Original Article Breastfeeding Support in Child Care: An International Comparison of Findings from Australia and the United States Barbara Cameron, 1 Sara Javanparast, 2 Miriam Labbok, 1 Rachel Scheckter, 1 and Ellen McIntyre 3 Abstract Introduction: Many women in industrialized countries return to work while their children are infants. This is often associated with decreased breastfeeding duration or exclusivity. In order to better understand the breastfeeding support activities in childcare settings, studies were undertaken in settings with very different levels of infant mortality, breastfeeding, and breastfeeding support: Adelaide, Australia, and Wake County, North Carolina. The researchers collaborated to explore, contrast, and compare their baseline data. Methods: Available data on breastfeeding rates and infant mortality rates were explored for the two settings. In addition, the two childcare datasets were explored for common questions, and descriptive and v 2 analyses were carried out. Results: Similarities were found between the response from childcare settings providers in Australia and the United States. Rates of having at least one breastfeeding infant (70.6% vs. 66.3%), a place to breastfeed (90.7% vs. 95%), and a refrigerator for storage (100% vs. 100%) were similar for Adelaide and Wake County, respectively. Qualitative data from Adelaide also mirrored Wake County data in that providers in neither setting were actively promoting breastfeeding. However, the Adelaide data reflected significantly higher rates of encour- agement (95.3% vs. 21.7%), written policy (77.8% vs. 20.8%), resource/materials distribution (76.6% vs. 1% and 93.8% vs. 17%), and training (44.4% vs. 13.9%). Conclusions: Childcare practices may reflect the environment of support, or lack thereof, for breastfeeding in the society as a whole. The similarities and differences seen in these settings may reflect both official guidance as well as the breastfeeding environment. There is much work to be done in the United States to come up to the same level of support for breastfeeding in child care and in other programs as is seen in Australia. Introduction B reastfeeding provides the healthiest start in life and a myriad of health benefits for mothers and children. 1 However, in the United States and abroad, breastfeeding practices continue to lag behind the World Health Organiza- tion/UNICEF recommendations of exclusive breastfeeding for 6 months and continued breastfeeding with age-appropriate complementary feeding for up to 2 years and beyond. 2 In industrialized settings, there are multiple and unique barriers to continued breastfeeding, one of which is the sep- aration that often occurs between working mothers and their babies due to formal workplace constraints. Studies have in- dicated that the anticipation of returning to work or school is associated with lower rates of breastfeeding. 3 In North Car- olina, returning to work/school is one of the most commonly cited reasons mothers name for not initiating breastfeeding and for stopping breastfeeding. 4 In Australia, one in 10 mothers report weaning before 6 months to return to work. 5 There are many reasons why returning to work is associated with reduced breastfeeding, but it is likely that one of the contributing factors is mothers’ expectations and experiences related to child care. When mothers place infants in the care of someone other than themselves, they are significantly less likely to breastfeed. 6 Therefore, it is not surprising that en- rollment in child care is associated with decreased durations of breastfeeding. 7 The likelihood of continuing breastfeeding is further reduced by the finding that childcare providers have inadequate knowledge of breastfeeding and other up-to-date recommendations for feeding infants. 8 1 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina—Chapel Hill, Chapel Hill, North Carolina. Disciplines of 2 Public Health and 3 General Practice, Faculty of Health Science, Flinders University, Adelaide, South Australia, Australia. BREASTFEEDING MEDICINE Volume 0, Number 0, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2011.0032 1