ABM Statement
Educational Objectives and Skills for the Physician
with Respect to Breastfeeding, Revised 2018
Joan Younger Meek and The Academy of Breastfeeding Medicine
The Academy of Breastfeeding Medicine is a worldwide o rganization of physicians dedicated to the promotion,
protection and support of breastfeeding and human lactation. Our mission is to unite into one association members of
the various medical specialties with this common purpose.
Introduction
T
he science of breastfeeding and human lactation
requires that physicians from many different specialties
have a collaborative forum to promote progress in physician
education. To optimize breastfeeding practices globally,
physicians must incorporate the attitudes and skills needed to
practice evidence-based breastfeeding medicine. The study
of breastfeeding and human lactation is not currently recog-
nized as a medical subspecialty, so the maintenance of a
multispecialty organization dedicated to physician education
and expansion of knowledge in this field has been vital.
Background
The numerous benefits of breastfeeding for mothers and
children have been well documented.
1–3
Physicians (medical
doctors) play a key role in supporting breastfeeding, and they
interact with women, children, and families throughout the
life span. To advocate for breastfeeding, educate families
about breastfeeding, and provide optimal clinical manage-
ment of breastfeeding, these physicians must be educated
about and skilled in breastfeeding establishment, mainte-
nance, and support, as well as how to diagnose and treat
breastfeeding complications.
4–8
Lack of sufficient education
to provide breastfeeding support and guidance by physicians
has been well documented in the medical literature.
9,10
The World Health Organization (WHO) and United Nations
Children’s Fund (UNICEF) ‘‘Ten Steps to Successful Breast-
feeding,’’ (Ten Steps), revised in 2018, called for all health care
staff to have sufficient knowledge, competence, and skills to
support breastfeeding.
11
The Innocenti Declaration on the
Protection, Promotion and Support of Breastfeeding
12
identi-
fied four key goals in breastfeeding support: establishing na-
tional committees for oversight, ensuring maternity facilities
practice the Ten Steps, enforcing the International Code of
Marketing of Breast-milk Substitutes,
13
andenactingleg-
islation that protects the breastfeeding rights of working
women. Where national committees exist, many have an
objective to educate all health care providers regarding ap-
propriate breastfeeding and lactation support (e.g., the
Australian National Breastfeeding Strategy,
14
the German
Breastfeeding Committee,
15
Breastfeeding Promotion Net-
work of India,
16
Kenya’s National Infant and Young Child
Feeding Committee, and the United States Breastfeeding
Committee,
17
). The United States Breastfeeding Committee
published ‘‘Core Competencies in Breastfeeding Care and
Services for All Health Professionals.’’
18
The Academy of Breastfeeding Medicine was founded to
promote physician education and has a central goal to de-
velop and disseminate the standard for physician education
around breastfeeding and human lactation.
19
Guidance for the
integration of breastfeeding medicine throughout the under-
graduate, graduate, and postgraduate medical education of
physicians is provided in this statement. While this guidance
may be applicable to other health care disciplines, the com-
petencies are aimed at physicians specifically. ABM protocols
are useful in teaching evidence-based practices throughout the
medical education continuum. ABM recognizes that termi-
nology used to describe levels of medical education in various
medical education systems around the globe differs. In this
statement, the term ‘‘undergraduate medical education’’ is
used to describe education received before obtaining a medical
doctor degree; ‘‘graduate medical education’’ refers to clinical
education received after the medical degree has been conferred
and before the independent practice of medicine (i.e., doctors
training during residency and/or fellowship); and ‘‘postgrad-
uate education’’ refers to continuing medical education (CME)
and maintenance of certification activities completed during
ongoing professional development and/or as a requirement to
maintain licensure/registration after the training phases have
been completed.
Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida.
BREASTFEEDING MEDICINE
Volume 14, Number 1, 2019
ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2018.29113.jym
5
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Guidelines
Undergraduate medical education
a. All physicians, regardless of discipline, should have
basic knowledge and skills in breastfeeding initiation,
maintenance, diagnosis, and treatment.
