canada, and Australia based on the studies included in this review. Likewise, barriers and supports to breastfeeding identified by women across the countries situated in the global north were quite similar. However, local policy context also impacted women’s experiences of breastfeeding. For example, maintaining breastfeeding while returning to paid employment has been identified as a challenge for mothers in the United States [ 39 , 45 ], a country with relatively short paid parental leave. Still, challenges with balancing breastfeeding while returning to paid employment were also noticed among women in New Zealand, despite a more generous maternity leave [ 49 ]. This suggests that while local and institutional policies might shape women’s experiences of breastfeeding, interpersonal and personal factors can also play a central role in how long they breastfeed their infants. Evidently, the importance of significant others, such as family members or friends, in providing support to breastfeeding mothers was cited as a key facilitator for breastfeeding across multiple geographic locations [ 29 , 34 , 48 ]. In addition, cultural beliefs and practices were also cited as an important component in either promoting breastfeeding or deterring women’s desire to initiate or maintain breastfeeding [ 15 , 29 , 37 ]. Societal support for breastfeeding and cultural practices can therefore partly explain the variation in breastfeeding rates across different countries [ 15 , 21 ]. Figure  5 summarizes the key barriers identified in the literature that inhibit women’s ability to breastfeed.

Barriers to Breastfeeding

At the individual level, women might experience challenges with breastfeeding stemming from various physiological and psychological problems, such as issues with latching, perceived or actual lack of breastmilk, and physical pain associated with breastfeeding. The onset of postpartum depression or other psychological problems may also impact women’s ability to breastfeed [ 54 ]. Given that many women assume that breastfeeding will happen “naturally” [ 15 , 40 ] these challenges can deter women from initiating or continuing breastfeeding. In light of these personal challenges, it is important to consider the potential challenges associated with breastfeeding that are conveyed to new mothers through the simplified message “breast is best” [ 21 ]. While breastfeeding may come easy to some women, most papers included in this review pointed to various challenges associated with initiating or maintaining breastfeeding [ 19 , 33 ]. By modifying public health messaging regarding breastfeeding to acknowledge that breastfeeding may pose a challenge and offering supports to new mothers, it might be possible to alleviate some of the guilt mothers experience when they are unable to breastfeed.

Barriers that can be experienced at the interpersonal level concern women’s communication with others regarding their breastfeeding choices and practices. The reviewed literature shows a strong impact of women’s social networks on their decision to breastfeed [ 24 , 33 ]. In particular, significant others – partners, mothers, siblings and close friends – seem to have a considerable influence over mothers’ decision to breastfeed [ 42 , 53 , 55 ]. Hence, public health messaging should target not only mothers, but also their significant others in developing breastfeeding campaigns. Social media may also be a potential medium for sharing supports and information regarding breastfeeding with new mothers and their significant others.

There is also a strong need for breastfeeding supports at the institutional and community levels. Access to lactation consultants, sound and practical advice from health care providers, and availability of physical spaces in the community and (for women who return to paid employment) in the workplace can provide more opportunities for mothers who want to breastfeed [ 18 , 33 , 44 ]. The findings from this review show, however, that access to these supports and resources vary greatly, and often the women who need them the most lack access to them [ 56 ].

While women make decisions about breastfeeding in light of their own personal circumstances, it is important to note that these circumstances are shaped by larger structural, social, and cultural factors. For instance, mothers may feel reluctant to breastfeed in public, which may stem from their familiarity with dominant cultural perspectives that label breasts as objects for sexualized pleasure [ 48 ]. The reviewed literature also showed that, despite the initial support, mothers who continue to breastfeed past the first year may be judged and scrutinized by others [ 47 ]. Tailoring public health care messaging to local communities with their own unique breastfeeding-related beliefs might help to create a larger social change in sociocultural norms regarding breastfeeding practices.

The literature included in this scoping review identified the importance of support from community services and health care providers in facilitating women’s breastfeeding behaviours [ 22 , 24 ]. Unfortunately, some mothers felt that the support and information they received was inadequate, impractical, or infused with conflicting messaging [ 28 , 44 ]. To make breastfeeding support more accessible to women across different social positions and geographic locations, it is important to acknowledge the need for the development of formal infrastructure that promotes breastfeeding. This includes training health care providers to help women struggling with breastfeeding and allocating sufficient funding for such initiatives.

Overall, this scoping review revealed the need for healthcare professionals to provide practical breastfeeding advice and realistic solutions to women encountering difficulties with breastfeeding. Public health messaging surrounding breastfeeding must re-invent breastfeeding as a “family practice” that requires collaboration between the breastfeeding mother, their partner, as well as extended family to ensure that women are supported as they breastfeed [ 8 ]. The literature also highlighted the issue of healthcare professionals easily giving up on women who encounter problems with breastfeeding and automatically recommending the initiation of formula use without further consideration towards solutions for breastfeeding difficulties [ 19 ]. While some challenges associated with breastfeeding are informed by local culture or health care policies, most of the barriers experienced by breastfeeding women are remarkably universal. Women often struggle with initiation of breastfeeding, lack of support from their significant others, and lack of appropriate places and spaces to breastfeed [ 25 , 26 , 33 , 39 ]. A change in public health messaging to a more flexible messaging that recognizes the challenges of breastfeeding is needed to help women overcome negative feelings associated with failure to breastfeed. Offering more personalized advice and support to breastfeeding mothers can improve women’s experiences and increase the rates of breastfeeding while also boosting mothers’ sense of self-efficacy.

Limitations

This scoping review has several limitations. First, the focus on “women’s experiences” rendered broad search criteria but may have resulted in the over or underrepresentation of specific findings in this review. Also, the exclusion of empirical work published in languages other than English rendered this review reliant on the papers published predominantly in English-speaking countries. Finally, consistent with Arksey and O’Malley’s [ 18 ] scoping review methodology, we did not appraise the quality of the reviewed literature. Notwithstanding these limitations, this review provides important insights into women’s experiences of breastfeeding and offers practical strategies for improving dominant public health messaging on the importance of breastfeeding.

Women who breastfeed encounter many difficulties when they initiate breastfeeding, and most women are unsuccessful in adhering to current public health breastfeeding guidelines. This scoping review highlighted the need for reconfiguring public health messaging to acknowledge the challenges many women experience with breastfeeding and include women’s social networks as a target audience for such messaging. This review also shows that breastfeeding supports and counselling are needed by all women, but there is also a need to tailor public health messaging to local social norms and culture. The role social institutions and cultural discourses have on women’s experiences of breastfeeding must also be acknowledged and leveraged by health care professionals promoting breastfeeding.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

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The authors would like to acknowledge the assistance of Jackie Stapleton, the University of Waterloo librarian, for her assistance with developing the search strategy used in this review.

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BB was responsible for the formal analysis and organization of the review. LK was responsible for data curation, visualization and writing the original draft. EN was responsible for initial conceptualization and writing the original draft. BB and LK were responsible for reviewing and editing the manuscript. All authors read and approved the final manuscript.

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Beggs, B., Koshy, L. & Neiterman, E. Women’s Perceptions and Experiences of Breastfeeding: a scoping review of the literature. BMC Public Health 21 , 2169 (2021). https://doi.org/10.1186/s12889-021-12216-3

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Benefits of Breastfeeding Versus Formula-Feeding Essay

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Introduction

History of breastfeeding, advantages of breastfeeding over bottle-feeding, advantages of bottle-feeding over breastfeeding, importance of research.

Nowadays, one of the most challenging tasks many young mothers have to face is the necessity of choosing between breastfeeding and formula/bottle-feeding. It is easy to surf the web and find several correlational, cohort, or experimental studies where different authors defend their positions on the chosen topic. On the one hand, breastfeeding is deemed preferable due to its perfect balance of nutrients, protection against allergies and diseases, and easy digestion for babies.

On the other hand, formula-feeding is characterized by certain merits, such as the possibility for another person to feed a baby anytime, a mother’s freedom to be involved in different activities or even start working, and no dependence on the mother-child diet. Although some mothers might still choose to bottle-feed their infants with formula due to practical concerns, research shows that breastfeeding is preferable due to its impact on maternal and child health.

The history of breastfeeding is as long as the existence of life on the planet. In ancient cultures and in modern times women continued to breastfeed children to nourish them. However, some cultures did not focus on breastfeeding as an intimate link between the mother and the child. For example, while most ancient civilizations had mothers feed their children, more structurally segregated Western European countries created the role of a wet nurse – a woman whose job was to breastfeed children of royal and noblewomen.

Various cultures assigned different meanings to the process of breastfeeding and followed their sets of rules to determine how, when, and where to feed children. In ancient times, Egyptian and Greek civilizations did not treat breastfeeding as a job fit only for common folk and allowed women of all social statuses to feed their children. Nevertheless, wet nurses still had a place in the culture and were respected for their work. In Japan, breastfeeding was common but declined in popularity in the 20th century due to the interest of mothers in modern medicine and artificial feeding options. However, with a well-thought-out campaign, the government was able to elevate breastfeeding to be the primary choice of mothers in the country.

Western countries faced similar challenges earlier, during the middle ages, and then again at the beginning of the 19th century. Here, the history of breastfeeding was firmly connected to the cultural aspects of these civilizations. Countries with a rigid societal structure viewed breastfeeding as a job for lower classes and the process became plagued with many preconceptions. The combination of men’s opinions on breastfeeding and their lack of medical knowledge pressured women into declining breastfeeding. Later efforts in raising the popularity of breastfeeding emphasized health benefits for mothers and children and an establishment of an emotional connection between the parent and the child.

The breastfeeding vs. formula-feeding dilemma appears as soon as women find out that they are pregnant. They have to evaluate all the pros and cons of their pregnancy outcomes, understand if they want to take sick leave, and recognize the relationship between baby feeding and health. All circumstances have to be taken into consideration to make the best decision. Both methods, breastfeeding and bottle-feeding, have their advantages and disadvantages.

Sometimes, it is hard to make a choice, and extensive research is required. This dilemma may be considered through the prism of health, social factors, emotional stability, and personal convenience. In this paper, special attention to the works by Belfort et al. (2013), Boué et al. (2018), Fallon, Komninou, Bennett, Halford, and Harrold (2017), Horta and Victoria (2013) will be made to clarify if the benefits of breastfeeding prevail over the benefits of bottle-feeding in terms of health.

The first months after a baby is born may be defined as the period when it is necessary to choose to breastfeed over bottle-feeding and establish a strong mother-child contact. There are many short- and long-term health benefits for both participants of a process that may be enhanced through its exclusivity and duration (Fallon et al., 2017). The representatives of the World Health Organization admit that exclusive breastfeeding during the first six months can decrease morbidity from allergies and gastrointestinal diseases due to the presence of nutritional benefits in human milk (Horta & Victoria, 2013).

For example, the nutrient n-3 fatty acid docosahexaenoic acid (DHA) found in breast milk aims at improving the functions of the brain (Belfort et al., 2013). Therefore, when the advantages of breastfeeding have to be identified, this point plays an important role.

In addition to nutrients, breastfeeding is a method in terms of which infants can control their condition and take as much amount of milk as they may need. They do not take more or less, just the portion they need at that moment. Mothers should take responsibility for the quality of milk they offer to their children and follow simple hygiene rules and schedules.

Another important aspect that underlines the necessity of breastfeeding is the protection of children against diseases and other health threats. Probiotics and prebiotics, also known as important live microorganisms, protect the body and establish a gut microbiota that promotes positive health outcomes through the creation of barriers to pathogens, improvement of metabolic function, and energy salvation (Boué et al., 2018). Stomach viruses and other conditions that may cause discomfort are also significantly reduced with breastfeeding.

