Tuesday, March 27, 2012

Breastfeeding Advocacy: You're Doin It Wrong

If there's one thing breastfeeding advocates are really good at, it's spouting off the numerous health benefits of breastfeeding while listing the risks of artificial formulas.  You'd be hard-pressed to find a mom who, for example, couldn't tell you that breastfed babies have less illness, fewer allergies, or a lower risk of childhood obesity. 

And yet US breastfeeding rates are abysmal, with fewer than 15% of American women exclusively breastfeeding for the WHO recommendation of six months, and only about 44% of six-month old babies are breastfeeding with supplementation or complementary foods.  The numbers drop even more once you get to the WHO's recommendation of breastfeeding with the addition of complementary foods past the first year, with only 23% of babies receiving any breastmilk at all past that landmark. And of course, lower-income women and women of color are far more likely to quit breastfeeding earlier.

We've heard it all before: "My milk dried up after three months."  "I had to go back to work, and it just wasn't possible anymore."  "I didn't know lactation consultants existed."  "I had way too much going on in my life to fix the problem."  "I couldn't afford lactation support."  "My partner didn't support my decision to breastfeed." For these situations, pamphlets and ad campaigns that regurgitate the old "breast is best" adage aren't going to suddenly resolve breastfeeding challenges.  All they're going to do is create more guilt and shame in the minds of mothers who, despite their best efforts, just couldn't make it work for them. 

So says a recent study regarding the Surgeon General's 2011 "Call to Action to Support Breastfeeding."  The Call, hardly a breastfeeding-friendly overhaul of the nation's health care system, has been received as mere propaganda that spouts a message without providing realistic solutions.  Mothers surveyed say the Call gave them more reasons to feel bad about not breastfeeding without providing actual mandates that change the way new mothers are able to make autonomous parenting choices.

I will say this: the article does an incredibly shoddy job of analyzing the situation.  Instead of asking why so few mothers make it to the six month mark, ABC News chooses instead to interview a medical professional, a professor of pediatrics nonetheless, who says that there are "other options" for women who aren't producing enough milk for their children.

On the other side, the Peanut Gallery provides very little reprieve, featuring commentary from the very short-sighted "I-Did-It-So-Everyone-Can" camp:
  • "Everyone has to do what works for them, but for most women who get past the learning curve (which takes up to 6 weeks), the convenience of breastfeeding is a huge blessing."
    Yeah, tell that to the woman who has to go back to her minimum-wage job after four weeks and won't be able to express milk while at work. 
  • "I think I'll wait until more moms get over their denial over being lazy mothers first. Children aren't dogs or cats, either put up or shut up if you're going to make the choice to have one."
    Right, that's why women stop breastfeeding, because they're lazy.  Not because they were in a situation that looks nothing like yours (gasp!). 
  • "3 babies died this year from formula i am sure the moms that fed there [sic] babies that formula had tried to breastfeed hard those babies would be here today and there are breastmilk banks throgh [sic] the hospital where people dnate [sic] extra milk it is drug tested and safe"
    Okay, first of all, let's try some punctuation.  You can learn how to use it at many public institutions including elementary school.  Secondly, donated milk at milk banks is generally reserved for very sick or premature babies and is generally not available for public use.  Finally, even if you did find a milk bank that would provide milk for a well baby, its distribution would not be covered by insurance.  Milk banks charge upwards of $3 per ounce (for those of you playing along at home, that's about $72 a day).  And while more communities now have underground (non-banked) milk sharing programs, many mothers just aren't comfortable accepting unpasteurized milk from a stranger. 

No one in either camp, be it "breast is best" or "stop shaming formula-feeding moms," seems to adequately get to the heart of the problem.  No, we shouldn't be guilt-tripping mothers who, for whatever reason, stopped breastfeeding before one year or never tried at all.  But we also shouldn't just accept that 86% of American mothers made some autonomous decision to not exclusively breastfeed!  Let me be clear: campaigns that tout the many benefits of breastfeeding (and risks of formula-feeding) are valuable, but they aren't going to raise the bar alone.  To truly create a society where mothers are able to make autonomous infant feeding decisions, we need to be a bit more radical. 

To start, let me suggest:
  • Complete physical, spiritual, and emotional control over when we bring children into the world in the first place.  About half of all pregnancies are unintended, and many mothers struggle just to be able to provide a safe place for their infants to sleep at night.  For these mothers, whether or not their babies are at heightened risk for childhood obesity may be the furthest thing from their minds.   
  • Access to quality maternity care regardless of ability to pay.  Actually, let's just go ahead and say that health care is a human right and should not be a part of our for-profit system.  
  • Insurance and Medicaid reimbursement for lactation support and any equipment needed to implement a plan of care.  
  • Longer maternity leave with full pay, followed by full employer support for mothers who need time and space to express breastmilk while at work.
  • Free childcare.
  • More support from friends, family, and society at large.  While women who are successful at breastfeeding are more likely to do so for longer than, say, thirty years ago, there is still a large percent of people who believe breastfeeding past six months is somehow akin to sexual abuse or just plain "creepy."  
  • Education about breastfeeding as the normal way to feed a baby beginning in the early years of elementary school.  Maybe bring back the famous Sesame Street segment
  • Teaching girls from an early age that our bodies are totally rad and that there's nothing "gross" or "weird" about our periods, our pregnancies, or our ability to produce milk. 
Pipe dreams.

No comments: