Everyone, it seems, has an opinion about breastfeeding. "Mommy bloggers" wax eloquently about it. The topic is covered extensively in the media. And protests—from breastfeeding "nurse-ins" organized to support mothers asked to refrain from breastfeeding in public to "Ban the Bag" campaigns urging hospitals to stop handing out formula to new mothers—continually flare up.
Clearly, it’s a hot-button issue. Yet, examined from a scientific perspective, it’s hard to understand why.
Breastfeeding is the gold standard of infant nutrition, according to the U.S. Department of Health and Human Services’ Office on Women’s Health and the American Academy of Pediatrics. The academy, in fact, recommends that an infant receive only mother’s milk for at least the first six months of life.
"Breastfed babies are significantly healthier," says Katy Lebbing, a certified lactation consultant and manager of the Schaumburg-based La Leche League’s Center for Breastfeeding Information. "One nursing baby is hospitalized for every 10 formula-fed babies, except in the first four months of life when it’s one to every 15."
In fact, research indicates that breastfed babies experience significantly lower occurrences of ear infections, respiratory and digestive illnesses, diarrhea and childhood obesity, and some studies even suggest that nursing an infant exclusively for at least six months can also reduce the risk of sudden infant death syndrome, diabetes and—for mother and child—even cancer. A government report, due out this winter, has evaluated all available research and will provide a synthesis of the science behind breastfeeding, highlighting medical evidence of the risks of not breastfeeding.
A matter of health
Information like this is rapidly transforming breastfeeding into something more than a personal choice. It’s becoming a public health issue.
"Among women who choose not to breastfeed, mother’s milk is often seen as ‘formula with extra vitamins,’ " says Nancy Mohrbacher of the Chicago Area Breastfeeding Coalition. "We’ve been talking about the advantages and benefits since the 1980s, but we don’t approach other aspects of health [as if] we’re talking about extra-credit points on a test. When breastfeeding is [viewed as] the norm, the issue is not that babies stand to gain from it; it’s that they stand to lose without it. As soon as we started saying that, people sat up and listened."
The risks of not breastfeeding indeed became the focus of a national public awareness campaign launched by the government in 2004. The initiative included "Babies Were Born to be Breastfed" public service announcements and advertisements created by the Ad Council that equated not breastfeeding with such risky behavior as riding a mechanical bull while pregnant.
This approach seems to be working.
Dr. Suzanne Haynes, the U.S. Department of Health and Human Services senior science advisor who led efforts in the breastfeeding awareness campaign, says that while 63 percent of women with children surveyed prior to the 2004 initiative had breastfed one of their children, 73 percent reported doing so in 2005. The number of women who correctly identified the recommended duration for exclusive breastfeeding as six months or longer—one of the campaign’s key messages—rose more than 10 percent as well.
The government’s official goal as outlined in its Healthy People 2010 blueprint is to have 75 percent of women initiating breastfeeding at childbirth, with 50 percent continuing until their child is at least six months old and 25 percent maintaining the practice for a full year.
New figures from the Centers for Disease Control and Prevention indicate that the United States is closer than ever to these goals: More new moms are initiating breastfeeding at birth—72.9 percent in 2005, up from 70.9 percent in 2003. The number of those still breastfeeding at the six-month mark has increased, too, from 29 to 39 percent (though only 14 percent are still nursing exclusively at this point), with approximately 20 percent of these moms continuing the practice for 12 months.
Efforts are ongoing
But while national rates are climbing toward governmental benchmarks and some states have met one or two of the goals (California, Hawaii, Oregon, Vermont and Washington have achieved all three), there is a long way to go, especially in Chicago. Here, breastfeeding rates are among the lowest in the country, Mohrbacher says. The next steps need to be taken closer to home.
That’s where the Chicago Area Breastfeeding Coalition comes in. Founded in 2003, the nonprofit organization is hitting its stride. The group held its second conference this fall, bringing together lactation consultants, private- and public-practice healthcare professionals, nutritionists and public health workers to strategize about measures needed to improve breastfeeding rates and promote it as a public health issue in the metropolitan area. The conference motto: "Making the City that Works a Place Where Breastfeeding Works."
According to Mohrbacher, one of the coalition’s biggest priorities is to partner with the American Academy of Pediatrics’ physician education initiative. The academy currently works with residents training as doctors; the coalition plans to pick up the slack among established practices.
"A major barrier [to increased breastfeeding rates] is that the people who women turn to first, their doctors, often don’t know how to help," Mohrbacher says. "It can’t be easy to be a doctor who doesn’t know the answers. Our efforts hook them up with lactation consultants who do. With any other problem, a doctor refers a mother to a specialist. Why not with breastfeeding?"
Another important focus for the Chicago coalition is working with public health officials to make sure low-income and minority mothers (breastfeeding rates are lowest in African-American communities) understand that breastfeeding keeps children healthier. According to La Leche League’s Lebbing, the taxpayer-supported Women, Infants and Children assistance program purchases more formula than any other group in the country.