Allergies pose another serious threat to infants. It is hard for a mother to comprehend what product is safe for a child and what ingredients should be avoided. Breast milk is characterized by appropriate natural filters and the possibility to avoid ingesting real food until the body is properly developed. It helps babies digest food and uses the enzymes in a mother’s milk to speed up digestion and avoid complications.

Finally, breastfeeding is preferable because of the promotion of the bond between a mother and a child, and its price. This process of feeding is a unique chance for mothers to be relieved from anxiety and develop an emotional attachment to their children. Sometimes, it is not enough for mothers to talk to their children, observe their smile, and touch them. Breastfeeding is an exclusive type of contact that is not available to other people, including even the closest family members. This relationship is priceless. Indeed, when talking about the price, it is also necessary to admit that compared to bottle-feeding, which requires buying special ingredients, bottles, and hygienic goods, breastfeeding is a cheap process with no additional products except a mother and a child being present in it.

However, despite all the benefits of breastfeeding, it is wrong to believe that formula-feeding is solely negative or does not have important characteristics that breast-feeding cannot offer. Many significant aspects should be considered by mothers who still have some doubts about their choice. For example, some mothers may be challenged by poor health or inappropriate health status for breastfeeding.

Mothers may suffer from the inability to breastfeed as they are unable to produce milk or the milk is of poor quality. In these cases, mothers still want to find new ways to be close to their children and support them and formula-feeding is one option that they can rely on on under any condition. No connection between the health problems of a mother and a child is observed. Bottle-feeding creates several good opportunities for mothers to stabilize their personal and professional lives. Fallon et al. (2017) admit that the choice of the formula is usually explained by breastfeeding management, not biological issues. Therefore, the advantages of bottle-feeding over breastfeeding in terms of health care are based on the emotional aspects and mental health of mothers.

An understanding of the differences between breastfeeding and formula-feeding should be based on thorough research. For example, a study developed by Horta and Victoria (2013) asserts that formula-fed children may have serious hormonal and insulin responses to feeding and an increased number of adipocytes compared to breast-fed children. Bottles have to be cleaned and properly stored to avoid the growth of bacteria that may harm a child (Boué et al., 2018). Finally, the study by Fallon et al. (2017) shows that mothers may feel guilt and stigma in case they choose formula as the main method of feeding. All these studies prove that research is a crucial step to comprehend the benefits of breastfeeding nowadays.

In general, it is hard to neglect the existing dilemma of breastfeeding vs. bottle-feeding. Mothers have to weigh all the pros and cons of both processes and understand what method is more appropriate to them. Regarding the chosen cohort and experimental studies and past research, it is concluded that despite several positive socio-cultural and emotional outcomes of formula-feeding, breastfeeding remains the preferred method due to its effects on health, the establishment of mother-child relations, and the promotion of the cognitive development of children.

Belfort, M. B., Rifas-Shiman, S. L., Kleinman, K. P., Guthrie, L. B., Bellinger, D. C., Taveras, E. M.,… Oken, E. (2013). Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity. JAMA Pediatrics, 167 (9), 836-844.

Boué, G., Cummins, E., Guillou, S., Antignac, J. P., Le Bizec, B., & Membré, J. M. (2018). Public health risks and benefits associated with breast milk and infant formula consumption. Critical Reviews in Food Science and Nutrition, 58 (1), 126-145.

Fallon, V., Komninou, S., Bennett, K. M., Halford, J. C., & Harrold, J. A. (2017). The emotional and practical experiences of formula‐feeding mothers. Maternal & Child Nutrition, 13 (4), 1-14.

Horta, B. L., & Victoria, C. G. (2013). Long-term effects of breastfeeding: A systematic review . Geneva, Switzerland: WHO Press.

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Persuasive Speech on Breastfeeding

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Sample Argumentative Essay On Breastfeeding In Public Lactation And The Law

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Topic: Milk , Law , Women , Parents , Breastfeeding , Family , Children , Nursing

Words: 1500

Published: 03/22/2020

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Essays on Breastfeeding in Public: Lactation and the Law

Introduction Breastfeeding is a natural and the most efficient way of nursing infants. However, breastfeeding in public has been taken to negatively make it impossible for mothers to feed their babies comfortably in public. In the United States, breasts have been sexualized, and used in advertisements and at multiple restaurants. Furthermore, breastfeeding in public has been taken negatively, ascetic, inappropriate, and tawdry. There are unique benefits of breastfeeding to the baby (Humphries, 2011). These benefits include advanced cognitive development, low rates of childhood obesity, and small risks of asthma among others. Companies manufacturing formula milk have developed products that resemble all the nutrients found in the breast milk. However, breastfeeding cannot be compared to formula milk. If breastfeeding is supported, mothers will be comfortable nursing their babies in public, thus providing them with the best nourishment (Humphries, 2011).

Benefits of breastfeeding to mother and child

Breast milk protects the baby from long term illnesses. Breast milk is a source of antibodies that help its body to fight diseases (Humphries, 2011). In addition, breastfeeding exclusively for at least six months gives the child maximum protection. Some infections such as meningitis, ear infection, lower respiratory diseases and many others are lesser in children who are breastfed. Furthermore, if the baby gets such illnesses, they are less severe. The breast milk changes to create more protection with time, unlike the formula milk. The protection found in formula milk is not as sufficient as the one found in breast milk. When the mother’s body responds to pathogens, the immunity is also passed to the baby in the form of antibodies. Breast milk also protects the child from allergies. When a baby is fed on formula, they are likely to get allergies from the formula milk can get contaminated during preparation. The contents of breast milk can also cause allergies to the child. Breast milk has the right composition appropriate for the child and therefore the child cannot develop allergies (Mulready-Ward & Hackett, 2014). Breast milk also has benefits to the mother. For example, the motor burns several calories, helping reducing baby fat that was gained during the pregnancy. The mother and the baby can bond (Lippitt et al., 2014). During breastfeeding, prolactin is produced, and it helps the mother to relax and focus on the baby. Oxytocin is also produced during breastfeeding, and it generates a strong connection of love and care and attachment between the mother and the child. On the other side, formula feeding does not promote bonding since these hormones are not produced (Salcedo, 2014). The bonding that is promoted through breastfeeding is another reason as to why formula cannot be as beneficial as breastfeeding. Oxytocin also has more health benefits to the mother including helping the uterus to return to its regular size more quickly (Lippitt et al., 2014). Breastfeeding also promotes higher cognitive development as compared to formula milk. Breast milk contains DHA that is an essential fatty acid that promotes cognitive development (ABC News, 2009). DHA has been added to formula milk currently, but its effects cannot be compared to that of breast milk. Research also indicates that the IQ scores and other intelligence tests were higher for those children who had prolonged and exclusive breastfeeding (Abc News, 2009). Lactation is cheaper and more efficient than formula milk. Breast milk is produced in sufficient amounts for the baby (Salcedo, 2014). On the other side, formula milk needs the mother to spend so much money, and they still have to ensure that it is prepared in the right way to prevent contamination. The breastfed baby will also not need excessive medical attention since they grow up healthier than the babies fed on formula. The preparation of formula milk also takes longer while nursing is simpler and faster. With formula milk, there is also an increase in the chances of tainting during the cleaning of the feeding equipment. When a mother is breastfeeding, they will not need to carry a bag full of feeding equipment. Through the production of Oxytocin, the mother relaxed, and this reduces the stress level, which sometimes results in postpartum depression (de Jager et al., 2014). Research indicated that mother who stopped breastfeeding early were at a greater risk of developing postpartum depression as compared to those who breastfed for longer (de Jager et al., 2014). Therefore, nursing in public should be supported to help the mother to give their babies the best nourishment. Lactation in public has been taken negatively because of the social and cultural norms that term, it indecent (Anderson, 2013). The whole issue relates to sexuality and the perception attached to various body parts in relation to the larger society (Mulready-Ward & Hackett, 2014). In encouraging breastfeeding in public, it is important to understand that breasts are not only for sex purposes. In understanding this, it is possible to make people understand that nurturing young ones are another function of breasts (Jocelyn, 2014). Since sex is taken to be a taboo, breastfeeding is associated with indecency. However, when breasts are not associated with sex, then the negativity on breastfeeding can be reduced (Anderson, 2013).

Laws protecting breastfeeding

Laws have been created to ensure nursing mothers have the freedom to breastfeed their children. However, parents have been forced to feed their babies in dirty bathrooms or uncomfortable situations (Jake 2007). It is also hypocritical to see that feeding bottle’s top is expected to resemble a nipple, but it is acceptable and real breastfeeding unacceptable. The laws that have been formulated help in making breastfeeding acceptable and showing that it is not indecency. In the U.S, there are states that have laws on breastfeeding while others do not. For example, Texas has a law allowing mothers to nurse their babies in the places they are while states such as Pennsylvania do not have any breastfeeding laws (Jake 2007). Two laws give limitations on how breastfeeding should be done in public. The state breastfeeding law says that a mother has a right to breastfeed her baby at any location in any place that she and her child have a right to be whether the breast is showing or not. In addition to this, a woman has a right to take legal action to anyone who interferes with her breastfeeding. The other provision says that a woman has a right to breastfeed in public but does not give a way in which this law is enforced. The third provision indicates that breastfeeding does not qualify as indecent exposure (Jake 2007). The woman, therefore, cannot be charged with a sex crime if found breastfeeding. In addition, in states where no law to protecting breastfeeding women has been created, harassment and discrimination on the breastfeeding basis breaks the mother’s right. The harassment can also qualify as inflicting emotional distress. A nursing mother also has the right to report such a case to the owner of the enterprise where she is harassed for breastfeeding. She can also file charges in the states that have breastfeeding laws against anyone who interferes with their breastfeeding (Jake 2007).

Nursing is a natural way of taking care of young one and therefore it should be supported. It is clear that no other form of feeding that can be as beneficial to a child as lactation. Therefore mothers should be given their space and not harassed when lactating in public. There should also be a change of attitudes towards nursing in public. The change in beliefs will help the public to be supportive to lactating mothers.

Anderson, R. (2013). Breastfeeding in public: what is and what is not "appropriate". Retrieved from http://savageminds.org/2013/09/23/breastfeeding-in-public-what-is-and-what-is-not-appropriate/ de Jager, E., Broadbent, J., Fuller-Tyszkiewicz, M., & Skouteris, H. (2014). The role of psychosocial factors in exclusive breastfeeding to six months postpartum. Midwifery, 30(6), 657-666. Humphries, J. M. (2011). Breastfeeding Promotion. AJN The American Journal of Nursing, Jake Marcus, J.D. (2007) Lactation and The Law. http://breastfeedinglaw.com/articles/lactation- and-the-law/ Jocelyn Hickenbotham. (2014). Interview with Jocelyn Hickenbotham (See other attachment) Lippitt, M., Masterson, A. R., Sierra, A., Davis, A. B., & White, M. A. (2014). An Exploration of Social Desirability Bias in Measurement of Attitudes toward Breastfeeding in Public. Journal of Human Lactation, 0890334414529020. Mulready-Ward, C., & Hackett, M. (2014). Perception and Attitudes Breastfeeding in Public in New York City. Journal of Human Lactation, 30(2), 195-200. Salcedo, E. S. (2014). Breastfeeding in the Workplace: What's Wrong with the Right?. Available at SSRN.

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Revealed: Harvard Business School’s New MBA Essays For Applicants

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Harvard Business School’s Baker Library.

With just 10 weeks before its first application deadline on Sept. 4th, Harvard Business School today (June 25) revealed a newly revised application for MBA candidates, including a new set of three short essays along with a refresh on how it will evaluate applicants for future classes.

The new prompts?

