title: Breastfeeding protection, promotion, and support in the United States: a time to nudge, a time to measure.
abstract: BACKGROUND
  Strong evidence-based advocacy efforts have now translated into high level political support and concrete goals for improving breastfeeding outcomes among women in the United States. In spite of this, major challenge remain for promoting, supporting and especially for protecting breastfeeding in the country.
  
  
  OBJECTIVE
  The goals of this commentary are to argue in favor of: A) Changes in the default social and environmental systems, that would allow women to implement their right to breastfeed their infants, B) A multi-level and comprehensive monitoring system to measure process and outcomes indicators in the country.
  
  
  METHODS
  Evidence-based commentary.
  
  
  RESULTS
  Breastfeeding rates in the United States can improve based on a well coordinated social marketing framework. This approach calls for innovative promotion through mass media, appropriate facility based and community based support (e.g., Baby Friendly Hospital Initiative, WIC-coordinated community based peer counseling), and adequate protection for working women (e.g., longer paid maternity leave, breastfeeding or breast milk extraction breaks during the working day) and women at large by adhering and enforcing the WHO ethics Code for the Marketing of Breast Milk Substitutes. Sound infant feeding practices monitoring systems, which include WIC administrative food package data, are needed.
  
  
  CONCLUSIONS
  Given the current high level of political support to improve breastfeeding in the United States, a window of opportunity has been opened. Establishing breastfeeding as the social norm in the USA will take time, but the global experience indicates that it can be done.
authors.affiliation: Yale School of Public Health, New Haven, CT 06510, USA. rafael.perez-escamilla@yale.edu
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Chapman
mesh_terms: D001942:Breast Feeding; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D011057:Politics; D040241:Social Marketing; D012944:Social Support; D014481:United States; D014931:Women, Working