Newborn circumcision rates trending unfortunately downward

By Sally Greenberg, NCL Executive Director

There are certain topics in public health that involve body parts that evoke embarrassment when raised for discussion but are absolutely critical in achieving optimal health – breastfeeding is one of them, and male circumcision is another. Breastfeeding may be embarrassing to some folks, but it shouldn’t be; it’s a totally natural act that not only leads to a myriad of positive health outcomes for the baby – fewer allergies, fewer illnesses, less incidence of obesity – but also for the nursing mother, including lower rates of cancer and diabetes.

Recently, USA Today reported on a series of improved medical outcomes brought about by male circumcision – a topic which some might find embarrassing but that is proving critical not only to men’s health, but also the health of their sexual partners. Unfortunately, rates of circumcision have been dropping since the 1970s, in part because shockingly, Medicaid programs have stopped covering the procedure in 18 states. About 56 percent of newborns were circumcised in 2008, down from 64 percent in 1995. In the 1970s and 80s, nearly 80 percent of male babies were circumcised. If the trend continues, and rates drop to 10%, this would mean:

  • 211% more urinary tract infections in baby boys
  • 12% more HIV cases in men
  • 29% more Human Papillomavirus in men
  • 18% more high risk HPV infections in women

More cases of cervical and penile cancer linked to HPV would result. Researchers estimate the each skipped circumcision in men costs an additional $313 in medical bills, which totals over a decade to $4 billion. These estimates are based on a study in Uganda in which men underwent circumcision and were followed, along with their female partners.

Interestingly, the American Academy of Pediatrics is about to issue a new policy statement that changes their formerly neutral stance and now will say that circumcising baby boys has significant health benefits. There are some risks as well, bleeding, pain and possibility of infection, that AAP’s research acknowledges. But this new information on circumcision is evidence-based research at its best. And we welcome these new studies in our quest to provide baby boys – and the men they grow up to be – with the best possible health outcomes.

Surgeon General urges support for breastfeeding moms in ‘call to action’

Surgen General Dr. Regina Benjamin speaking to a packed auditorium at GW University in Washington, DC.

Earlier today, Surgeon, General Regina M. Benjamin – a 2010 NCL Trumpeter Awardee – issued a “Call to Action to Support Breastfeeding,” The SG’s report outlines steps communities, clinicians, and employers can take to improve breastfeeding rates across the country. Dr. Benjamin spoke to a packed George Washington University auditorium.

The health benefits of breastfeeding, for both babies and mothers, are well documented. According to the U.S. Department of Health and Human Services, breastfed infants have a lower risk of contracting ear infections, stomach viruses, diabetes, and leukemia, and mothers who breastfeed enjoy lower risks of type 2 diabetes, breast cancer, and postpartum depression. They can also lose much of the weight gained during pregnancy because nursing burns up to 900 calories a day. And it’s free! Buying formula can cost $1,200-1,500 the first year alone.

Yet according to the Center for Disease Control, while 75 percent of American babies start out breastfeeding, only 13 percent are exclusively breastfed at the end of 6 months—rates Benjamin considers low compared to other countries. The SG noted that breastfeeding is significantly lower among African-American, with only 8 percent of infants exclusively breastfed at 6 months.

Some of the steps outlined in the call to action include:

Speakers at the Call to Action for breastfeeding moms.

  • Launch or establish campaigns for breastfeeding education that target mothers, as well as fathers and grandparents
  • Provide education and training in breastfeeding for all health professionals who care for women and children
  • Ensure access to services provided by International Board Certified Lactation Consultants
  • Work toward establishing paid maternity leave for all employed mothers
  • Ensure that maternity care practices throughout the U.S. are fully supportive of breastfeeding

NCL has been advocating for measures to improve the health of women and children since its founding in 1899. We’ve expressed concern that the IRS has denied nursing mothers the ability to use their tax-sheltered health care accounts to pay for breast pumps and other supplies.

NCL Executive Director Sally Greenberg was in attendance and asked Dr. Benjamin how the surgeon general’s office can work with the IRS to get breast pumps listed as medical devices. Benjamin pledged to work with the federal steering committee, which includes representatives from the FDA, FDC, and USDA, to ensure all branches of government understand the importance of breastfeeding for the health of America’s mothers and children.

IRS shortsighted in not recognizing breast pumps as disease prevention tools

NCL recently sent the following letter to the Internal Revenue Service, calling for change with the way the IRS doesn’t classify breast pumps for breast-feeding moms as an item (under IRS Publication 502) that can be reimbursed because they aid in the  “prevention of disease” — an outrageous idea to health advocates who cite numerous data about the proven reduction in health risks to both nursing moms and babies. The letter originally appeared in the Disruptive Women in Health Care blog.