Business-Minded Essay : Please reflect on how your experiences have influenced your career choices and aspirations and the impact you will have on the businesses, organizations, and communities you plan to serve. (up to 300 words)

Leadership-Focused Essay : What experiences have shaped who you are, how you invest in others, and what kind of leader you want to become? (up to 250 words)

Growth-Oriented Essay : Curiosity can be seen in many ways. Please share an example of how you have demonstrated curiosity and how that has influenced your growth. (up to 250 words)

NEW HARVARD BUSINESS SCHOOL ESSAYS PUT THROUGH BY NEW MBA ADMISSIONS CHIEF

Eagerly awaited by thousands of prospective students and admission consultants, you can bet that the admissions pages of the HBS website were continually refreshed all morning for a glimpse at the new essay. The Harvard Business School essay prompt for the Class of 2027 was posted at 10:30 a.m. with the opening of the 2024-2025 application online.

This year’s change was put through by Rupal Gadhia , who joined the school as managing director of admissions and financial aid last October. A 2004 Harvard MBA, Gadhia came to the school with no previous admissions experience, having been the global head of marketing for SharkNinja robots.

In explaining the change in a blog post , Gadhia noted that “we have refreshed the criteria on which we evaluate candidates. We are looking for applicants who are business-minded, leadership-focused, and growth-oriented…This is your opportunity to discuss meaningful or formative experiences that are important to you that you haven’t had a chance to fully explore elsewhere in your application…Be authentic, be yourself.”

WHAT HARVARD BUSINESS SCHOOL IS REALLY LOOKING FOR IN THE NEW ESSAYS

The school added some context to its new criteria for admission, more clearly defining what it means by business-minded, leadership-focused, and growth-oriented.

Business-Minded

We are looking for individuals who are passionate about using business as a force for good – who strive to improve and transform companies, industries, and the world. We are seeking those who are eager to solve today’s biggest problems and shape the future through creative and integrated thinking. Being business-minded is about the interest to help organizations succeed, whether in the private, public, or non-profit sector. This business inclination can be found in individuals with a variety of professional and educational experiences, not just those who come from traditional business backgrounds.

In Your Application: We will look for evidence of your interpersonal skills, quantitative abilities, and the ways in which you plan to create impact through business in the future.

Leadership-Focused

We are looking for individuals who aspire to lead others toward making a difference in the world, and those who recognize that to build and sustain successful organizations, they must develop and nurture diverse teams. Leadership takes many forms in many contexts – you do not have to have a formal leadership role to make a difference. We deliberately create a class that includes different kinds of leaders, from the front-line manager to the startup founder to the behind-the-scenes thought leader.

In Your Application: Your leadership impact may be most evident in extracurriculars, community initiatives, or your professional work.

Growth-Oriented

We are looking for individuals who desire to broaden their perspectives through creative problem solving, active listening, and lively discussion. At HBS you will be surrounded by future leaders from around the world who will make you think more expansively about what impact you might have. Our case and field-based learning methods depend on the active participation of curious students who are excited to listen and learn from faculty and classmates, as well as contribute their own ideas and perspectives.

In Your Application: We will look for the ways in which you have grown, developed, and how you engage with the world around you.

TIGHTER TIMEFRAME FOR ROUND ONE APPLICANTS

The new essay prompts come  nearly two months after candidates to the school’s MBA program would more typically know what was expected of them. Some admission consultants say the delay over the prompt’s release, along with nearly a month’s slow down in releasing application deadlines, is “wildly insensitive” to applicants who will have less time than normal to prepare for the round one deadline of Sept. 4th.

That’s especially true because the most successful applicants to HBS have highly demanding jobs that consume the vast majority of their time. Many candidates go through multiple drafts of their essays to get them as close to perfection as humanly possible. MBA admission consultants are expecting a lot of up-to-the-deadline work this year to help prep candidates for Harvard and other top business schools.

The new application still preserves the post-interview reflection for applicants who are invited to a 30-minute admissions interview. Within 24 hours of the interview, candidates are required to submit a written reflection through the school’s online application system.

REACTION TO THE NEW CHANGE IS MIXED

Early reaction to the change suggests the likelihood of mixed reviews. “This is an uninspired and odd set of questions,” says Sandy Kreisberg, founder of HBSGuru.com and an MBA admissions consultant who closely reads the tea leaves of Harvard’s admissions process. “I don’t know how it’s different from what else do you want us to know about you, frankly,” he adds in a reference to last year’s single essay prompt.

“HBS has certainly moved from the abstract to the concrete,” believes Jeremy Shinewald, founder and CEO of mbaMission, a leading MBA admissions consulting firm. “Some applicants previously felt like they didn’t know where to start and some weren’t sure if they had answered the question, even when they were done. Now, the questions are quite straightforward and all have a cause and effect relationship — one where the applicant discusses the past to reveal the present or future. Smart applicants will understand how to share their experiences and, more importantly, how to relay their values. Some will mistakenly try to whack HBS over the head with stories of their epic feats, but the key isn’t to brag or embellish – the key is to simply create a clear relationship, via narrative, between past experience and true motivations.”

Shinewald found it astonishing that Harvard could not have made the change earlier. “It is, of course, surprising that HBS left applicants on edge until the last minute, all to create very traditional essays,” he adds. “As applicants learn in MBA classrooms, change can be hard and take time. The bottom line here is that these essays are somewhat of an applicant’s dream – they allow the savvy applicant to play to their strengths and draw on their best anecdotes and experiences to create a complete story. Some applicants will lament the absence of a ‘Why HBS?’ prompt, but my guess is that the admissions committee recognized that they would get an almost homogenous collection of essays touting the case method and other well known features. HBS gets some kudos for keeping the focus on the applicant.”

Adds Petia Whitmore of My MBA Path: “I think they reflect one of the traits of this new generation of candidates which is that they don’t handle ambiguity well. So it seems like Harvard had to spell out what they’re looking for way more prescriptively than in the past.”

Some, however, find the new essays a return to the past. “To me, the prompts feel quite regressive, and a return to the more formulaic approach that pervaded MBA applications two decades ago,” believes Justin Marshall, a New York-based MBA admissions consultant. “Because the previous prompt was so open ended, it forced applicants to be introspective and self-aware. You couldn’t just ramble for 900 words; you had to identify themes in your life to show how your personal experiences shaped your values, your leadership style, and your goals. Comparatively, these new prompts are much more paint-by-numbers. Applicants will likely cover the same ground in terms of topic, but there’s very little room for nuance and self-expression. I think it will be harder for applicants with less conventional backgrounds and experiences to differentiate themselves. I’m sure HBS grew tired of reading so many painfully earnest ‘life story’ essays, but I suspect they’ll soon find themselves yearning for essays that have a heartbeat and personality. 250 words just doesn’t allow for that unless you’re a very crafty writer.”

Whatever the case, getting into Harvard’s MBA program is still a daunting exercise. Last year, 1,076 of the 8,264 candidates who applied for admission to Harvard Business School gained admission, an acceptance rate of 13.2%, making HBS the second most selective prestige MBA program in the country after Stanford Graduate School of Business which had an admit rate of 8.4%. Harvard saw a 15.4% drop in MBA applications from the 9,773 it received a year-earlier.

Joint degree applicants for the Harvard Medical School, Harvard School of Dental Medicine, Harvard Graduate School of Arts and Sciences, Harvard Law School, and Harvard Kennedy School must provide an additional essay: How do you expect the joint degree experience to benefit you on both a professional and a personal level? (up to 400 words)

BIGGEST CHANGE IN HARVARD BUSINESS SCHOOL ESSAY IN NEARLY A DECADE

Joint degree applicants for the Harvard Paulson School of Engineering and Applied Sciences must provide an additional essay: The MS/MBA Engineering Sciences program is focused on entrepreneurship, design, and innovation. Describe your past experiences in these areas and your reasons for pursuing a program with this focus. (recommended length: 500 words). Applicants will also be able to respond to an optional essay.

In any case, it’s the biggest change in Harvard Business School’s application in nearly a decade. The last time HBS made a major switch, moving to the essay prompt it just eliminated, was in 2016. That change to just one essay with no word limit and a post-interview reflection was made by then admissions chief Dee Leopold.

When Leopold applied to Harvard as an MBA candidate in 1978, she had to write eight essays. Over her years as managing director of admissions, she first cut the essays down to four and then one, making it optional, and finally the one last prompt with a post-interview reflection, saying that applying to HBS should not be a writing contest .

OUR BUSINESS CASUAL PODCAST: The New HARVARD BUSINESS SCHOOL MBA Application:   Fortuna Admissions’ Caroline Diarte-Edwards and ApplicantLab’s Maria Wich-Vila join P&Q’s John A. Byrne to offer applicant advice on how to answer the new HBS essay prompts

DON’T MISS: 2024-2024 MBA APPLICATION DEADLINES or  HARVARD BUSINESS SCHOOL WILL NOW UPDATE ITS MBA ESSAY 

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More From Forbes

Harvard business school announces 3 new application essays.

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Harvard Business School.

Harvard Business School announced a surprising departure from its single, open-ended application essay to three short essays with specific prompts. The HBS website sums up the kind of applicant the school is seeking: “We are looking for future leaders who are passionate about business, leadership, and growth.”

The prompts for the class that will begin in fall 2025 instruct applicants to address each topic in turn.

• Business-Minded Essay : Please reflect on how your experiences have influenced your career choices and aspirations and the impact you will have on the businesses, organizations, and communities you plan to serve. (up to 300 words)
• Leadership-Focused Essay : What experiences have shaped who you are, how you invest in others, and what kind of leader you want to become? (up to 250 words)
• Growth-Oriented Essay : Curiosity can be seen in many ways. Please share an example of how you have demonstrated curiosity and how that has influenced your growth. (up to 250 words)

The prompts ask applicants to go beyond simply asserting their allegiance to the ideals of business, leadership and growth. Each of the three questions asks for evidence: “experiences,” “experiences” and “an example,” respectively.

The prompts do not expect a straightforward list of what happened in the past. Rather, they encourage reflection on how these experiences affected present realities and future goals.

Applicants are asked to reflect on past, present and future as an ongoing process of becoming who they are now and who they wish to become. Even the “Business-Minded Essay” is about past choices and future impact; it also assumes you “plan to serve.” The “Leadership-Focused Essay” does not ask applicants to recite a list of titles, but to discuss who they are and how they relate to others; not what title they aspire to, but “what kind of leader you wish to become.”

Perhaps the most surprising essay prompt is No. 3, which asks about curiosity. It opens the door for applicants to discuss a more personal aspect of their candidacies. The prompt asks not about end result, but about the process of change. Once again, the emphasis is on “growth.”

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In short, the prompts ask about person and process.

How The 3 New Prompts Differ From Last Year’s Single Question

This year’s prompts give applicants more direction than the previous open-ended instruction, which was: “As we review your application, what more would you like us to know as we consider your candidacy for the Harvard Business School MBA program?”

Applicants may find it easier to follow these more detailed instructions and to stay on topic. They no longer need to face an open question and a blank page.

Another aid is the shorter word limit. The essay on being business-minded has a limit of 300 words, and the essays on leadership and growth through curiosity are limited to 250 words each.

A third difference is the specific inquiry about business. Last year’s prompt allowed candidates to choose anything they thought would be important for HBS to consider. Some applicants struggled to decide whether to focus on business or something beyond work. While the “Business-Minded Essay” is still personal, it does ask applicants to reflect on their careers.

One might also speculate that the new, more directive prompts makes it easier for the admissions committee to compare essays across applications, while still leaving room for considerable variation in how applicants choose to address the essay prompts.

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Nutrition During Lactation (1991)

Chapter: 1 summary, conclusions, and recommendations, 1 summary, conclusions, and recommendations.

During the past decade, the benefits of breastfeeding have been emphasized by many authorities and organizations in the United States. Federal agencies have set specific objectives to increase the incidence and duration of breastfeeding (DHHS, 1980, 1990), and the Surgeon General has held workshops on breastfeeding and human lactation (DHHS, 1984, 1985). At the federal and state levels, the Special Supplemental Food Program for Women, Infants, and Children (WIC) has produced materials designed to promote breastfeeding (e.g., Malone, 1980; USDA, 1988). Furthermore, the Office of Maternal and Child Health has sponsored breastfeeding projects (e.g., The Steering Committee to Promote Breastfeeding in New York City, 1986), as have state health departments and others. However, less attention has been given to two general topics: (1) the effects of breastfeeding on the nutritional status and long-term health of the mother and (2) the effects of the mother's nutritional status on the volume and composition of her milk and on the potential subsequent effects of those changes on infant health. The present report was designed to address these topics.

This summary briefly describes the origin of this effort and the process; provides key definitions; reviews what was learned about who is breastfeeding in the United States and if those women are well nourished; discusses nutritional influences on milk volume or composition; and describes how breastfeeding may affect infant growth, nutrition, and health, as well as maternal health. It then presents major conclusions, clinical recommendations, and the research recommendations most directly related to the nutrition of lactating women in the United States.

ORIGIN OF THIS STUDY

This study was undertaken at the request of the Maternal and Child Health Program (Title V, Social Security Act) of the Health Resources and Services Administration, U.S. Department of Health and Human Services. In response to that request, the Food and Nutrition Board's Committee on Nutritional Status During Pregnancy and Lactation and its Subcommittee on Nutrition During Lactation were asked to evaluate current scientific evidence and formulate recommendations pertaining to the nutritional needs of lactating women, giving special attention to the needs of lactating adolescents; women over age 35; and women of black, Hispanic, or Southeast Asian origin. Part of this task included consideration of the effects of maternal dietary intake and nutritional status on the volume and composition of human milk, the appropriateness of various anthropometric methods for assessing nutritional status during lactation, and the effects of lactation both on maternal and infant health and on the nutritional status of both the mother and the infant.

APPROACH TO THE STUDY

The study was limited to consideration of healthy U.S. women and their healthy, full-term infants. The Subcommittee on Nutrition During Lactation conducted an extensive literature review, consulted with a variety of experts, and met as a group seven times to discuss the data and draw conclusions from them. The Committee on Nutritional Status During Pregnancy and Lactation (the advisory committee) reviewed and commented on the work of the subcommittee and helped establish appropriate linkages between this report and the reports on weight gain and nutrient supplements during pregnancy contained in Nutrition During Pregnancy —a report prepared by two other subcommittees of this advisory committee (IOM, 1990). Compared with earlier reports from the National Research Council, Nutrition During Pregnancy recommended a higher range of weight gain (11.5 to 16 kg, or 25 to 35 lb, for women of normal prepregnancy weight for height). In addition, it advised routine low-dose iron supplementation during pregnancy, but supplements of other vitamins or minerals were recommended only under special circumstances.

In examining the nutritional needs of lactating women, priority was given to energy and to those nutrients believed to be consumed in amounts lower than Recommended Dietary Allowances (RDAs) by many women in the United States. These nutrients include calcium, magnesium, iron, zinc, folate, and vitamin B 6 . Careful attention was given to the effects of lactation on various indicators of nutritional status, such as measurements of levels of biochemical compounds; functions related to specific nutrients; nutrient levels in specific body compartments; and height, weight, or other indicators of body size or

adiposity. The subcommittee took into consideration that weight gain recommendations for pregnant women have been raised (see Nutrition During Pregnancy [IOM, 1990]) and that average weight gains of U.S. women during pregnancy have risen over the past two decades.

When possible, a distinction was made between exclusive breastfeeding, defined as the consumption of human milk as the sole source of energy, and partial breastfeeding, defined as the consumption of human milk in combination with formula or other foods, or both.

The nutritional demands imposed by lactation were estimated from data on volume and composition of milk produced by healthy, successfully lactating women, as done in Recommended Dietary Allowances (NRC, 1989). When it was feasible, evidence relating to possible depletion of maternal stores or to a decrease in the specific nutrient content of milk resulting from low maternal intake of the nutrient was also addressed. Because of the complex relationships between the nutrition of the mother and infant, the subcommittee examined the nutrition and growth of the breastfed infant.

The terms maternal health and infant health were interpreted in a broad sense. Consideration was given to both beneficial and adverse consequences for the health of the mother and her offspring, both during lactation and long after breastfeeding has been discontinued. For the mother, there was a search for evidence of differences in outcome related to whether or not she had breastfed. For the infant, evidence was sought for differences in outcome related to the method of feeding (breast compared with bottle). The possible influences of breastfeeding on prevention or promotion of chronic disease were addressed.

To the extent possible, this report includes detailed coverage of published evidence linking maternal nutrition, breastfeeding, and maternal and infant health. Because breastfeeding is encouraged primarily as a method for promoting the health of infants, considerable attention is also directed toward infant health even when there is no established relationship to maternal nutritional status. Recognizing the serious gaps in knowledge of nutrition during lactation, the subcommittee gave much thought to establishing directions for research.

The members of the subcommittee realized that nutrition is not the sole determinant of successful breastfeeding. A network of overlapping social factors including access to maternal leave, instructions concerning breastfeeding, availability of prenatal care, the length of hospital stay following delivery, infant care in the workplace, and the public attitudes toward breastfeeding are important. Given the goals of this report, the subcommittee did not specifically address those factors, but it recognizes that they should be considered in depth by public health groups that are attempting to improve rates of breastfeeding in this and other countries.

WHAT WAS LEARNED

Who is breastfeeding.

The incidence and duration of breastfeeding changed markedly during the twentieth century—first declining, then rising, and, from the early 1980s, declining once again. Currently, women who choose to breastfeed tend to be well educated, older, and white. Data on the incidence and duration of breastfeeding in the United States are especially limited for mothers who are economically disadvantaged and for those who are members of ethnic minority groups. The best data for any minority groups are for black women. Their rates of breastfeeding are substantially lower than those for white women, but factors that distinguish breastfeeding from nonbreastfeeding women tend to be similar among black and white women. Social, cultural, economic, and psychological factors that influence infant feeding choices by adolescent mothers are not well understood. In the United States, where few employers provide paid maternity leave, return to work outside the home is associated with a shorter duration of breastfeeding, but little else is known about when mothers discontinue either exclusive or partial breastfeeding. Such data are needed to estimate the total nutrient demands of lactation.

How Can It Be Determined Whether Lactating Women Are Well Nourished

The few lactating women who have been studied in the United States have been characterized as well nourished, but this observation cannot be generalized since these subjects were principally white women with some college education. Women from less advantaged, less well studied populations may be at higher risk of nutritional problems but tend not to breastfeed.

To determine whether women are adequately nourished, investigators use biochemical or anthropometric methods, or both. For lactating women, however, there are serious gaps and limitations in the data collected with these methods. Consequently, there is no scientific basis for determining whether poor nutritional status is a problem among certain groups of these women. To identify the nutrients likely to be consumed in inadequate amounts by lactating women, the subcommittee used an approach involving nutrient densities (nutrient intakes per 1,000 kcal) calculated from typical diets of nonlactating U.S. women. That is, they made the assumption that the average nutrient densities of the diets of lactating women would be the same as those of nonlactating women but that lactating women would have higher total energy intake (and therefore higher nutrient intake). Using this approach, the nutrients most likely to be consumed in amounts lower than the RDAs for lactating women are calcium, zinc, magnesium, vitamin B 6 , and folate.

Data for U.S. women indicate that successful lactation occurs regardless of whether a woman is thin, of normal weight, or obese. Anthropometric measurements (such as weight, weight for height, and skinfold thickness) have not been useful for predicting the success of lactation among the few U.S. women who have been studied. The predictive ability is not known for anthropometric measurements that fall outside the ranges observed in these limited samples.

Lactating women eating self-selected diets typically lose weight at the rate of 0.5 to 1.0 kg (˜1 to 2 lb) per month in the first 4 to 6 months of lactation. Such weight loss is probably physiologic. During the same period, values for subscapular and suprailiac skinfold thickness also decrease; triceps skinfold thickness does not. Not all women lose weight during lactation; studies suggest that approximately 20% may maintain or gain weight.

Biochemical data for lactating women have been obtained only from small, select samples. Such data are of limited use in the clinical situation because there are no norms for lactating women, and the norms for nonpregnant, nonlactating women may not be applicable to breastfeeding women. For example, there appear to be changes in plasma volume post partum, and there are changes in blood nutrient values over the course of lactation that are unrelated to changes in plasma volume.

Does Maternal Nutritional Status or Dietary Intake Influence Milk Volume

The mean volume of milk secreted by healthy U.S. women whose infants are exclusively breastfed during the first 4 to 6 months is approximately 750 to 800 ml/day, but there is considerable variability from woman to woman and in the same woman at different times. The standard deviation of daily milk intake by infants is about 165 ml; thus, 5% of women secrete less than 550 ml or more than 1,200 ml on a given day. The major determinant of milk production is the infant's demand for milk, which in turn may be influenced by the size, age, health, and other characteristics of the infant as well as by his or her intake of supplemental foods. The potential for milk production may be considerably higher than that actually produced, as evidenced by findings that the milk volumes produced by women nursing twins or triplets are much higher than those produced by women nursing a single infant.

Studies of healthy women in industrialized countries demonstrate that milk volume is not related to maternal weight or height or indices of fatness. In developing countries, there is conflicting evidence about whether thin women produce less milk than do women with higher weight for height.

Increased maternal energy intake has not been linked with increased milk production, at least among well-nourished women in industrialized countries. Nutritional supplementation of lactating women in developing countries where undernutrition may be a problem has generally been reported to have little

or no impact on milk volume, but most studies have been too small to test the hypothesis adequately and lacked the design needed for causal inference. Studies of animals indicate that there may be a threshold below which energy intake is insufficient to support normal milk production, but it is likely that most studies in humans have been conducted on women with intakes well above this postulated threshold.

The weight loss ordinarily experienced by lactating women has no apparent deleterious effects on milk production. Although lactating women typically lose 0.5 to 1 kg (˜1 to 2 lb) per month, some women lose as much as 2 kg (˜4 lb) per month and successfully maintain milk volume. Regular exercise appears to be compatible with production of an adequate volume of milk.

The influence of maternal intake of specific nutrients on milk volume has not been investigated satisfactorily. Early studies in developing countries suggest a positive association of protein intake with milk volume, but those studies remain inconclusive. Fluids consumed in excess of thirst do not increase milk volume.

Does Maternal Nutritional Status Influence Milk Composition

The composition of human milk is distinct from the milk of other mammals and from infant formulas ordinarily derived from them. Human milk is unique in its physical structure, types and concentrations of macronutrients (protein, fat, and carbohydrate), micronutrients (vitamins and minerals), enzymes, hormones, growth factors, host resistance factors, inducers/modulators of the immune system, and anti-inflammatory agents.

A number of generalizations can be made about the effects of maternal nutrition on the composition of milk (see also Table 1-1 ):

Even if the usual dietary intake of a macronutrient is less than that recommended in Recommended Dietary Allowances (NRC, 1989), there will be little or no effect on the total amount of that nutrient in the milk. However, the proportions of the different fatty acids in human milk vary with maternal dietary intake.

The concentrations of major minerals (calcium, phosphorus, magnesium, sodium, and potassium) in human milk are not affected by the diet. Maternal intakes of selenium and iodine are positively related to their concentrations in human milk, but there is no convincing evidence that the concentrations of other trace elements in human milk are affected by maternal diet.

The vitamin content of human milk is dependent upon the mother's current vitamin intake and her vitamin stores, but the strength of the relationships varies with the vitamin. Chronically low maternal intake of vitamins may result in milk that contains low amounts of these essential nutrients.