20
Therefore, the
theory and practice of breastfeeding should be incorpo-
rated routinely into the medical school curricula.
21
Medical students should learn the anatomy of the breast,
the physiology of lactation (including milk production),
hormonal impact on mother and child, fertility changes, and
the biochemical and immunological properties of human
milk. Students should be able to explain the biological,
sociological, and cultural aspects involved in protecting,
promoting, and supporting breastfeeding. They should
recognize the disparities that exist among different
groups,
22
and that structural, institutional, and systemic
barriers, as well as exposure to racism and implicit biases,
pose challenges to Black, Indigenous, People of Color
(BIPOC) receiving equitable breastfeeding and lactation
support.
23
They should have opportunities to take a ma-
ternal history, obtain a feeding history of a newborn or
child, and observe breastfeeding mothers and children in a
variety of settings. Students need to recognize the value of
breastfeeding and human milk feeding, as well as the risk of
less than optimal breastfeeding. Ideally, this education
should be integrated longitudinally throughout the curric-
ulum, incorporated into block rotations, systems-based
curricula, or case-based learning in the preclinical educa-
tion, and be reinforced during maternal/child health clinical
rotations, including obstetrics and gynecology, pediatrics,
and family medicine.
24
All students, regardless of specialty
choice, should receive this basic education.
All applicable examinations, whether standardized subject
matter, written or oral examinations, or observed structured
clinical examinations, should assess knowledge base and
clinical decision-making skills in breastfeeding. Examina-
tions for licensure or board certification, as applicable, should
also include breastfeeding knowledge and skills assessment.
At a basic level, all medical students, and therefore, all
physicians, should understand the scientific evidence for
breastfeeding, evidence-based clinical management of
mothers and newborns, and the societal context of lactation to
provide health care that supports breastfeeding initiation and
maintenance, avoids creating barriers for breastfeeding wo-
men, and enables women to meet their breastfeeding goals.
25
Online courses are available for medical student education.
26
Additional resources may be helpful in developing a breast-
feeding curriculum.
24,25,27–29
b. Preclinical medical school training in breastfeeding
should address the following objectives
8,20,24,25,30
:
List the health risks of not breastfeeding for chil-
dren, mothers, families, and society.
Recognize that most infants, even those with special
health care needs, can breastfeed.
Diagram anatomy of the mammary gland and sup-
portive breast structures and identify normal and
abnormal histology.
Describe the physiology of milk production and
secretion.
Describe the hormones of lactation and their mul-
tiple effects on mother and child.
Explain the biochemical and immunologic proper-
ties of human milk.
Describe the physiology of lactation-related fertility
suppression.
Discuss the biological, sociological, psychological,
and cultural aspects of supporting breastfeeding.
Identify structural, institutional, and systemic bar-
riers that contribute to disparities in breastfeeding
initiation and duration experienced by BIPOC or
based on education level and socioeconomic status.
Identify national and/or international goals for
breastfeeding rates and goals for breastfeeding
practices, as appropriate.
Compare latch (attachment) and suckling dynamics
of breastfeeding to bottle-feeding mechanics.
Describe evidence-based practices for maternity care
providers shown to increase rates of initiation, du-
ration, and exclusivity of breastfeeding.
c. Clinical training in medical school (clerkship rotations
in obstetrics and gynecology, pediatrics, family medi-
cine, maternal/child health, preventive medicine or
public health, etc.,) should address relevant objectives
related to clinical management of breastfeeding, as
follows
8,20,24,25,30
:
Identify factors that contribute to parental decision-
making about breastfeeding.
Apply the principles of shared decision-making to
engage families in discussions about breastfeeding
initiation and continuation.
Obtain a detailed breastfeeding history and perform
a breastfeeding-related examination of the mother
and infant.
Describe the association between labor and delivery
interventions and initiation of breastfeeding.
Describe the impact of intrapartum and immediate
postpartum procedures and medications on lactation.
Observe and be prepared to facilitate the first
feeding in the delivery room.
Recognize correct attachment and effective suck-
ling at the breast.
