Last month, the New York Times published The Ideal and The Real of Breast-Feeding, written by Jane Brody. In the article, Brody examined the judgment and guilt that too often accompany the choices of how to feed our babies. Now this month, the Chicago Tribune published a column by Steve Chapman, entitled New York Says: Breast-Feed or Else. I can’t help but respond to this piece, as it runs a great risk of misinforming the public on the benefits of breastfeeding, and paints a picture of breastfeeding advocates as harsh, judgmental, and unsympathetic.
Chapman and Brody both assert that the benefits of breastfeeding are overemphasized by the medical establishment, and that the campaigns designed to encourage breastfeeding set women up for disappointment, guilt, and failure. Chapman, though, takes it one step further, scolding Mayor Bloomberg for meddling in the maternity ward, stating that the Mayor is using “the power of government to induce conformity to his preference [breastfeeding]”.
Like Brody, Chapman also misses the point so many breastfeeding advocates are trying to make. Individuals’ preferences about infant feeding are not the issue, and access to formula in the hospital is not the issue. The issue requiring our country’s attention is the myriad environmental and cultural barriers that make true informed choice on this matter unattainable.
The barriers to breastfeeding include not enough hospital support, no paid maternity leave benefits, not enough societal support for breastfeeding, and not enough workplace support for breastfeeding (among many others). By setting high breastfeeding expectations, and providing little social support, minimal professional support in the hospital, and countless environmental and cultural barriers to breastfeeding, we are putting women and their families in a position of no choice. How are women to breastfeed without these supports? Without adequate maternity leave? Without a cultural appreciation for breastfeeding?
Chapman’s tunnel-vision focuses on the new limitations to formula promotion at New York City hospitals, but omits any discussion of the broader initiative that this strategy is part of. “Latch On NYC” is a citywide initiative to support mothers who breastfeed. Certainly there is much more to supporting women than limiting the promotion of commercially produced infant formula in the hospital, but this is a start. Chapman misinterprets the initiative as preventing women who may want or need formula from being able to access it in the hospital. This is not an accurate description of the initiative. Instead, “Latch On NYC” aims to prevent formula from getting in the way of breastfeeding initiation in women who want to breastfeed. In combination with other supports, this strategy has been shown to have a significant impact on improving rates of breastfeeding initiation and duration.
As an example, the Baby-Friendly Hospital Initiative (BFHI) takes a broad approach by enhancing the environmental support for breastfeeding in hospitals. The initiative has demonstrated a positive impact on breastfeeding initiation and duration in hospitals that follow these ten steps (*pay special attention to number 6):
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give newborn infants no food or drink other than breastmilk, unless medically indicated.
- Practice “rooming in”– allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
The BFHI is one of several efforts to change the current environment to be more conducive to breastfeeding. Unfortunately though, Chapman’s article might dissuade many mothers from even trying to breastfeed because he portrays breastfeeding supporters and maternity nurses as harsh and judgmental, as unsympathetic to the challenges and barriers of breastfeeding, and especially because he inaccurately downplays the health benefits of breastfeeding for women and for babies.
Chapman echoes Brody, stating that “no randomized, controlled trials – the gold standard of scientific research – have proved that breast-fed babies fare better, at least in industrialized countries.” However, there is good reason that these trials don’t exist: it would be unethical to randomly assign feeding patterns; arbitrarily prescribing that half the mothers in a trial would bottle feed their babies. Chapman’s oversimplification of the research inaccurately portrays the data as unreliable and overstated. He overemphasizes misleading correlations, stating that “women who nurse tend to be better educated and wealthier than those who don’t” – when in reality, this correlation can easily be attributed to the financial and workplace barriers that low-income women encounter. Similarly, Chapman asserts that “women with the time and inclination to breast-feed may devote more attention to their kids’ development”. While this may or may not contribute to improvements in breastfed infants’ neurodevelopment, it is certainly not evidence based. And regardless, if breastfeeding encourages women to devote more attention to their kids’ development, shouldn’t we be uncontrollably devoted to putting the supports in place to make it a reality for more families?
The BFHI provides a comprehensive review of the leading research on the benefits of breastfeeding here, including decreased risk of infections, allergies, diabetes, obesity, SIDS, and childhood leukemia, improved neurological development, dental health, and improved cardiovascular health later in life. Additionally, breastfeeding decreases women’s risk of breast cancer, ovarian cancer, and reduced bone density. Hardly inconsequential benefits – not to mention that Lack of Breastfeeding in the U.S. costs $2.2 Billion Annually.
I agree that setting limitations on women’s access to infant formula at the hospital does not adequately support women in breastfeeding on its own. I also agree that women should make the choice that works best for their families, and have the right to true informed choice on this matter. That is why I, and many other breastfeeding advocates, support the changes necessary to make the American Academy of Pediatrics’ (AAP) recommendation of at least 6 months exclusive breastfeeding a realistic goal for U.S. mothers. In their revised guidelines, the AAP emphasizes the importance of breastfeeding as a public health issue rather than an individual parenting choice. If we could adopt a public health approach to breastfeeding, the “milk wars” would no longer take on such a personal dynamic.
I understand the barriers that mothers face in breastfeeding – I too stopped breastfeeding and started bottle feeding earlier than I had hoped due to the challenges of pumping breast milk in the workplace.
- If women had any paid maternity leave, like most countries in the world (but not the U.S.)…
- If women had the option for extended maternity leave…
- If hospitals were baby-friendly…
- If breastfeeding was normalized and respected in society…
- If workplaces made the minimal accommodations required for mothers to continue breastfeeding…
Just imagine the true informed decisions that women would make! Chapman closes his piece stating that Mayor Bloomberg should stay out of these matters, as he can’t possibly “know the unique circumstances and alternatives confronted by individual women”. I would argue that rather than focusing on individual women’s unique circumstances, it is time for a more population-based approach to breastfeeding, including putting the supports in place that would give women the opportunity to breastfeed without financial, social, and personal barriers. To level the playing field, Mayor Bloomberg has taken some admirable first steps toward providing the support women and their families need with “Latch On NYC”.
Oh, and as far as the article’s claim that infant formula is a “nonsugary beverage”? Although not reported on nutritional labels, tests show that infant formulas contain varying amounts of sugar, likely conditioning our infants to crave sweetness, and influencing their metabolic health from the start.