TABLE 1-1 Possible Influences of Maternal Intake on the Nutrient Composition of Human Milk and Nutrients for Which Clinical Deficiency Is Recognizable in Infants

The content of at least some nutrients in human milk may be maintained at a satisfactory level at the expense of maternal stores. This applies particularly to folate and calcium.

Increasing the mother's intake of a nutrient to levels above the RDA ordinarily does not result in unusually high levels of the nutrient in her milk; vitamins B 6 and D, iodine, and selenium are exceptions. Studies have not been conducted to evaluate the possibility that high levels of nutrients in milk are toxic to the infant.

Some studies suggest that poor maternal nutrition is associated with decreased concentrations of certain host resistance factors in human milk, whereas other studies do not suggest this association.

In What Ways May Breastfeeding Affect Infant Growth and Health

Infant nutrition.

Several factors influence the nutritional status of the breastfed infant: the infant's nutrient stores (which are largely determined by the length of gestation and maternal nutrition during pregnancy), the total amount of nutrients supplied by human milk (which is influenced by the extent and duration of breastfeeding), and certain genetic and environmental factors that affect the way nutrients are absorbed and used.

Human milk is ordinarily a complete source of nutrients for the exclusively breastfed infant. However, if the infant or mother is not exposed regularly to sunlight or if the mother's intake of vitamin D is low, breastfed infants may be at risk of vitamin D deficiency. Breastfed infants are susceptible to deficiency of vitamin B 12 if the mother is a complete vegetarian—even when the mother has no symptoms of that vitamin deficiency.

The risk of hemorrhagic disease of the newborn is relatively low. Nonetheless, all infants (regardless of feeding mode or of maternal nutritional status) are at some risk for this serious disease unless they are supplemented with a single dose of vitamin K at birth.

Full-term, exclusively breastfed infants ordinarily maintain a normal iron status for their first 6 months of life, regardless of maternal iron intake. Providing solid foods may reduce the percentage of iron absorbed by the partially breastfed infant, making it important in such cases to ensure that adequate iron is provided in the diet.

Growth and Development

Breastfed infants gain weight at about the same rate as formula-fed infants during the first 2 to 3 months post partum, although breastfed infants usually ingest less milk and thus have a lower energy intake. After the first few months post partum, healthy breastfed infants gain weight more slowly than those who

are formula fed. In general, this pattern is not altered by the introduction of solid foods. Differences in linear growth between breastfed and formula-fed infants are small if statistical techniques are used to control differences in size at birth.

Infant Morbidity and Mortality

Several types of health problems occur less often or appear to have less serious consequences in breastfed than in formula-fed infants. These include certain infectious diseases (especially ones involving the intestinal and respiratory tracts), food allergies, and, perhaps, certain chronic diseases. There is suggestive evidence that severe maternal malnutrition might reduce the degree of immune protection afforded by human milk, but further studies will be required to address that issue.

Few infectious agents are commonly transmitted to the infant via human milk. The most prominent ones are cytomegalovirus in all populations that have been studied and human T lymphocytotropic virus type 1 (HTLV-1) in certain Asian populations. The transmission of cytomegalovirus by breastfeeding does not result in disease; the consequences of the transmission of HTLV-1 by breastfeeding are unknown. There are some case reports that indicate that human immunodeficiency virus (HIV) can be transmitted by breastfeeding as a result of the transfusion of HIV-contaminated blood during the immediate postpartum period. The likelihood of transmitting HIV via breastfeeding by women who tested seropositive for the agent during pregnancy has not been determined. Public policy on this issue has ranged from the Centers for Disease Control's recommendation not to breastfeed under these circumstances to the World Health Organization's encouragement to breastfeed, especially among women in developing countries.

In developing countries, mortality rates are lower among breastfed infants than among those who are formula fed. It is not known whether this advantage also holds in industrialized countries, in which death rates are lower in general. It is reasonable to believe that breastfeeding will lead to lower mortality among disadvantaged groups in industrialized countries if they have higher than usual infant and child mortality rates, but this issue has not been studied.

Medications, Drugs, and Environmental Contaminants

The few prescription drugs that are contraindicated during lactation because of potential harm to the infant can usually be avoided and replaced with safer acceptable ones. For example, there are a number of safe and effective substitutes for the antibiotic chloramphenicol, which is contraindicated for lactating women. If treatment with antimetabolites or radiotherapeutics is required by the mother, breastfeeding is contraindicated.

Cigarette smoking and alcohol consumption by lactating women in excess

of 0.5 g/kg of maternal weight may be harmful to the infant, partly because of potential reduction in milk volume. Furthermore, a single report (Little et al., 1989) associates heavy alcohol use by the mother with retarded psychomotor development of the infant at 1 year of age. Infrequent cigarette smoking, occasional consumption of small amounts of alcohol, and moderate ingestion of caffeine-containing products are not considered to be contraindicated during breastfeeding. Use of illicit drugs is contraindicated because of the potential for drug transfer through the milk as well as hazards to the mother. Since the limited information on the impact of these habits upon the nutrition of women in the childbearing years is reviewed in Nutrition During Pregnancy (IOM, 1990), they were not considered further by this subcommittee.

In the uncommon situation of a high risk of exposure to such environmental contaminants as organochlorinated compounds (such as dichlorodiphenyl-trichloroethane [DDT] or polychlorinated biphenyls [PCBs]) or toxic metals (such as mercury), risks must be weighed against the benefits of breastfeeding for both mother and infant on a case-by-case basis. In areas of unusually high exposure, levels of the contaminant should be measured in the mother's blood and milk.

How Does Breastfeeding Affect Maternal Nutrition and Health

Breastfeeding substantially increases the mother's requirements for most nutrients. The magnitude of the total increase is most strongly affected by the extent and duration of lactation. Adequacy of intakes of calcium, magnesium, zinc, folate, and vitamin B 6 merits special attention since average intakes may be below those recommended. The net long-term effect of lactation on bone mass is uncertain. Some data associate lactation with short-term bone loss, whereas most recent studies suggest a protective long-term effect. Those data are provocative but of such preliminary nature that no definitive conclusions may be drawn from them.

Although most lactating women lose weight gradually during lactation, some do not. The influence of lactation on long-term postpartum weight retention and maternal risk of adult-onset obesity has not been determined.

A well-documented effect of lactation is delayed return to ovulation. In addition, some recent epidemiologic evidence indicates that breastfeeding may lessen the risk that the mother will develop breast cancer, but the data are not consistent across all studies.

CONCLUSIONS AND RECOMMENDATIONS

The major conclusions of the report are as follows.

Women living under a wide variety of circumstances in the United

States and elsewhere are capable of fully nourishing their infants by breastfeeding them. Throughout its deliberations, the subcommittee was impressed by evidence that mothers are able to produce milk of sufficient quantity and quality to support growth and promote the health of infants—even when the mother's supply of nutrients and energy is limited. With few exceptions (identified later in the summary under "Infant Growth and Nutrition"), the full-term exclusively breastfed infant will be well nourished during the first 4 to 6 months after birth.

In contrast, the lactating woman is vulnerable to depletion of nutrient stores through her milk. Measures should be taken to promote food intake during lactation that will prevent net maternal losses of nutrients, especially of calcium, magnesium, zinc, folate, and vitamin B 6 .

Breastfeeding is recommended for all infants in the United States under ordinary circumstances. Exclusive breastfeeding is the preferred method of feeding for normal full-term infants from birth to age 4 to 6 months. Breastfeeding complemented by the appropriate introduction of other foods is recommended for the remainder of the first year, or longer if desired. The subcommittee and advisory committee recognize that it is difficult for some women to follow these recommendations for social or occupational reasons. In these situations, appropriate formula feeding is an acceptable alternative.

Data are lacking for use in developing strategies to identify lactating women who are at risk of depleting their own nutrient stores. Although nutrient intake appears adequate for the small number of lactating women who have been studied in the United States, evidence from U.S. surveys of nonpregnant, nonlactating women suggests that usual dietary intake of certain nutrients by disadvantaged women is likely to be somewhat lower than that by women of higher socioeconomic status. Thus, if breastfeeding rates increase among less advantaged women as a result of efforts to promote breastfeeding, it will be important to examine more completely the nutrient intake of these women during lactation.

If lactating women follow eating patterns similar to those of the average U.S. woman in sufficient quantity to meet their energy requirements, they are likely to meet the recommended intakes of all nutrients except perhaps calcium and zinc. However, if they curb their energy intakes, their intakes of several nutrients are likely to be less than the RDA.

Recommendations for Women Who Wish To Breastfeed and for Their Care Providers

Because of serious gaps in information about nutrition assessment and nutrient requirements during lactation and about effects of maternal nutrition on the wide array of components in the milk, the following recommendations should be considered preliminary. Although they reflect the best judgment of

the subcommittee and advisory committee, these recommendations are open to reconsideration as the knowledge base grows.

Diet and Vitamin-Mineral Supplementation

Lactating women should be encouraged to obtain their nutrients from a well-balanced, varied diet rather than from vitamin-mineral supplements.

Provide women who plan to breastfeed or who are already doing so with nutrition information that is culturally appropriate (that is, information that is sensitive to the foodways, eating practices, and health beliefs and attitudes of the cultural group). To facilitate the acquisition of this information, health care providers are encouraged to make effective use of teaching opportunities during prenatal visits, hospitalization following delivery, and routine postpartum visits for maternal or pediatric care.

Encourage lactating women to follow dietary guidelines that promote a generous intake of nutrients from fruits and vegetables, whole-grain breads and cereals, calcium-rich dairy products, and protein-rich foods such as meats, fish, and legumes. Such a diet would ordinarily supply a sufficient quantity of essential nutrients. The individual recommendations should be compatible with the woman's economic situation and food preferences. The evidence does not warrant routine vitamin-mineral supplementation of lactating women.

If dietary evaluation suggests that the diet does not provide the recommended amounts of one or more nutrients, encourage the woman to select and consume foods that are rich in those nutrients.

For women whose eating patterns lead to a very low intake of one or more nutrients, provide individualized diet counseling (preferred) or recommend nutrient supplementation (as described in Table 1-2 ).

Encourage sufficient intake of fluids—especially water, juice, and milk—to alleviate natural thirst. It is not necessary to encourage fluid intakes above this level.

The elimination of major nutrient sources (e.g., all dairy products) from the maternal diet to treat allergy or colic in the breastfed infant is not recommended unless there is evidence from oral elimination-challenge studies to determine whether the mother is sensitive or intolerant to the food or that the breastfed infant reacts to the foods ingested by the mother. If a key nutrient source is eliminated from the maternal diet, the mother should be counseled on how to achieve adequate nutrient intake by substituting other foods.

A Defined Health Care Plan for Lactating Women

There should be a well-defined plan for the health care of the lactating woman that includes screening for nutritional problems and providing dietary guidance. Since preparation for lactation should begin during the prenatal period, the physician, midwife, nutritionist, or other member of the obstetric

TABLE 1-2 Suggested Measures for Improving Nutrient Intake of Women with Restrictive Eating Patterns

team should introduce general information about nutrition during lactation and should screen for possible problems related to nutrition. Ideally, more extensive evaluation and counseling should take place during hospitalization for childbirth. If that is precluded by the brevity of the hospital stay, an early visit to an appropriate health care professional by the mother or a visit to the mother's home is advisable.

To implement routine screening economically and practically, the subcommittee considers it sufficient to continue the practice of weighing women (using standard procedures as described in Nutrition During Pregnancy [IOM, 1990]) at scheduled visits and to ask a few simple questions to determine the following:

Are calcium-rich foods eaten regularly?

Does the diet include vitamin D-fortified milk or cereal or is there adequate exposure to ultraviolet light?

Are fruits and vegetables eaten regularly?

Is the mother a complete vegetarian?

Is the mother restricting her food intake severely in an attempt to lose weight or to treat certain medical conditions?