Counsel mothers about the importance of exclusive
breastfeeding.
Counsel a breastfeeding mother about basic nutri-
tional needs for herself and her child.
Counsel mothers about establishing and maintaining
milk supply during separation due to illness or re-
turn to school or employment.
Provide anticipatory guidance for breastfeeding
mothers and children.
Access evidence-based resources to recommend
medications and treatment options that are com-
patible with lactation.
Apply the principles of shared decision-making to
discuss family planning options with the lactating
woman.
Discuss causes, prevention, and management of
common breastfeeding problems (e.g., sore nip-
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ples, low milk supply, poor weight gain, and
jaundice).
Describe normal growth patterns for breastfed in-
fants and children.
Describe appropriate timing, introduction, and se-
lection of complementary foods.
Coordinate services with, and provide appropriate
referral to, other health professionals, laypersons,
and community groups to provide support for
breastfeeding.
Support policies and procedures across all specialty
services that promote breastfeeding.
Graduate medical education
a. Residents (postmedical school training) in obstetrics
and gynecology, pediatrics, family medicine, and pre-
ventive medicine residency training programs report a
lack of education in breastfeeding, lack of knowledge
and clinical experience in breastfeeding skills, and lack
of competence or confidence in providing breastfeeding
support to patients.
31–35
Inconsistencies also exist
among breastfeeding training received in various
training programs in pediatrics.
36
Resident physicians
report a need for more direct patient interaction with
regard to breastfeeding. Residents also note a lack of
experience in counseling breastfeeding mothers and
developing problem-solving skills during their train-
ing.
37
Residents have demonstrated deficits in inter-
preting growth patterns of breastfed babies.
38
Program
directors also report that training programs do not pro-
vide adequate training or experience in breastfeeding.
39
b. Several specific activities to achieve resident competency
in breastfeeding management have resulted in an increase
in knowledge of residents and improved breastfeeding
management and behaviors. Examples include
40–42
:
Didactic presentations and small group discussions
about breastfeeding recommendations, benefits, re-
sources, and maternal medication use
Role playing of breastfeeding counseling skills.
Videos on breastfeeding initiation, assessing latch
on, and adequacy of breastfeeding.
Panel discussion with breastfeeding mothers and
individuals who provide support services.
Participation on postpartum rounds with a physician
with expertise in breastfeeding support and/or with
an international board-certified lactation consultant
(IBCLC).
Supervised assessment of latch and breastfeeding
technique with mother/infant dyads.
Supervised management of maternal problems and
maintenance of breastfeeding after return to work,
including knowledge of applicable legal protections
for lactating women in the workplace and training
in use of hand expression or breast pumps.
Observation of breastfeeding consults.
Participation in outpatient breastfeeding or lactation
consultant/specialist clinics.
Attendance at peer counselor meetings (e.g., La Leche
League International) or at peer support provided at
other volunteer or government-supported programs
(e.g., Australian Breastfeeding Association, National
Childbirth Trust [United Kingdom], or Special Sup-
plemental Nutrition Program for Women, Infants, and
Children [United States], and hospital-based groups).
c. For primary care disciplines, resident competencies in
breastfeeding build on those established for medical
students.
8,10,20,24,25,30,32,42–44
The residency compe-
tencies are classified below according to the Accred-
itation Council for Graduate Medical Education
45
(ACGME) competency domains. The ACGME is the
organization responsible for the accreditation of post-
medical degree medical training programs within the
United States and some international sites. The com-
petencies are relevant worldwide.
Medical knowledge.
Identify risks of not breastfeeding for infants,
mothers, and society.
Identify anatomic structures of the breast.
Describe physiology of milk production and removal.
Describe the physiology of lactational fertility
suppression and its use and limitations as a method
of family planning.
Describe the hormones of lactation and their mul-
tiple effects on mother and child.
Explain the biochemical and immunologic proper-
ties of human milk.
Describe the importance of breastfeeding in the
establishment of microbiome.
Describe breastfeeding recommendations.
Discuss the importance of exclusive breastfeeding.
