The following is a student blog post by Holley Freeman
Breastfeeding Rates in the United States of America: Our Largest Public Health Issue
Breastfeeding is the normative standard for mammals, including us humans. Breastfeeding is not “better than” anything else- it just is. Everything else is a substitute that tries to replicate the intricate nuances of breast milk, though nothing has yet come close. Artificial infant replacer, or formula, is the next recommended choice, should a mother not be able, or not want, to breastfeed. Breastfeeding is highly stigmatized in the United States, and that’s unfortunate because it’s also a public health issue.
The American Academy of Pediatrics released a statement in February 2012 in which they deemed breastfeeding a “public health issue and not only a lifestyle choice.” High breastfeeding rates will create a healthier general population, which will require less government funds to treat. Higher breastfeeding rates will also provide a decline in ovarian and breast cancer for the lactating women. Breastfeeding is a packaging-free method of infant feeding, creating much less waste contributions into the landfills. Alternatively fed babies have an increased risk of dying from SIDS, more ear infections, and are more likely to be obese in childhood; these children are also at greater risk of dying from GI disease.
How can we fix this problem? Much has to be done. First, the culture regarding breastfeeding must change. Predatory marketing by formula companies needs to go- the WHO code is violated at every turn. Formula needs to be removed from mother’s hospital bags, free coupons and samples should be per specific request only, and there should be no advertisement. Laws must be made in every state that offer specific, unambiguous support of the mother and her child’s breastfeeding relationship regardless of what that looks like- the language must remove adjectives such as “modestly”, “covered”, “discreet”, and “lewd” from the laws because there is too much room for intolerant interpretation. The laws also need enforcement provisions- the state of Georgia currently has nothing. This means when someone breaks the law and removes a breastfeeding mother from their place of business simply for the act of breastfeeding, there is no specific disciplinary action. Businesses must be made aware of these laws and their staff appropriately and sensitively trained.
Places of employment also need to be included in new legislation. Paid, generous maternity leave requirements need to be implemented in order to provide a good basis for breastfeeding between mother and child. National laws that protect nursing moms once they return to work need to include an acceptable allotment of time for pumping milk, depending upon hours worked. Requiring appropriate healthcare for all peoples of the country will help bridge the wide disparities in access to IBCLCs and CLCs amongst a lower income class of women.
The best way to change the culture is to become it, and when women see other women breastfeeding, they will feel more comfortable and empowered. This, in turn, will also encourage pregnant women to consider breastfeeding if they hadn’t before. Our subsequent generations will then be raised knowing nothing other than breastfeeding being normal, and the social acceptance will be greater than the dissent. It’s well-known that support from friends and family, and notably the woman’s partner, will translate into breastfeeding for longer periods of time. For those with unsupportive family and friends, they often don’t seek outside help even if it’s free- La Leche League meetings are coming to more and areas.
Much of USA’s cultural problem is in sexualization of the female breasts and overall objectification of women. People everywhere seem to have a negative opinion regarding a woman exposing her breast, a non sexual body part, to feed her child, yet nothing much is said when a hamburger commercial drips ketchup down a scantily-clad model’s bare front. Women already have a more difficult part in society with wage disparity, being seen as the “lesser sex,” and being generally viewed as a low-class housewife, maid, and nanny rather than an equal. Many women see breastfeeding and pumping as another disparity between herself and her male counterparts; women that feel like they have to prove themselves, whether personally or professionally, are less likely to commit to breastfeeding because of the perceived time and resource drain.
Another piece of the puzzle is to acknowledge the normalcy of formula in this country. Formula is far too widely accepted- baby toys all have bottles, formula is normally shown in media when you see someone feeding a baby, and most of our support system is quick to recommend formula at the smallest hint of a problem (or perceived problem). This issue is exacerbated by the use of language that speaks to “benefits” of breastfeeding rather than the risks of artificial methods- a terminology that implies breastfeeding is above and beyond while formula is the normal baseline. Misinformation is rampant, and word of mouth can be extremely detrimental to moms-to-be’s decisions to even begin trying breastfeeding. Much of this is due to lack of access to a skilled breastfeeding specialist, but also to the high lack of knowledge in a woman’s other antenatal and postpartum providers.
The reality of postpartum life for women in America is also unsupportive of a breastfeeding relationship. With zero guaranteed maternity leave and no cultural acceptance for a lying-in period, women are forced back to work quickly and fiercely without so much as a nod to the transformation they’ve just undergone physically and mentally. Postpartum depression rates are high here, and this is a huge problem. Mothers end up internalizing their issues and telling themselves that they can handle it- just as every other woman she’s seen. But they aren’t handling it, and we are all suffering those consequences. Unrealistic expectations that women hold themselves to are then translated into expectations of their boss and society. Many women are still not functioning well at six weeks postpartum, which is the socially acceptable recheck and all clear time frame. While I support the notion that a pregnant woman is not sick, we do not need to pretend that a postpartum woman isn’t healing. Allowing access to paid maternity leave would be one less burden for the recovering woman to bear. Having more frequent, and earlier, checkups with her OB/GYN or midwife would also be helpful in her practitioner either assuring her that her healing speed is normal, or recognizing trouble and having an earlier intervention.
Acknowledging the woman post birth is generally surpassed in favor of cooing over her infant, and that’s a hard adjustment too; this is one reason a postpartum doula is integral. She not only is there to mother the mother, but she is also a pillar of calm, cool, collected. She’s likely been there before and can offer information that is legitimately helpful because she’s been in the trenches. She can recognize red flags before any providers will, and can help synergically within the family to bring it back to it’ new equilibrium. She is the mother’s handmaiden and is more than willing to do what it takes to support the mother and allow her as much of a lying-in period as is possible, thus facilitating breastfeeding by nature. Most postpartum doulas are also trained in lactation of varying degrees, and has quite likely breastfed her own baby. Doulas, both birth and postpartum, are often seen as frivolous personnel and extra expenses, however many families aren’t aware that they are frequently worth their weight in gold. Allowing insurance coverage of both birth and postpartum doulas could significantly raise breastfeeding rates.
The task of raising breastfeeding rates in this country, especially exclusive ones, seems incredibly daunting. Many systemic changes will need to happen, and culture will need to take a large progressive leap forward. Bringing to light what a postpartum period truly looks like, providing health coverage for every woman, working to get doulas covered by health care, and foraging ahead with the rest of the world regarding paid maternity leave are all integral to this movement. Education is also necessary and we need to change our vernacular regarding the current infant feeding practices. Clear, concise legislation needs to be drafted and accepted into law on a national level to protect breastfeeding women undoubtedly. Proper lactation training for all of the woman’s healthcare professionals is an essential piece of the puzzle as sooner postpartum visits and support. We have a long way to move from where we are now societally to becoming a truly supportive country- but it all begins with just the first step.