Are there life circumstances (e.g., poverty, or abuse of drugs or alcohol) that might interfere with an adequate diet?

It is not necessary to obtain measurements of skinfold thickness or to conduct laboratory tests as a part of the routine assessment of the nutritional status of lactating women.

The subcommittee recognizes that establishing standard health care procedures for lactating women requires expanded training of health care providers. Activities to achieve this expanded training are being initiated by the Surgeon General's workshop committee comprising representatives from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and other professional organizations.

Breastfeeding Practices

Efforts to support lactation must consider breastfeeding practices.

Because the early management of lactation has a strong influence on the establishment of an adequate milk supply, breastfeeding guidance should be provided prenatally and continued in the hospital after delivery and during the early postpartum period.

All hospitals providing obstetric care should provide knowledgeable staff in the immediate postpartum period who have responsibility for providing support and guidance in initiating breastfeeding and measures to promote establishment of an ample supply of milk.

Breastfeeding practices that are responsive to the infant's natural appetite should be promoted. In the first few weeks, infants should nurse at least 8 times per day, and some may nurse as often as 15 or more times per day. After the first month, infants fed on demand usually nurse 5 to 12 times per day.

Maternal Weight

Women who plan to breastfeed or who are breastfeeding should be given realistic, health-promoting advice about weight change during lactation.

Advise women that it is normal to lose weight during the first 6 months of lactation. The average rate of weight loss is 0.5 to 1.0 kg (˜ 1 to 2 lb)/month after the first month post partum. However, not all women who breastfeed lose weight; some women gain weight post partum, whether or not they breastfeed.

If a lactating woman is overweight, a weight loss of up to 2 kg (˜4.5 lb) per month is unlikely to adversely affect milk volume, but such women should be alert for any indications that the infant's appetite is not being satisfied. Rapid weight loss (>2 kg/month after the first month post partum) is not advisable for breastfeeding women.

Advise women who choose to curb their energy intake to pay special attention to eating a balanced, varied diet and to including foods rich in calcium, zinc, magnesium, vitamin B 6 , and folate. Encourage energy intake of at least 1,800 kcal/day. Calcium, multivitamin-mineral supplements, or both may be advised when dietary sources are marginal and it is unlikely that appropriate dietary practices will or can be followed. Intakes below 1,500 kcal/day are not recommended at any time during lactation, although fasts lasting less than 1 day have not been shown to decrease milk volume. Liquid diets and weight loss medications are not recommended. Since the impact of curtailing maternal energy intake during the first 2 to 3 weeks post partum is unknown, dieting during this period is not recommended.

Maternal Substance Use and Abuse

The use of illicit drugs should be actively discouraged, and affected women (regardless of their mode of feeding) should be assisted to enter a rehabilitative program that makes provision for the infant. The use of certain legal substances by lactating women is also of concern, including the potential for alcohol abuse.

There is no scientific evidence that consumption of alcoholic beverages has a beneficial impact on any aspect of lactation performance. If alcohol is used, advise the lactating woman to limit her intake to no more than 0.5 g of alcohol per kg of maternal body weight per day. Intake over this level may impair the milk ejection reflex. For a 60-kg (132-lb) woman, 0.5 g of alcohol per kg of body weight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer.

Actively discourage smoking among lactating women, not only because it may reduce milk volume but because of its other harmful effects on the mother and her infant.

Discourage intake of large quantities of coffee, other caffeine-containing beverages and medications, and decaffeinated coffee. The equivalent of 1 to 2 cups of regular coffee daily is unlikely to have a deleterious effect on the nursling, although preliminary evidence suggests that maternal coffee intake may adversely influence the iron content of milk and the iron status of the infant.

Infant Growth and Nutrition

The subcommittee recommends that health care providers be informed

about the differences in growth between healthy breastfed and formula-fed infants. On average, breastfed infants gain weight more slowly than those fed formula after the first 2 to 3 months. Slower weight gain, by itself, does not justify the use of supplemental formula. When in doubt, clinicians should evaluate adequacy of growth according to the guidelines described by Lawrence (1989).

Regardless of what the mother eats, the following steps should be taken to ensure adequate nutrition of breastfed infants.

All newborns should receive a 0.5- to 1.0-mg injection or a 1.0-to 2.0-mg oral dose of vitamin K immediately after birth regardless of the type of feeding that will be offered the infant.

If the infant's exposure to sunlight appears to be inadequate, the infant should be given a 5- to 7.5-µg supplement of vitamin D per day.

Fluoride supplements should be provided to breastfed infants if the fluoride content of the household drinking-water supply is low (<0.3 ppm)

When breastfeeding is complemented by other foods, and by 6 months of age in any case, the infant should be given food rich in bioavailable iron or a daily low-dose oral iron supplement.

Infant Health

Health care providers should recognize that breastfeeding is recommended to reduce the incidence and severity of certain infectious gastrointestinal and respiratory diseases and other disorders in infancy. Breastfeeding ordinarily confers health benefits to the infant, but in certain rare cases it may pose some health risks, as indicated below.

For mothers requiring medication and desiring to breastfeed, the clinician should select the medication least likely to pass into the milk and to the infant.

Although medications rarely pose a problem during lactation, breastfeeding is contraindicated in the case of a few. Such drugs include antineoplastic agents, therapeutic radiopharmaceuticals, some but not all antithyroid agents, and antiprotozoan agents.

In those rare cases when there is heavy exposure to pesticides, heavy metals, or other contaminants that may pass into the milk, breastfeeding is not recommended if maternal levels are high.

Recommendations for Nutrition Monitoring

The committee recommends that the U.S. government provide a mechanism for periodically monitoring trends in lactation and developing normative indicators of nutritional status during lactation.

Monitoring of trends . Data are needed on the incidence and duration of breastfeeding among the population as a whole, and among some particularly vulnerable subpopulations. Exclusive, partial, and minimal breastfeeding should be distinguished; and data should be collected at several ages during infancy. Current or planned surveys by such agencies as the National Center for Health Statistics or the Nutrition Monitoring Division of the U.S. Department of Agriculture could be modified to serve these goals.

Developing normative indicators of nutritional status . There is a need for data on dietary intakes by, and nutritional status among, lactating women and their relationship to lactation performance. Identification of groups of lactating women who are at nutritional risk is a problem of public health importance.

Research Recommendations

In its deliberations, the subcommittee was well aware that many factors (such as hospital practices, social attitudes, governmental policies, and exposure to infectious agents) may have a great influence on breastfeeding rates and lactation performance and that there is a need for studies to examine approaches that hold the most promise for improving both of these. Similarly, the subcommittee recognized the great need for studies to examine the short- and long-term benefits of breastfeeding in the United States among mothers and infants in all segments of the population, but especially among disadvantaged groups, which currently have the lowest rates of breastfeeding. Research recommendations concerning several of these issues (infant mortality, growth charts for breastfed infants, possible transmission of HIV, indicators of infant nutritional status) are contained in Chapter 10 . They have been excluded from this summary, not because they are unimportant, but rather because they relate only indirectly to the nutrition of healthy U.S. women during lactation.

Research is needed to develop indicators of nutritional status for lactating women. First, the identification of normative values for nutritional status should be based on observations of representative, healthy, lactating women in the United States. In addition, indicators are needed of both (1) risks of adverse outcomes related to the mother's dietary intake and (2) the potential of the mother or her nursing infant to benefit from interventions designed to improve their nutritional status or health.

Research is needed to identify groups of lactating women in the United States who are at nutritional risk or who could benefit from nutrition intervention programs. In general, it has been difficult to identify groups of mothers and infants in the United States with nutritional deficits that are severe enough to have measurable functional consequences. Priority should be given to the study of lactating women in subpopulations believed to be at risk of inadequate intake of certain nutrients, such as calcium by blacks and vitamin A by low-income women. The potential influence of culture-specific food

beliefs on nutrient intake of lactating women should be included in any such investigations.

Intervention studies of improved design and technical sophistication are needed to investigate the effects of maternal diet and nutritional status on milk volume; milk composition; infant nutritional status, growth, and health; and maternal health. The nursing dyad (the mother and her infant) has seldom been the focus of studies. Thus, a key aspect of this recommendation is concurrent examination of the mother, the volume and composition of the milk, and the infant. The design of such research needs to be adequate for causal inference; thus, if possible, it should include random assignment of lactating subjects to treatment groups. Appropriate sampling and handling of milk for the valid assessment of energy density, nutrient concentration, and total milk volume are essential, as is accurate measurement of nutrient concentrations.

With regard to the energy balance of lactating women, the threshold below which energy intake is insufficient to support adequate milk production has not yet been identified. Resolution of this question will probably require supplementation studies of women in developing countries whose diets are chronically energy deficient. Although such deficient diets are not common in the United States, identification of the level of energy intake that is too low to support lactation will be useful in establishing guidelines for women who want to breastfeed but who also want to restrict their energy intake to lose weight. Although chronically low energy intakes by women in disadvantaged populations may not be completely analogous to acute energy restriction among otherwise well-nourished women, ethical considerations limit the kinds of investigations that could directly address the influence of energy restriction. In supplementation studies, measurements should be made of lactation performance and of any impact on the mother's nutritional status and health, including the period of lactation amenorrhea.

With regard to specific nutrients, the impact of relatively low intakes of folate, vitamin B 6 , calcium, zinc, and magnesium during lactation on the mother's nutritional status and health needs to be assessed in more detail. As a part of this assessment, studies of the absorption of calcium, zinc, and magnesium during lactation will be useful. There is also a need to identify a reliable indicator of vitamin B 6 status of infants and to document the relationships between this indicator, maternal vitamin B 6 intake, and vitamin B 6 content in milk. Finally, resolution of the conflicting findings concerning the impact of maternal protein intake on milk volume would be desirable.

DHHS (Department of Health and Human Services). 1980. Promoting Health/Preventing Disease: Objectives for the Nation. Public Health Service, U.S. Department of Health and Human Services, U.S. Government Printing Office, Washington, D.C. 102 pp.

DHHS (Department of Health and Human Services). 1984. Report of the Surgeon General's Workshop on Breastfeeding and Human Lactation. DHHS Publ. No. HRS-D-MC 84-2. Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, Rockville, Md. 93 pp.

DHHS (Department of Health and Human Services). 1985. Followup Report: The Surgeon General's Workshop on Breastfeeding & Human Lactation. DHHS Publ. No. HRS-D-MC 85-2. Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services, Rockville, Md. 46 pp.

DHHS (Department of Health and Human Services). 1990. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Conference Edition. U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary of Health, Washington, D.C. 672 pp.

IOM (Institute of Medicine). 1990. Nutrition During Pregnancy: Weight Gain and Nutrient Supplements. Report of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy, Subcommittee on Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board. National Academy Press, Washington, D.C. 468 pp.

Lawrence, R.A. 1989. Breastfeeding: A Guide for the Medical Profession, 3rd ed. C.V. Mosby, St. Louis. 652 pp.

Little, R.E., K.W. Anderson, C.H. Ervin, B. Worthington-Roberts, and S.K. Clarren. 1989. Maternal alcohol use during breastfeeding and infant mental and motor development at one year. N. Engl. J. Med. 321:425-430.

Malone, C. 1980. Breast-Feeding. Cumberland County WIC Program, People's Regional Opportunity Program, Portland, Maine. 13 pp.

NRC (National Research Council). 1989. Recommended Dietary Allowances, 10 th ed. Report of the Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 284 pp.

The Steering Committee to Promote Breastfeeding in New York City. 1986. The Art and Science of Breastfeeding. Division of Maternal and Child Health, Bureau of Health Care Delivery and Assistance, Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, D.C. 74 pp.

USDA (U.S. Department of Agriculture). 1988. Promoting Breastfeeding in WIC: A Compendium of Practical Approaches. FNS-256. Food and Nutrition Service, U.S. Department of Agriculture, Alexandria, Va. 171 pp.