Describe differences in the rates of breastfeeding
initiation and duration based on factors, such as
race/ethnicity, socioeconomic status, and maternal
education.
Describe suckling and compare breastfeeding and
bottle-feeding mechanics.
Recognize the impact of intrapartum and postpar-
tum medications and procedures on lactation.
Describe the importance of skin-to-skin care for the
initiation of breastfeeding.
Describe signs of adequate milk intake by the infant.
Describe the normal growth pattern of breastfed
infants.
List absolute contraindications to breastfeeding.
Describe the lactational amenorrhea method of
family planning.
Identify indications for maternal milk expression.
Describe how to maintain breastfeeding during
maternal/infant separation.
List the specific benefits of human milk for pre-
mature infants.
Identify the late preterm infant as being at higher
risk of complications and breastfeeding failure
compared with the term infant.
Describe the interactions between jaundice, breast-
feeding, and breast milk with appropriate diagnostic
and management strategies.
Describe the role of human milk banking and the
appropriate indications and utilization of donor
human milk.
ABM STATEMENT 7
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Patient care.
Obtain a relevant medical history of breastfeeding
mothers and babies.
Perform a maternal breast assessment, including
nipple configuration and assessment for scars.
Facilitate skin-to-skin care in the delivery room or
operating room.
Provide assistance with the first feeding after de-
livery as needed.
Perform infant oral assessment and general health
assessment.
Evaluate breastfeeding latch and attachment for the
breastfeeding mother and infant.
Evaluate effective nutritive suckling pattern.
Identify mothers and infants at risk for inadequate
milk transfer.
Weigh the benefits of exclusive breastfeeding
against a potential need for supplementation.
Counsel mothers about the perception of inadequate
milk.
Counsel mothers on techniques for hand expression.
46
Counsel mothers about breastfeeding multiples.
Counsel mothers about maternal nutrition during
lactation.
Recommend supplementation of vitamin D, iron,
and other nutrients as appropriate.
Counsel mothers and families about safe sleep prac-
tices for breastfeeding newborns and infants.
47,48
Identify common causes, prevention, and treatment
of engorgement.
49
Develop a differential diagnosis for sore nipples or
breast pain.
Evaluate and manage sore nipples and breast pain.
Diagnose and treat plugged ducts, mastitis, and
abscess.
50
Evaluate maternal infections and potential risk of
transmission to the breastfed infant.
Counsel families on the risks and benefits of in-
formal milk sharing.
51
Develop a differential diagnosis for neonatal hy-
poglycemia and manage newborn blood sugars in a
manner that supports breastfeeding.
52
Evaluate and manage infants with neonatal jaundice
in a manner that supports breastfeeding.
53
Monitor for inadequate milk production or milk
transfer and implement supplementation when
medically necessary.
54
Identify and manage newborns at risk for excessive
weight loss and dehydration.
Evaluate and manage infants with ankyloglossia.
55
Measure, plot, monitor, and interpret infant growth
patterns using the WHO growth standards.
Evaluate and manage infants with poor weight gain.
Develop management plans that incorporate the use
of expressed maternal milk and/or donor human
milk when supplementation is necessary.
Support nontraditional family units in breastfeeding
support (e.g., same sex couples, transgender).
Counsel families about breastfeeding adopted or
surrogate children.
Counsel families about vaccination practices during
breastfeeding.
Counsel families about family planning and the
potential impact on breastfeeding.
Counsel mothers about maintaining breastfeeding
during separation from the infant.
Counsel mothers about storage of expressed human
milk.
Counsel mothers about returning to work or school.
Evaluate medication risk during lactation by refer-
ring to appropriate evidence-based resources (e.g.,
LactMed).
56
Counsel breastfeeding mothers on the use of rec-
reational drugs.
Evaluate and manage infants born to mothers with
substance abuse who desire to breastfeed.
57
Support breastfeeding in special circumstances (e.g.,
prematurity, infant congenital anomalies, cleft
lip/palate,
58
congenital heart disease, trisomy 21,
maternal diabetes, and delayed lactogenesis stage II).