"This is an absolutely critical piece of our coalition. WIC [Women, Infants and Children] clinic coordinators and peer counselors are singlehandedly responsible for increases in breastfeeding rates," Mohrbacher says. They do this through one-on-one visits with new mothers and a focused effort on educating grandmothers, who often serve as their grandchild’s primary caregiver.
Validating mothers’ choices
In fact, Lebbing says, addressing grandmothers could be key in turning the United States into a breastfeeding culture. "Around World War II, anything made in a factory, including formula, had more worth than something from nature," she says. "Our mothers and grandmothers came out of this thinking, and they’ll say to their daughters, ‘I didn’t breastfeed you, and you’re OK.’ Women want to validate their mothering."
For that reason, it’s important that no mother is made to feel guilty about her decisions regarding breastfeeding. Many women who try to nurse without proper tools or instruction are frustrated and give up. Others, heading back to work or struck by illness, simply cannot breastfeed exclusively, and thus, turn to formula.
"To be a new mom, a working mom, is hard enough," says Patti Wolter, a Northwestern University journalism professor living in Evanston. For her, breastfeeding was a "no brainer." Her friends, many of whom work for health magazines, all breastfed, and she had the time and resources to learn about its advantages. Still, she sympathizes with those for whom breastfeeding is a luxury rather than a necessity. "I have no interest in demonizing those who don’t breastfeed. Nobody needs any other pressure. Don’t guilt a mom with a low-wage job who gets a bathroom break if she’s lucky. And I’m saying this as a mom who fervently believes in breastfeeding."
When pressed, some breastfeeding advocates also agree.
"We are not against formula," Lebbing says. "Sometimes we have to use it. We are against it being used inappropriately. The less you breastfeed, the more hospitalizations and illness you might face. Who wants to walk the floor ever with a sick baby?"
As more mothers learn about the problems that breastfeeding can help prevent, and as they continue to connect with professionals who can teach them the tricks of the trade, breastfeeding rates likely will increase. Still, it will take time for the emotion and controversy surrounding this issue to die.
"In 1963, the U.S. Surgeon General announced that smoking was bad for you," Mohrbacher says. "How many years did it take before people were forced to stop smoking in hospitals and on planes? The only thing that’s going to convince people that breastfeeding is the norm is if they continue to see it."
• Academy of Breastfeeding Medicine: www.bfmed.org
• African-American Breastfeeding Alliance: www.aabaonline.com
• Chicago Area Breastfeeding Coalition: www.chicagoareabfc.org
• International Lactation Consultant Association: www.ilca.org
• La Leche League International: www.llli.org
• The National Women’s Health Information Center: www.4woman.gov/breastfeeding
What’s next for the U.S. government?
In 2000, the U.S. Department of Health and Human Services published its Blueprint for Action on Breastfeeding in conjunction with the U.S. Surgeon General.
Having met its first objective, with breastfeeding peer counseling for low-income mothers and the completion of the National Breastfeeding Awareness public health campaign, the agency is moving toward its next hurdle: the workplace.
To that end, late this fall or early winter, the government will release "The Business Case for Breastfeeding," a guide for employers on providing rooms for breastfeeding and pumping, cold storage for breastmilk, reasonable breaks throughout the day and on-site day care, as well as guides for employees on how to ask for such facilities and marketing materials for advocates on how to achieve this goal.
According to Dr. Suzanne Haynes, senior science advisor at the government's Office on Women’s Health, returning to work is one primary reason women stop breastfeeding exclusively before the doctor-recommended six-month benchmark.
"We need workplace programs to get the breastfeeding rates up at six months," Haynes says. "They’re tied together. We’re asking for this as a health benefit for women. It doesn’t cost much and saves companies thousands of dollars in reduced sickness in terms of the mother’s absence and the medical cost for her child."
10 steps for successful breastfeeding
The United Nations Children’s Fund and World Health Organization have identified the following as critical elements for hospitals worldwide to follow to promote breastfeeding among new mothers. Having this checklist in hand when investigating birthing and postpartum healthcare options can help facilitate a successful breastfeeding experience. If your hospital doesn’t officially employ all the practices, make it clear which policies you are most interested in.
1. Maintain a written breastfeeding policy that is routinely communicated to all healthcare staff.
2. Train all 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 infants no food or drink other than breastmilk, unless medically indicated.
7. Practice "rooming in" by allowing mothers and infants to remain together 24 hours a day.
8. Encourage unrestricted breastfeeding.
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.
La Leche League fulfills this 10th step, acting as a clearinghouse for breastfeeding information and resources. The organization also facilitates peer counseling groups that explore the risks of not breastfeeding, discuss new research and help mothers prepare for the challenges of childbirth and managing breastfeeding.
While formula in the Chicagoland area can cost as much as $140 a month, membership in La Leche League is just $40 a year, group meetings are not obligatory and members can talk to League leaders for free any time, day or night.
For more information on the organization and the services it offers, or to find a group near you, go to www.llli.org or call (800) LA-LECHE.
Eryn McGary is a writer (and former Chicagoan) who followed her heart to Kansas City. She and her new husband, Mick, keep their eyes out every day for the yellow brick road back to Chicago.
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