On the basis of a comprehensive literature review and analysis, Nutrition During Lactation points out specific directions for needed research in understanding the relationship between the nutrition of healthy mothers and the outcomes of lactation. Of widest interest are the committee's clear-cut recommendations for mothers and health care providers.

The volume presents data on who among U.S. mothers is breastfeeding, a critical evaluation of methods for assessing the nutritional status of lactating women, and an analysis of how to relate the mother's nutrition to the volume and composition of the milk.

Available data on the links between a mother's nutrition and the nutrition and growth of her infant and current information on the risk of transmission through breastfeeding of allergic diseases, environmental toxins, and certain viruses (including the HIV virus) are included. Nutrition During Lactation also studies the effects of maternal cigarette smoking, drug use, and alcohol consumption.

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A year after affirmative action ban, how students are pitching themselves to colleges

• Deep Read ( 13 Min. )
• By Olivia Sanchez, Nirvi Shah, and Meredith Kolodner The Hechinger Report

June 28, 2024

In the year since the U.S. Supreme Court banned the consideration of race in college admissions, students have had to give more thought to how they present themselves in their application essays – to what they will disclose.

Data from the Common Application shows that in this admissions cycle, about 12% of students from underrepresented racial and ethnic groups used at least one of 38 identity-related phrases in their essays, a decrease of roughly 1% from the previous year. The data shows that about 20% of American Indian and Alaskan Native applicants used one of these phrases; meanwhile 15% of Asian students, 14% of Black students, 11% of Latinx students, and fewer than 3% of white students did so.

Why We Wrote This

A year ago, the U.S. Supreme Court barred affirmative action in college admissions. Students have since used their application essays as a place to explore identity.

To better understand how students were deciding what to include, The Hechinger Report asked newly accepted students from across the United States to share their application essays and to describe how they thought their writing choices ultimately influenced their admissions outcomes. Among them was Jaleel Gomes Cardoso from Boston, who wrote about being Black. 

“If you’re not going to see what my race is in my application, then I’m definitely putting it in my writing,” he says, “because you have to know that this is the person who I am.”   

In the year since the Supreme Court banned  the consideration of race in college admissions last June, students have had to give more thought to how they present themselves in their application essays .

Previously, they could write about their racial or ethnic identity if they wanted to, but colleges would usually know it either way and could use it as a factor in admissions. Now, it’s entirely up to students to disclose their identity or not.

Data from the Common Application shows that in this admissions cycle about 12% of students from underrepresented racial and ethnic groups used at least one of 38 identity-related phrases in their essays, a decrease of roughly 1% from the previous year. The data shows that about 20% of American Indian and Alaskan Native applicants used one of these phrases; meanwhile 15% of Asian students, 14% of Black students, 11% of Latinx students, and fewer than 3% of white students did so.

To better understand how students were making this decision and introducing themselves to colleges, The Hechinger Report asked newly accepted students from across the country to share their college application essays. The Hechinger staff read more than 50 essays and talked to many students about their writing process, who gave them advice, and how they think their choices ultimately influenced their admissions outcomes.

Here are thoughts from a sampling of those students, with excerpts from their essays. 

Jaleel Gomes Cardoso of Boston: A risky decision

As Jaleel Gomes Cardoso sat looking at the essay prompt for Yale University, he wasn’t sure how honest he should be. “Reflect on your membership in a community to which you feel connected,” it read. “Why is this community meaningful to you?” He wanted to write about being part of the Black community – it was the obvious choice – but the Supreme Court’s decision to ban the consideration of a student’s race in admissions gave him pause.

“Ever since the decision about affirmative action, it kind of worried me about talking about race,” says Mr. Cardoso, who grew up in Boston. “That entire topic felt like a risky decision.” 

In the past, he had always felt that taking a risk produced some of his best writing, but he thought that an entire essay about being Black might be going too far. 

“The risk was just so heavy on the topic of race when the Court’s decision was to not take race into account,” he says. “It was as if I was disregarding that decision. It felt very controversial, just to make it so out in the open.” 

In the end, he did write an essay that put his racial identity front and center. He wasn’t accepted to Yale, but he has no regrets about his choice.

“If you’re not going to see what my race is in my application, then I’m definitely putting it in my writing,” says Mr. Cardoso, who will attend Dartmouth College this fall, “because you have to know that this is the person who I am.”                       

 – Meredith Kolodner

Essay excerpt:

I was thrust into a narrative of indifference and insignificance from the moment I entered this world. I was labeled as black, which placed me in the margins of society. It seemed that my destiny had been predetermined; to be part of a minority group constantly oppressed under the weight of a social construct called race. Blackness became my life, an identity I initially battled against. I knew others viewed it as a flaw that tainted their perception of me. As I matured, I realized that being different was not easy, but it was what I loved most about myself.  

Klaryssa Cobian of Los Angeles: A seminomadic mattress life

Klaryssa Cobian is Latina – a first-generation Mexican American – and so was nearly everyone else in the Southeast Los Angeles community where she grew up. Because that world was so homogenous, she really didn’t notice her race until she was a teenager.

Then she earned a scholarship to a prestigious private high school in Pasadena. For the first time, she was meaningfully interacting with people of other races and ethnicities, but she felt the greatest gulf between her and her peers came from her socioeconomic status, not the color of her skin. 

Although Ms. Cobian has generally tried to keep her home life private, she felt that colleges needed to understand the way her family’s severe economic disadvantages had affected her. She wrote about how she’d long been “desperate to feel at home.”

She was 16 years old before she had a mattress of her own. Her essay cataloged all the places she lay her head before that. She wrote about her first bed, a queen-sized mattress shared with her parents and younger sister. She wrote about sleeping in the backseat of her mother’s red Mustang, before they lost the car. She wrote about moving into her grandparents’ home and sharing a mattress on the floor with her sister, in the same room as two uncles. She wrote about the great independence she felt when she “moved out” into the living room and onto the couch.  

“Which mattress I sleep on has defined my life, my independence, my dependence,” Ms. Cobian wrote. 

She’d initially considered writing about the ways she felt she’d had to sacrifice her Latino culture and identity to pursue her education, but said she hesitated after the Supreme Court ruled on the use of affirmative action in admissions. Ultimately, she decided that her experience of poverty was more pertinent. 

“If I’m in a room of people, it’s like, I can talk to other Latinos, and I can talk to other brown people, but that does not mean I’m going to connect with them. Because, I learned, brown people can be rich,” Ms. Cobian says.  She’s headed to the University of California, Berkeley, in the fall.

– Olivia Sanchez

Essay excerpt: 

With the only income, my mom automatically assumed custody of me and my younger sister, Alyssa. With no mattress and no home, the backseat of my mom’s red mustang became my new mattress. Bob Marley blasted from her red convertible as we sang out “could you be loved” every day on our ride back from elementary school. Eventually, we lost the mustang too and would take the bus home from Downtown Los Angeles, still singing “could you be loved” to each other.  

Oluwademilade Egunjobi of Providence, Rhode Island: The perfect introduction

Oluwademilade Egunjobi worked on her college essay from June until November. Not every single day, and not on only one version, but for five months she was writing and editing and asking anyone who would listen for advice.

She considered submitting essays about the value of sex education, or the philosophical theory of solipsism (in which the only thing that is guaranteed to exist is your own mind). 

But most of the advice she got was to write about her identity. So, to introduce herself to colleges, Oluwademilade Egunjobi wrote about her name.

Ms. Egunjobi is the daughter of Nigerian immigrants who, she wrote, chose her first name because it means she’s been crowned by God. In naming her, she said, her parents prioritized pride in their heritage over ease of pronunciation for people outside their culture. 

And although Ms. Egunjobi loves that she will always be connected to her culture, this choice has put her in a lifelong loop of exasperating introductions and questions from non-Nigerians about her name. 

The loop often ends when the person asks if they can call her by her nickname, Demi. “I smile through my irritation and say I prefer it anyways, and then the situation repeats time and time again,” Egunjobi wrote. 

She was nervous when she learned about the Supreme Court’s affirmative action decision, wondering what it might mean for where she would get into college. Her teachers and college advisors from a program called Matriculate told her she didn’t have to write a sob story, but that she should write about her identity, how it affects the way she moves through the world and the resilience it’s taught her. 

She heeded their advice, and it worked out. In the fall, she will enter the University of Pennsylvania to study philosophy, politics, and economics. 

I don’t think I’ve ever had to fight so hard to love something as hard as I’ve fought to love my name. I’m grateful for it because it’ll never allow me to reject my culture and my identity, but I get frustrated by this daily performance. I’ve learned that this performance is an inescapable fate, but the best way to deal with fate is to show up with joy. I am Nigerian, but specifically from the ethnic group, Yoruba. In Yoruba culture, most names are manifestations. Oluwademilade means God has crowned me, and my middle name is Favor, so my parents have manifested that I’ll be favored above others and have good success in life. No matter where I go, people familiar with the language will recognize my name and understand its meaning. I love that I’ll always carry a piece of my culture with me.  

Francisco Garcia of Fort Worth, Texas: Accepted to college and by his community

In the opening paragraph of his college application essay, Francisco Garcia quotes his mother, speaking to him in Spanish, expressing disappointment that her son was failing to live up to her Catholic ideals. It was her reaction to Mr. Garcia revealing his bisexuality. 

Mr. Garcia said those nine Spanish words were “the most intentional thing I did to share my background” with colleges. The rest of his essay delves into how his Catholic upbringing, at least for a time, squelched his ability to be honest with friends about his sexual identity, and how his relationship with the church changed. He said he had striven, however, to avoid coming across as pessimistic or sad, aiming instead to share “what I’ve been through [and] how I’ve become a better person because of it.” 

He worked on his essay throughout July, August, and September, with guidance from college officials he met during campus visits and from an adviser he was paired with by Matriculate, which works with students who are high achievers from low-income families. Be very personal, they told Mr. Garcia, but within limits. 

“I am fortunate to have support from all my friends, who encourage me to explore complexities within myself,” he wrote. “My friends give me what my mother denied me: acceptance.”

He was accepted by Dartmouth, one of the eight schools to which he applied, after graduating from Saginaw High School near Fort Worth, Texas, this spring.

– Nirvi Shah

Essay excerpt:  

By the time I got to high school, I had made new friends who I felt safe around. While I felt I was more authentic with them, I was still unsure whether they would judge me for who I liked. It became increasingly difficult for me to keep hiding this part of myself, so I vented to both my mom and my closest friend, Yoana ... When I confessed that I was bisexual to Yoana, they were shocked, and I almost lost hope. However, after the initial shock, they texted back, “I’m really chill with this. Nothing has changed Francisco:)”. The smiley face, even if it took 2 characters, was enough to bring me to tears. 

Hafsa Sheikh of Pearland, Texas: Family focus above all 

Hafsa Sheikh felt her applications would be incomplete without the important context of her home life: She became a primary financial contributor to her household when she was just 15, because her father, once the family’s sole breadwinner, could not work due to his major depressive disorder. Her work in a pizza parlor on the weekends and as a tutor after school helped pay the bills. 

She found it challenging to open up this way, but felt she needed to tell colleges that, although working two jobs throughout high school made her feel like crying from exhaustion every night, she would do anything for her family. 

“It’s definitely not easy sharing some of the things that you’ve been through with, like really a stranger,” she says, “because you don’t know who’s reading it.”

And especially after the Supreme Court ruled against affirmative action, Ms. Sheikh felt she needed to write about her cultural identity. It’s a core part of who she is, but it’s also a major part of why her father’s mental illness affected her life so profoundly. 

