An open letter to the Secretary of the U.S. Department of Health and Human Services
Background: On June 9, 2014, Sylvia Mathews Burwell was sworn in as the new Secretary of the U.S. Department of Health and Human Services.
Dear Secretary Burwell,
Congratulations on your position as the new Secretary of the U.S. Department of Health and Human Services. As you work to establish policies and priorities under your leadership, may I please offer a suggestion… send a message to the world that the U.S. is finally going to get serious about increasing the number of breastfeeding American women and infants.
The U.S. Breastfeeding Committee is convening their fifth annual Coalitions Conference on August 2 through August 4, 2014. The conference will be in Arlington, VA. I checked the Google Map website and found that the location of the conference is a mere 3.6 miles from the Hubert H. Humphrey Building in Washington, DC where your office is located. According to Google Map it will only take you 7 minutes to travel to the conference from your office.
The Coalition Conference will include several “Special Interest Meetings” on Sunday August 3, 2014. One of those special meetings is for State Breastfeeding Coordinators. That meeting would be the perfect setting for you to make the point that you are personally committed to promoting breastfeeding in the U.S. Many of the State Breastfeeding Coordinators are affiliated with the state WIC Programs. Therefore, they haven’t provided much input in the past as far as what the federal government should be doing to help support breastfeeding. Quite frankly, the State Breastfeeding Coordinators fear that if their opinions are perceived in Washington, DC as criticism, they will face retribution in the form of funding cuts to their programs or even a loss of their job. That’s not exactly a shining example of democracy in action.
There probably won’t be enough time at the special interest meeting on August 3 to establish a meaningful dialogue between you and the State Breastfeeding Coordinators. Perhaps you could offer to host a follow-up meeting in Washington, DC for all of the State Breastfeeding Coordinators.
Providing the best possible nutrition for your baby should never have become such a difficult challenge. I hope you have the leadership capability to create an atmosphere in which every woman in America who wants to breastfeed will finally have the full support of her hospital, her insurance company, and her government.
Well written! I hope the new Secretary can do some good.
On August 4, 2014, our current acting Surgeon General, Dr. Boris Lushniak, spoke at the annual conference of the U.S. Breastfeeding Committee. Surgeon General Lushniak expressed his support of the effort to increase the number of breastfeeding women in America.
Well of course the Surgeon General expressed support for breastfeeding… he’s a doctor. And dentists are supportive of brushing your teeth. And teachers are supportive of education. Etc.
Secretary Burwell, with all due respect, I don’t think you quite understand why this thread was started in the first place. The lack of government support of breastfeeding is not a medical issue, it’s a political issue. Therefore, sending the acting Surgeon General to the conference to deal with an administrative problem simply won’t work. As the head of the U.S. Department of Health and Human Services, the burden is on you to establish policies for the Federal government that finally put words into action.
On June 11, 1984, the U.S. Surgeon General, Dr. C. Everett Koop, released a report titled “The Surgeon General’s Workshop on Breastfeeding and Human Lactation.” Dr. Koop’s opening statement in that report included the following: “The Surgeon General’s Workshop on Breastfeeding and Human Lactation represents a milestone in our continuing efforts to improve the health of our nation’s mothers and infants. Research findings have documented the benefits of human milk and lactation for babies and mothers.”
There are 6 categories covered in Dr. Koop’s report. The following appears under Category 3: Professional Education, on page 68 of the report: “Develop accreditation guidelines for health care facilities that specifically include a requirement of staff education in lactation and breastfeeding.”
The following appears under Category 4: Health Care System, Definition of the Issue, on page 69 of the report:
“The current organization and delivery of maternal and child health services and attitudes of health-care team members frequently negate support for breastfeeding. The problem is compounded by the significant numbers of health-care providers who are not adequately educated about the process and advantages of lactation in human reproduction and in infant health. Achievement of the goal to increase the incidence and duration of breastfeeding will require thorough education of all members of the health-care team. The result should be a clearer recognition of support for lactation and breastfeeding as an important and valuable component of family-centered maternity/newborn care. Furthermore, the application of this knowledge will require on the part of all members of the healthcare team a positive attitude, based upon the conviction that lactation has specific and significant advantages for both mother and baby. Accordingly, all providers and facilities should adopt a posture of advocating lactation as the natural and preferred means of infant feeding. This attitude should include institutional policies clearly supportive of lactation and breastfeeding. At the present time, some of the federal programs serving women and children include disincentives to breastfeeding. The federal government should address these barriers and become committed to the elimination or modification of such policies.”
The following appears under Category 4: Health Care System, Suggested Strategies, on page 70 of Dr. Koop’s report:
“Explore the potential for third-party coverage for lactation counseling and breastfeeding support through the Health Care financing Administration, the National Association of Insurance Carriers, and other appropriate groups/agencies.”
By now Madame Secretary you should have a sense of why I’m so cynical. For thirty years (30 years!) U.S. Surgeon Generals have been urging our Federal government to take a more active and effective role in promoting breastfeeding. Both Democrat and Republican administrations have failed to embrace breastfeeding as a national priority. This is your moment. As I said in my original post, I hope you have the leadership capability to create an atmosphere in which every woman in America who wants to breastfeed will finally have the full support of her hospital, her insurance company, and her government.
Secretary Burwell - In his final State of the Union speech on January 12, 2016, President Obama gave you the green light to make changes that will have a positive effect on the lives of Americans. Previously, for some unknown reason, neither you nor your predecessor, Kathleen Sebelius, have used the authority you were given by Congress under the Affordable Care Act to issue clearly written regulations which would require insurance companies (1) to provide the women they insure, without charge, with a good quality and appropriate breast pump, which has been recommended by a qualified health care provider, prior to childbirth or immediately following childbirth, to mothers who have made the commitment to breastfeed, AND (2) to cover the cost of consulting with a lactation specialist if needed. After President Obama's speech, you can now feel confident that you have been given permission by your boss to do what is in the best interest of American women and infants by mandating that those two items be provided cost free.
There is no medical justification for an insurance company to withhold a breast pump for a breastfeeding mother when a medical professional has recommended that she should have one. Also, there is no medical justification for an insurance company to deny coverage for a breastfeeding mother to get help from a lactation specialist when she has problems or concerns about breastfeeding.
The lack of support for breastfeeding from the insurance industry is a direct result of the lack of leadership displayed by the DHHS. Secretary Burwell, this problem has existed since 2012 in spite of the fact that several organizations have put together a specific set of guidelines for insurance companies to follow which could resolve this problem today. For more information about that set of guidelines you can contact the U.S. Breastfeeding Committee, or the National Women's Law Center, or the United States Lactation Consultant's Association.
Please don't allow this situation to continue. Take action now!
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