Just last week I wrote about criticism and unwanted advice in pregnancy and parenthood. This week, the New York Times published an article called The Ideal and The Real of Breast-Feeding. In the article, Jane Brody examined the judgement and guilt that too often accompany the choices of how to feed our babies. The article asserts that the benefits of breastfeeding are overemphasized by the medical establishment, and that the challenges are ignored, setting women up for disappointment, guilt, and failure. I read the article and couldn’t help thinking that Brody misses the point here (not to mention misleading the public by questioning the benefits of breastfeeding).
The barriers to breastfeeding success include not enough hospital support, no paid maternity leave benefits, not enough societal support for breastfeeding, and not enough workplace support for breastfeeding (and others). However, rather than examining solutions to these barriers, Brody focuses on adapting breastfeeding goals to our current barrier-ridden reality. In this way, the article puts the onus on the individual mothers to compensate for these environmental barriers. High breastfeeding expectations and an unsupportive infrastructure produce a culture of judgment and guilt surrounding breastfeeding.
I understand the barriers that mothers face in breastfeeding – I too stopped earlier than planned due to the challenges of pumping breast milk in the workplace. But the solution is not in lowering our breastfeeding expectations. Rather, let’s set families up for success by providing the environmental support necessary to make breastfeeding a reality.
- If women had any paid maternity leave, like most of the 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…
|1 -||Have a written breastfeeding policy that is routinely communicated to all health care staff.|
|2 -||Train all health care staff in skills necessary to implement this policy.|
|3 -||Inform all pregnant women about the benefits and management of breastfeeding.|
|4 -||Help mothers initiate breastfeeding within one hour of birth.|
|5 -||Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.|
|6 -||Give newborn infants no food or drink other than breastmilk, unless medically indicated.|
|7 -||Practice “rooming in”– allow mothers and infants to remain together 24 hours a day.|
|8 -||Encourage breastfeeding on demand.|
|9 -||Give no pacifiers or artificial nipples to breastfeeding infants.|
|10 -||Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic|
The BFHI is just one of several efforts to change the current environment to be more conducive to breastfeeding. Unfortunately though, this article might dissuade many mothers from even trying to breastfeed because the challenges seem nearly insurmountable, and because it inaccurately downplays the health benefits for mother and baby. The Baby Friendly Initiative provides a comprehensive review of the leading research on the benefits of breastfeeding here, even stating that the “gold standard” of a randomized controlled trial is not feasible in the case of breastfeeding.
I agree that the environmental barriers are huge. I also agree that women should make the choice that works best for their families. That is why I, and many other breastfeeding advocates, support the changes necessary (see above) 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.
Jane Brody closes the article stating that “Perhaps it is time for more realistic, less polarizing messages about breast-feeding.” I’d argue that perhaps it is time for a more population-based approach to breastfeeding, and less focus on individuals’ ability (or inability) to overcome the many barriers to breastfeeding.
Oh, and as far as the article’s claim that breastfeeding does not actually save money? A population approach to this question would show that Lack of Breastfeeding in the U.S. costs $2.2 Billion Annually. Read about a pediatric cost-analysis of the sub-optimal breastfeeding in the U.S. here.