Provide appropriate introduction and progression of
breastfeeding for premature infants according to
gestational age.
Counsel mothers about introduction of comple-
mentary feedings.
Counsel mothers about weaning.
Communication and interpersonal skills.
Apply shared decision-making principles to coun-
seling mothers and families about optimal infant
feeding decision for health outcomes, child spacing,
and nutrition.
Demonstrate sensitivity to cultural and ethnic dif-
ferences and practices related to breastfeeding and
infant care.
Demonstrate sensitivity to the spectrum of family
configurations and the impact on breastfeeding.
Systems-based practice.
Identify and help implement policies that support
breastfeeding in maternity care facilities (e.g., the
Ten Steps),
11
managed by Baby-Friendly USA,
59
in
the United States and other appropriate country-
specific agencies, such as ministries of health.
Identify barriers to successful breastfeeding and
suggest strategies to overcome them.
Describe structural, institutional, and systemic bar-
riers that contribute to disparities in breastfeeding
initiation and duration experienced by BIPOC, or
based on education level and socioeconomic status.
Describe how exposure to racism and implicit bia-
ses pose challenges to families of color receiving
equitable breastfeeding and lactation support.
Identify cultural and psychosocial factors that im-
pact breastfeeding rates.
Refer breastfeeding mothers and babies for expert
assistance as needed.
List ways in which the community can support
breastfeeding.
Identify community resources to assist breastfeed-
ing mothers, including breastfeeding-friendly prac-
8 ABM STATEMENT
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titioners, prenatal or postpartum classes, drop in
breastfeeding services, mother-to-mother support,
and internet resources.
Describe the role of IBCLCs, other levels of pro-
fessional and lay breastfeeding support, as well as
other members of the health care team in caring for
mothers and babies.
Be able to identify current laws protecting breast-
feeding mothers with regard to maternity leave,
breastfeeding or pumping/expressing breast milk at
work, and breastfeeding in public.
Advocate for legislative policies to enable families
to meet their breastfeeding goals.
Facilitate follow-up visits for breastfeeding mothers
and babies.
Practice-based learning and improvement.
Locate resources for CME.
Assess current breastfeeding knowledge base and
identify gaps in knowledge and clinical skills.
Perform evidence-based review of breastfeeding
educational topics or clinical issues.
Investigate program or hospital-specific breast-
feeding initiation and duration rates.
Participate in or develop quality improvement plans
to improve breastfeeding rates and support in the
local clinic, practice, or hospital environment.
d. Lactation education should be integrated longitudi-
nally throughout the curriculum and should occur in a
variety of clinical settings: outpatient continuity clinic
and practices; inpatient settings (e.g., labor and deliv-
ery, newborn nursery, mother/baby units or postpartum
units, neonatal intensive care units, inpatient general
pediatrics, and adult medical and surgical wards); and
community settings such as public health department
clinics or government-funded community health cen-
ters. In addition, breastfeeding-specific curricula
should be presented through a variety of teaching
modalities, to include didactics, case presentations and
discussions, daily attending rounds, and journal
‘‘clubs’’ in which peer-reviewed journal articles are
reviewed critically. Residents may attend live presen-
tations or discussions, review online resources (e.g.,
videos), read breastfeeding textbooks or periodicals
(e.g., Breastfeeding Medicine, the Journal of Human
Lactation, or specialty-specific literature), and com-
plete online web-based training modules.
60–62
In the
United States, a multidisciplinary, competency-based
curriculum in breastfeeding education that provides
multiple activities for integration throughout the resi-
dency program is available on the American Academy
of Pediatrics website.
63
Use of this curriculum has
been associated with better care of lactating mothers
and infants and improved breastfeeding rates when
implemented in residency programs.
64
In each country,
resident participation in public clinics would provide
an important exposure to common breastfeeding
problems in a diverse patient population.
e. The knowledge, skills, and attitudes of residents are
important in supporting breastfeeding in patients. It is
equally important that residents in training are sup-
ported themselves when they are breastfeeding par-
ents. Residents report lack of support for breastfeeding,
and their need to express milk after return to work,
from their faculty and peer colleagues.