December 29, 2010

Dear Internal Revenue Service Commissioner Douglas H. Shulman:

The National Consumers League has been advocating on behalf of women and children’s health since our founding in 1899. We were therefore very concerned to read about the IRS’ decision to deny nursing mothers the ability to use  their tax-sheltered health care accounts to pay for breast pumps and other supplies. Under IRS regulations, eligible medical expenses under the flex programs.

According to IRS Publication 502, items that can be reimbursed  include those that aid in the  “prevention of disease.” The IRS apparently has inexplicably determined that breastfeeding does not help in the “prevention of disease.” The National Consumers League could not disagree more with this determination. We ask that you review and reverse this misguided decision. Indeed, the medical evidence is overwhelming that far more widespread breastfeeding would not only “prevent disease” in the United States, but would save our health care system billions of dollars.

Consider the following evidence about the myriad health benefits to both mother and child of breastfeeding:

  • According to a Harvard study published in April of this year, if 90 percent of US families would comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be among infants ($10.5 billion and 741 deaths at 80 percent compliance).
  • The risk of infant death due to Sudden Infant Death Syndrome (SIDS) is lowered, and respiratory infections such as pneumonia, and necrotizing enterocolitis is nearly eliminated if mothers breastfeed their infants until at least six months after birth.
  • The US Department of Health and Human Services has found that  breastfed infants have a lower risk of contracting ear infections, stomach viruses, atopic dermatitis, type 1 and 2 diabetes, childhood leukemia, and other health problems.
  • Mothers also benefit from breastfeeding because of lower risk of contracting type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression (PPD).
  • A former acting Surgeon General, Steven Galson, has noted that for most women, breastfeeding is biologically possible. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections.
  • Breastfed infants typically need fewer sick care visits, Congress recently acknowledged the importance of breastfeeding in the landmark health care reform legislation it enacted this year by requiring that workplaces provide women with a private place to nurse or use a breast pump.

As  Dr. Robert W. Block, president-elect of the American Academy of Pediatrics noted in the New York Times this week “The old adage that breast-feeding is a child’s first immunization really is true … So we need to do everything we can to remove the barriers that make it difficult.”

We agree with Dr. Block. We need to encourage, not discourage, barriers to widespread breastfeeding. Unfortunately, the IRS determination NOT to allow parents to use their tax-sheltered flex accounts to cover the cost of breast pumps has the impact of further discouraging  women  from breast-feeding and directly undermines what is by every measure a critical practice for improved public health.  We ask that you, as IRS Commissioner, review this decision and, in light of the overwhelming evidence, reverse it. We believe the cost of breast pumps should and must be a covered cost in these flex plans.

Thank you for your attention to our concerns.

Sincerely,

Sally Greenberg
Executive Director, National Consumers League

Cc:

Senate HELP Committee Chairman Tom Harkin
Treasury Secretary Timothy Geithner
Surgeon General Regina Benjamin
House Energy and Commerce Chairman Henry Waxman

Breastfeeding denied coverage by IRS

By Sally Greenberg, NCL Executive Director

Since our founding in 1899, the National Consumers League has worked hard to advocate for the better health of women and children. Florence Kelley, the League’s first leader, grew up in a family in which five of her mother’s eight children died from infection or disease. Babies during that time – the period right after the Civil War – were relatively safe while breastfeeding. Once weaned, they were exposed to illness from unsanitary food, water, and milk. Today, though we pasteurize milk and have access to safe drinking water, breastfeeding remains the best option for babies and their mothers, at least for the first 6 months of a child’s life.

That is why NCL was disturbed to read about an Internal Revenue Service decision that denies nursing mothers the ability to use their tax-sheltered health care accounts to pay for breast pumps and other breastfeeding supplies. NCL has written to the IRS to ask that the agency reverse its decision.

According to IRS Publication 502, reimbursable items include those that aid in the “prevention of disease.” The IRS apparently has determined that breast-feeding does not help in the prevention of disease. NCL could not disagree more. Medical evidence that far more widespread breastfeeding would not only “prevent disease” in the United States, but would save our health care system billions of dollars is overwhelming.

Consider the following evidence about the myriad health benefits to both breastfeeding mother and child:

  • According to a Harvard study published in April of this year, if 90 percent of American families would comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be among infants ($10.5 billion and 741 deaths at 80 percent compliance).

