National efforts to support breastfeeding: A progress update on the Surgeon General's Call to Action

background: In 2011, the U.S. Surgeon General released a Call to Action to Support Breastfeeding (SG-CTA) outlining 20 action steps and associated implementation strategies for family members, communities, clinicians, healthcare systems, employers, and public health professionals to support mothers’ breastfeeding efforts.

purpose: To review and record progress on SG-CTA recommendations by national and state-level agencies from 2011-2014.

methods: We collected descriptive information about breastfeeding activities from national and state-level organization websites and documents and reviewed research, organization publications, and new policies. We categorized and classified breastfeeding activities into the 20 SG-CTA action steps and each step’s associated implementation strategies.

results: All 20 action steps were represented by the range of breastfeeding activities recorded. In particular, national and state-level policies and programs have focused attention on SG-CTA action steps related to 1) improving maternity care practices (Steps 7 & 8), 2) supporting mothers in the workplace through lactation support programs (Step 14), and 3) improving access to community-level peer and professional breastfeeding support (Steps 3 & 4). The least number of activities were recorded for training a wide range of health professionals in breastfeeding (Steps 9 & 10), strengthening capacity and increasing funding for high-quality breastfeeding research (Steps 17 & 18), and promoting paid maternity leave policies (Step 13).

conclusion: National and state-level programs and policies are addressing all 20 action steps in the SG-CTA, but with varying levels of activity. This review highlights progress made on each SG-CTA step and identifies areas that may benefit from additional activity.