65,66
Residency
directors, faculty, deans and department chairs, and
administrative support personnel need to advocate for
program and human resource policies that support
breastfeeding for residents, as well as for medical
students, faculty, and staff.
f. The need for physician leadership in residency training
to make the human lactation curriculum an ongoing
sustainable component of medical education has been
described.
24
Physician administrators (e.g., department
chairs, residency program directors) either need to
identify and support or develop this expertise within
the local training program, institution, or hospital.
g. Breastfeeding medicine electives in the form of block
rotations devoted to breastfeeding, occurring in a variety
of clinical settings, have been described in family
medicine and pediatric residency training programs.
37,67
These electives may include more advanced topics
(e.g., relactation, induced lactation) and should stim-
ulate more sophisticated clinical problem solving skills
and/or provide an experience in clinical research or
advocacy. Faculty oversight by individuals with a high
degree of knowledge and skills in breastfeeding and
human lactation is essential. The ABM has a peer-
reviewed process for review of the credentials and
background of physicians in breastfeeding with the
Fellow of the Academy of Breastfeeding Medicine
award.
19
Fellowship in the ABM is one, but not the
only, means of identifying those individuals with a
high degree of specialization in breastfeeding medi-
cine. The emergence of breastfeeding medicine prac-
tices provides an additional opportunity for education
of residents in an intensive setting and should assist in
encouraging participating residents to make the prac-
tice of breastfeeding medicine an integral part of their
professional practices.
68
h. Subspecialty training programs (e.g., fellowship pro-
gram in subspecialty disciplines, such as maternal/fetal
medicine or neonatology) require additionally struc-
tured didactic and experiential education, as well as
research opportunities, to further the science and ad-
vance the understanding of the role and importance of
breastfeeding and human milk.
Postgraduate/In-Service/CME
a. Practicing physicians, especially those in the disci-
plines of obstetrics and gynecology,
69
pediatrics, and
family medicine,
70
require ongoing CME in breast-
feeding medicine to maintain and enhance their clin-
ical skills and expertise. Key components of ongoing
education should encompass the importance of breast-
feeding and, especially, the risks of not breastfeeding,
lactation management, and counseling skills.
71,72
Prac-
ticing physicians acknowledge that they do not under-
stand clearly the health outcomes related to
breastfeeding.
73
Patients have reported not receiving
ABM STATEMENT 9
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routine prenatal or postpartum counseling about
breastfeeding by their physicians.
74
Physician attitudes
about counseling mothers have been shown to be a
significant factor in the mother’s infant feeding deci-
sions. Breastfeeding education of physicians can in-
crease breastfeeding initiation rates.
75,76
Physicians’
lack of knowledge has led patients to seek guidance
elsewhere. Some physicians are not proactive about
supporting breastfeeding, are neutral, or may not pro-
vide appropriate advice.
77,78
Mothers who report re-
ceiving encouragement from their physician are more
likely to continue breastfeeding.
79
The role of the phy-
sician in encouraging breastfeeding has been shown to
be especially important in those patient populations less
likely to initiate breastfeeding.
80
Surveys of practicing
physicians indicate that many are either not aware of
policy statements on breastfeeding or are not following
these policies in counseling patients.
6,81–83
Require-
ments to maintain specialty or subspecialty certification
should incorporate breastfeeding-related materials into
activities required for ongoing certification.
b. Practicing physicians have the following areas of need
in terms of CME regarding breastfeeding:
Skills in teaching breastfeeding techniques.
Clinical management and problem solving skills in
breastfeeding.
84
Awareness about maternal concerns such as weight
loss, contraception during lactation, and maternal
medications.
Training in evaluating latch and attachment.
85
Identification and treatment of maternal complica-
tions such as mastitis and engorgement.
86
Evaluating problems with nipple or breast pain.
Applying evidence-based strategies for assessment
and monitoring to support exclusive breastfeeding.
Addressing maternal perception of not enough
breast milk.