  • The U.S. Department of Health and Human Services has found that breastfed infants have a lower risk of contracting ear infections, stomach viruses, atopic dermatitis, type 1 and 2 diabetes, childhood leukemia, and other health problems.

  • Mothers also benefit from breastfeeding because of lower risk of contracting type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression (PPD).
  • Breastfed infants typically need fewer sick care visits; Congress recently acknowledged the importance of breastfeeding in landmark health care reform legislation by requiring that workplaces provide women with a private place to nurse or use a breast pump.

As Dr. Robert W. Block, president-elect of the American Academy of Pediatrics (AAP) noted in the New York Times this week, “The old adage that breast-feeding is a child’s first immunization really is true … So we need to do everything we can to remove the barriers that make it difficult.”

We agree with Dr. Block. And NCL reached out to our friends at AAP to share our letter and join forces with those who work to protect and improve the health of babies.

NCL strongly believes we need to encourage, not discourage, barriers to widespread breastfeeding. As in Florence Kelley’s day and ours, breast-fed babies get the best of all protections. Unfortunately, the IRS determination NOT to allow parents to use their tax-sheltered flex accounts to cover the cost of breast pumps has the impact of further discouraging women from breastfeeding and directly undermines what is by every measure a critical practice for improved public health. We believe the cost of breast pumps should and must be covered cost in these flex plans. We hope that NCL’s voice, along with the voices of AAP and so many others, will help to press the IRS Commissioner to reverse his decision.

Breastfeeding a public health issue

By Sally Greenberg, NCL Executive Director

A study published recently brings news that breastfeeding could save 900 lives a year and billions of dollars if 90 percent of women breast-fed their babies for the first six months of life. These findings are from the journal Pediatrics, which determined that there are hundreds of deaths and many more illnesses from health problems that breastfeeding could prevent – like asthma, diabetes, ear infections, stomach viruses, or even childhood leukemia.

The analysis studied the prevalence of 10 common childhood illnesses, costs of treating those diseases, including hospitalization, and the level of disease protection other studies have linked with breastfeeding.

The $13 billion in estimated losses due to the low breastfeeding rate includes an economist’s calculation partly based on lost potential lifetime wages, at $10.56 million per death. Breast milk contains antibodies that help babies fight infections; it also can affect insulin levels in the blood, which may make breast-fed babies less likely to develop diabetes and obesity.

One or two critical things the study failed to note – breast feeding is FREE . Check out the prices of infant formula some time – it’s expensive!  And it doesn’t provide nearly the benefits that mother’s milk contains. Secondly, breastfeeding is a wonderful bonding experience for baby and mom.

We need to do so much more to encourage women to nurse their children – like a major education campaign for starters about the benefits of breastfeeding. And marketing baby formula to new moms should be vastly curtailed in hospitals and doctors’ offices.

Happily, the new health reform legislation encourages breastfeeding by requiring that employers create a private space for working women to nurse their children. And under a new provision the Joint Commission, a hospital accrediting agency, hospitals may be evaluated on their efforts to ensure that newborns are fed only breast milk before they’re sent home.

“The magnitude of health benefits linked to breast-feeding is vastly underappreciated,” said lead author Dr. Melissa Bartick, an internist and instructor at Harvard Medical School. Bartick calls breastfeeding a public health issue, and I couldn’t agree more.

About 43 percent of U.S. mothers do at least some breastfeeding for six months, but only 12 percent follow government guidelines recommending that babies receive only breast milk for six months.

Why do moms either never start or quit breastfeeding early? It’s not always easy to get started – the kid and the mom have to figure it out together, and it can be frustrating when the baby won’t “latch on.” It also can be messy and you have to keep up with it, which means pumping at work if you’re a working mom, which can be a pain. But as this study shows, it’s the best thing for the baby, and we have to do a much better job of communicating the importance of breastfeeding to expectant and new moms. In short, there are ways to address all of these challenges.

The pediatrics academy says babies should be given a chance to start breastfeeding immediately after birth. Bartick said that often doesn’t happen, and at many hospitals newborns are offered formula even when their mothers intend to breast-feed.

“Hospital practices need to change to be more in line with evidence-based care,” Bartick said. “We really shouldn’t be blaming mothers for this.”

Bartrick’s study is invaluable. No, not every woman can successfully breast-feed and she shouldn’t feel guilty if it doesn’t work for her. But the statistics in this study demonstrate that we need to do all that we can to ensure that women who want to and can nurse their infants are given all the encouragement in the world to succeed.