Ms. Sheikh, the daughter of Pakistani immigrants, said her family became isolated because of the negative stigma surrounding mental health in their South Asian culture. She said they became the point of gossip in the community and even among extended family members, and they were excluded from many social gatherings. This was happening as she was watching the typical high school experiences pass her by, she wrote. Because of the long hours she had to work, she had to forgo the opportunity to try out for the girls’ basketball team and debate club, and often couldn’t justify cutting back her hours to spend time with her friends.  

She wrote that reflecting on one of her favorite passages in the Holy Quran gave her hope:

“One of my favorite ayahs, ‘verily, with every hardship comes ease,’ serves as a timeless reminder that adversity is not the end; rather, there is always light on the other side,” Ms. Sheikh wrote.

Her perseverance paid off, with admission to Princeton University.

-- Olivia Sanchez

Besides the financial responsibility on my mother and I, we had to deal with the stigma surrounding mental health in South Asian culture and the importance of upholding traditional gender roles. My family became a point of great gossip within the local Pakistani community and even extended family. Slowly, the invitations to social gatherings diminished, and I bailed on plans with friends because I couldn’t afford to miss even a single hour of earnings.

David Arturo Munoz-Matta of McAllen, Texas: Weighing the risks of being honest

It was Nov. 30 and David Arturo Munoz-Matta had eight college essays due the next day. He had spent the prior weeks slammed with homework while also grieving the loss of his uncle who had just died. He knew the essays were going to require all the mental energy he could muster – not to mention whatever hours were left in the day. But he got home from school to discover he had no electricity. 

“I was like, ‘What am I gonna do?’” says Mr. Munoz-Matta, who graduated from Lamar Academy in McAllen, Texas. “I was panicking for a while, and my mom was like, ‘You know what? I’m just gonna drop you off at Starbucks and then just call me when you finish with all your essays.’ And so I was there at Starbucks from 4 until 12 in the morning.” 

The personal statement he agonized over most was the one he submitted to Georgetown University.  

“I don’t want to be mean or anything, but I feel like a lot of these institutions are very elitist, and that my story might not resonate with the admissions officers,” Mr. Munoz-Matta says. “It was a very big risk, especially when I said I was born in Mexico, when I said I grew up in an abusive environment. I believed at the time that would not be good for universities, that they might feel like, ‘I don’t want this kid, he won’t be a good fit with the student body.’”

He didn’t have an adult to help him with his essay, but another student encouraged him to be honest. It worked. He got into his dream school, Georgetown University, with a full ride. Many of his peers were not as fortunate. 

“I know because of the affirmative action decision, a lot of my friends did not even apply to these universities, like the Ivies, because they felt like they were not going to get in,” he says. “That was a very big sentiment in my school.”                       

– Meredith Kolodner  

While many others in my grade level had lawyers and doctors for parents and came from exemplary middle schools at the top of their classes, I was the opposite. I came into Lamar without middle school recognition, recalling my 8th-grade science teacher’s claim that I would never make it. At Lamar, freshman year was a significant challenge as I constantly struggled, feeling like I had reached my wit’s end. By the middle of Freshman year, I was the only kid left from my middle school, since everyone else had dropped out. Rather than following suit, I kept going. I felt like I had something to prove to myself because I knew I could make it.

Kendall Martin of Austin, Texas: From frustration to love

Kendall Martin wanted to be clear with college admissions officers about one thing: She is a young Black woman, and her race is central to who she is. Ms. Martin was ranked 15th in her graduating class from KIPP Austin Collegiate. She was a key figure on her high school basketball team. She wanted colleges to know she had overcome adversity. But most importantly, Ms. Martin says, she wanted to be sure, when her application was reviewed, “Y’all know who you are accepting.”

It wouldn’t be as simple as checking a box, though, which led Ms. Martin, of Kyle, Texas, to the topic she chose for her college admissions essay, the year after the Supreme Court said race could not be a factor in college admissions. Instead, she looked at the hair framing her face, hair still scarred from being straightened time and again. 

Ms. Martin wrote about the struggles she faced growing up with hair that she says required extensive time to tame so she could simply run her fingers through it. Now headed to Rice University in Houston – her first choice from a half-dozen options – she included a photo of her braids as part of her application. Her essay described her journey from hating her hair to embracing it, from heat damage to learning to braid, from frustration to love, a feeling she now hopes to inspire in her sister.  

“That’s what I wanted to get across: my growing up, my experiences, everything that made me who I am,” she says.

–  Nirvi Shah

I’m still recovering from the heat damage I caused by straightening my hair every day, because I was so determined to prove that I had length. When I was younger, a lot of my self worth was based on how long my hair was, so when kids made fun of my “short hair,” I despised my curls more and more. I begged my mom to let me get a relaxer, but she continued to deny my wish. This would make me so angry, because who was she to tell me what I could and couldn’t do with my hair? But looking back, I’m so glad she never let me. I see now that a relaxer wasn’t the key to making me prettier, and my love for my curls has reached an all-time high. 

This story about  college admission essays  was produced by  The Hechinger Report , a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s  higher education newsletter . Listen to Hechinger’s  higher education podcast .

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The Asahi Shimbun

Educators fear rise in AI-created essays as tools for detection lag

THE ASAHI SHIMBUN

July 3, 2024 at 07:00 JST

A trickle of essays generated through artificial intelligence were entered in the School Library Association’s contest last year, but educators fear such cheating could become a deluge with no effective countermeasures in place.

For the nationwide contest, elementary, junior high and high school students entered more than 2.6 million essays about books they read during the summer vacation.

Teachers noticed something odd with more than 10 of the essays, and the students who submitted them admitted to inappropriately using AI chatbots. Their essays were subsequently dropped from the competition.

The next essay contest is scheduled for autumn, and officials fear more AI-generated works may escape detection.

Students apply for the contest through their schools, and teachers read the essays before they can advance to the next stage of the selection process.

The association does not impose a blanket ban on AI tools for the contest.

“Our stance is that generative AI can be educationally beneficial, depending on how the technology is used,” an association official said.

The association’s guidelines for applicants forbid plagiarism and inappropriate citations.

For example, essays that include content copied and pasted directly from AI-generated text constitute an “inappropriate” use of the technology, according to the association.

As AI chatbots have become readily available to anyone, the association since last fiscal year has warned teachers about potentially problematic use of the tools.

The association has conducted experiments to spot artificially generated texts, but an official at its secretariat said AI technology remains ahead of detection.

“Each time we have AI write essays, it produces different content,” the official said. “That made it difficult for us to distinguish hallmarks of material made by AI. Besides, the generative technology has advanced dramatically since last year.”

The association said teachers who are familiar with the writing abilities of their students are the most reliable party to check the authenticity of essays.

“If teachers cannot find cheats, I am afraid that nobody can,” the official said.

Another essay contest for high school students faces similar challenges.

More than 20,000 essays were submitted to the competition last year. In a questionnaire after the contest, some members of the judging panel said they suspected several entries were manufactured by AI, according to the organizer.

The organizer said it could not conclude whether the essays were made with AI because it could not confirm the suspicions with the authors. But the judges did not allow such essays to move to the next stage.

In last year’s contest, the organizer did not spell out its policy concerning computer-generated texts. It believes that generative AI is useful in terms of brainstorming and proofreading.

For the contest this year, the organizer will touch on “inappropriate use” of AI models.

“Fairness is critical,” an official with the organizer said. “To get ahead, some students emphasize their prize-winning essays during the admissions process for high school or college.”

However, many organizers agree that current technology to distinguish between text composed by humans from those generated by AI remains unreliable.

In guidelines published last year, the education ministry said children from elementary to high school level should become aware of the importance of learning how to use AI tools.

But it also pointed out that it would be unacceptable for students to submit contest entries that have been “outsourced” to AI.

ARTWORKS COPIED

The use of AI art generators is also a source of concern.

In fiscal 2023, Trident College, a technical school in Nagoya that teaches skills for such endeavors as creating computer games, graphics and illustrations, accepted entries to its competition for 2-D and 3-D illustrations for high school students around Japan.

It forbade the use of AI models.

The school is affiliated with Kawaijuku Educational Institution, a major cram school chain.

Trident College students well versed in the field of illustrations were enlisted to weed out suspicious entries from the initial screening.

Experts say works created by AI generators tend to mimic existing art and specific works.

None of the entries showed telltale signs of AI-generated art, according to the school.

But school officials said the visual checks by humans may not be effective much longer.

“If a user abuses an AI tool and trains it to create works that do not look like specific art pieces, we may not be able to recognize AI-generated content,” said Yuji Kojima, a lecturer at the school.

SOLUTIONS SOUGHT

Businesses are working on programs to determine if something was made with AI or by humans.

Kawaijuku in March said it has developed a program to detect computer-generated text. It is part of a larger system that has been offered to universities since fiscal 2018 mainly for handling admissions processes.

Kawaijuku said the new program has the potential for wider applications, including screening entries for essay contests and evaluating reports produced by college students.

When used to evaluate essay questions in the admissions process, the program is designed to issue a warning when it detects suspicious texts.

“We feel there is a great need out there for a tool that recognizes artificially generated texts,” a Kawaijuku official said.

The official quoted a university staffer as saying that AI may have been used to generate material required for admissions.

“Our program is just a reference, but it may be useful as part of the overall assessment of applicants,” the official said.

Kazunori Sato, associate professor specializing in media literacy and information education at Shinshu University, stressed the need for adults to employ AI tools to understand such creations.

“Essays using AI models tend to have generic content and lack originality,” he said. “Adults, including educators, should routinely experiment with AI to learn patterns of computer-generated texts.”

He noted the use of generative AI has been permitted in academic circles.

Sato said the rule requiring researchers to report their AI use and for which parts of their studies has been widely accepted so that reviewers can carefully check for potential copyright issues.

The same approach can be applied to essays and other contests, he said.

Some contest organizers invite works created by generative AI.

Last year, Gunma Prefecture allowed elementary, junior high and high school students to use AI-created works in a manga and anime event as well as in a contest of computer graphics and games.

While permitting the use of AI models, the prefecture cautions students against potential copyright infringements. Entrants are obliged to declare which AI tool was used in which part of their works and in what manner.

Nineteen entries used AI, but none won prizes, according to the prefecture.

“We believe that generative AI will grow to be an indispensable tool in the future,” a prefectural official in charge of the events said. “We hope that participating in these events will nurture students’ ability to use AI as we work to minimize the risk of copyright issues.”

(This article was written by Kohei Kano and Yukihito Takahama.)

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Hillary Clinton to release essay collection about personal and public life

This cover image released by Simon & Schuster shows “Something Lost, Something Gained: Reflections on Life, Love and Liberty” by Hillary Rodham Clinton. The book will be released Sept. 17. (Simon & Schuster via AP)

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Hillary Clinton’s next book is a collection of essays, touching upon everything from marriage to politics to faith, that her publisher is calling her most personal yet.

Simon and Schuster announced Tuesday that Clinton’s “Something Lost, Something Gained: Reflections on Life, Love and Liberty” will be released Sept. 17.

Among the topics she will cover: Her marriage to former President Bill Clinton, her Methodist faith, adjusting to private life after her failed presidential runs, her friendships with other first ladies and her takes on climate change, democracy and Vladimir Putin.

“The book reads like you’re sitting down with your smartest, funniest, most passionate friend over a long meal,” Clinton’s editor, Priscilla Painton, said in a statement.

“This is the Hillary Americans have come to know and love: candid, engaged, humorous, self-deprecating — and always learning.”

Clinton, the former first lady, U.S. senator and secretary and presidential candidate, will promote her book with a cross country tour. “Something Lost, Something Gained” comes out two months before Bill Clinton’s memoir about post-presidential life, “Citizen.”

Financial terms were not disclosed. Clinton was represented by Washington attorney Robert Barnett, whose other clients have included former President George W. Bush and former President Barack Obama.

Clinton’s previous books include such bestsellers as “It Takes a Village,” “Living History” and “What Happened.”