79
Advising mothers about returning to work and
continued breastfeeding.
Availability of referral services existing for breast-
feeding support.
87
More practical training and self-study materials.
88
Interactive training sessions.
89,90
Recognition of the role of family support.
89
Importance of avoiding routine provision of infant
formula, infant formula samples, or educational
materials that bear infant formula logos or product
information.
91
c. The ABM course, ‘‘What Every Physician Needs to
Know about Breastfeeding,’’ offered annually, provides
CME at an introductory level for physicians and other
health care practitioners. The ABM also sponsors an an-
nual international conference that provides education for
physicians about the current state-of-the-art of breast-
feeding knowledge and research.
19
Many national orga-
nizations also offer CME in breastfeeding medicine for
practicing physicians. A growing number of sources that
provide breastfeeding CME for physicians are available,
including online resources and web-based seminars.
d. The residency competencies for resident physicians are
equally applicable to practicing physicians. Many
practicing physicians are in positions of authority and
may be able to affect health policy, so additional ed-
ucational objectives for CME relate to breastfeeding
advocacy
6–8
:
Promote hospital policies and procedures that fa-
cilitate breastfeeding.
Develop the hospital policies indicated in the Ten
Steps and implement those policies and practices.
Collaborate with other primary care disciplines,
appropriate subspecialties (e.g., neonatologists,
maternal/fetal medicine specialists), and dental
health professionals to ensure optimal outcomes.
Provide space for breastfeeding or milk expression
and private lactation areas for all breastfeeding
mothers, both patient and staff, in hospital and of-
fice settings.
Develop office practices that promote and support
breastfeeding.
Advocate for reimbursement for breastfeeding ser-
vices provided by physicians and/or lactation spe-
cialists from government payers and third-party
health insurance companies.
Promote governmental policies and legislation that
support breastfeeding mothers and children and in-
crease breastfeeding rates.
Increase availability of lactation consultants and
other skilled breastfeeding support personnel in in-
patient and outpatient settings.
Monitor breastfeeding rates in the practice and/or
hospital to include initiation and duration, as well as
exclusive breastfeeding rates.
Develop quality improvement practices that have a
positive impact on breastfeeding rates.
Advocate for dismantling of structural, institutional,
and systemic barriers and take steps to mitigate
racism and implicit biases that contribute to racial
inequities in breastfeeding.
Incorporate practices that acknowledge cultural
differences in the local breastfeeding community.
Achieve a positive image of breastfeeding as nor-
mative behavior in the media.
Encourage support of breastfeeding and the use of
expressed milk in childcare settings.
Implement evidence-based protocols addressing
breastfeeding policy and management, such as those
available from the ABM.
Summary
The medical community plays a critical role in promoting,
protecting, and supporting breastfeeding for optimal out-
comes for all families. Implementation of high-quality
breastfeeding education throughout the continuum of medi-
cal education is critical to ensure that physicians-in-training
develop appropriate knowledge, skills, and attitudes and that
practicing physicians maintain their skills and competency to
protect every parent’s human right to breastfeed and the right
of every child to be breastfed.
92
10 ABM STATEMENT
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Acknowledgment
The author acknowledges Dr. Abigail Adair-Dimmick for
her contribution to conducting the literature review for this
revised statement.
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Joan Younger Meek, MD, MS, FABM
Lead Author
The Academy of Breastfeeding
Medicine Protocol Committee:
Michal Young, MD, FABM, Chairperson
Larry Noble, MD, FABM, Translations Chairperson
Sarah Calhoun, MD
Sarah Dodd, MD
Megan Elliott-Rudder, MD
Susan Lappin, MD
Ilse Larson, MD
Ruth A. Lawrence, MD, FABM
Kathleen A. Marinelli, MD, FABM
Nicole Marshall, MD
Katrina Mitchell, MD
Sarah Reece-Stremtan, MD
Casey Rosen-Carole, MD, MPH, MSEd
Susan Rothenberg, MD
Tomoko Seo, MD, FABM
Adora Wonodi, MD
ABM STATEMENT 13
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