A Quick Look
at Breastfeeding's Most Revolutionary Year Yet
Dia L. Michels
Washington, DC USA
From: LEAVEN, Vol. 34 No. 6, August-September 1998, pp. 115-18
News on the Breastfeeding
Front
Breastfeeding has undergone
a revolution this year. It began with the American Academy of Pediatrics
(AAP) releasing sweeping new guidelines that called for breast milk
for every child to guarantee optimal mental, physical and emotional
development. These guidelines were designed to help mothers and babies
reap the health benefits of breastfeeding. Stressing that human milk
is the foundation of good infant nutrition, the Academy stated that
"human milk is uniquely superior for infant feeding" and recommended
that mothers breastfeed for a minimum of one year after the birth of
a child. Within weeks of the AAP action, the American Association of
Family Physicians (AAFP) and the Canadian Association of Pediatrics
(CAP) released similar statements endorsing the importance of human
milk.
Just two generations ago,
pediatricians were convinced that a sterile, scientifically formulated
product was better than mother's milk. This erroneous conclusion evolved
from the technology, industrialism and emerging pharmaceutical industry
of post-World War II, the era in which La Leche League was formed. Today,
well-trained doctors have enough biochemical, micro-nutritional and
medical data to convince them that human milk is not only superior to
canned formula, but more miraculous than Mt. Everest. If human milk
were sold in supermarkets, it would be a bestseller because it offers
complete nutrition for babies. Its nutrition is fortified with hormones
and antibodies. Unlike canned formula, human milk has no unnatural byproducts
or additives.
While doctors were announcing
the good news about human milk, researchers in New Zealand were finding
that the longer babies were breastfed, the higher they scored on intelligence
tests later in childhood. An extensive psychological study measuring
IQ and academic performance showed that children who were nursed for
more than eight months consistently outscored children raised on formula
in reading comprehension and mathematical ability.
To bring these exciting new
discoveries into the lives of working mothers in the US, New York Congresswoman
Carolyn Maloney introduced the New Mother's Breastfeeding Promotion
and Protection Act, federal legislation that would protect women from
being fired or discriminated against in the workplace for breastfeeding
or expressing milk. Under present laws, no such protections exist. Maloney
appeared on TV explaining the importance of ensuring that every baby
has the opportunity to get the best nutrition - the human milk that
doctors recommend.
As an expert in lactation
and as a journalist who has covered the breastfeeding scene for a decade,
I have seen the impact of the events of this revolutionary year at every
level from ILCA to the Internet, from neonatal intensive care units
to LLL meetings, from WIC to WHO. Although this information is good
news and is exciting for all of us who want a better world, the sheer
amount of it is staggering. To keep up with it all, a mother interested
in breastfeeding would need a degree in biochemistry, a computer constantly
hooked to the Internet and a stack of journals from floor to ceiling.
As any nursing mother can tell you, there is no time for this.
Leaders know there are many
facets to the breastfeeding experience. On a very personal level, it
is a magnificent experience for a woman to have within herself the perfect
food for the important little person in her life. It is a profoundly
intimate experience to share one's body by nurturing another. And it
is an empowering time when a mother can watch her baby thriving, fueled
on nothing but her milk
On a global level, breastfeeding
has an impact too: whether it is the statement women make that their
breasts are functioning parts of their bodies, not merely sexual objects,
whether it is the pride in knowing the importance of breastfeeding for
the environment, or whether it is the confidence it instills that allows
women to feel it is legitimate to make a career out of mothering. Breastfeeding's
benefits reach far beyond the baby. Leaders are the ones who are shaping
the future now - one mother and baby at a time. To new mothers, breastfeeding
is a here-and-now experience that may last for a few months or a few
years of the child's life. Yet, human milk's benefits last well beyond
the period of infancy. Through their example Leaders show mothers that
this experience is one that endures - for the baby, for the mother and
for the planet.
- For the baby:
Human milk is a living biological fluid that emanates from the breast
on demand and is continuously changing to meet the exact immunological
needs of the child. In childhood, in adulthood, even in old age, people
who were breastfed have better health profiles. Not only do they have
stronger eyes, teeth and bones, but they also experience lower rates
of obesity, cancer and heart disease.
- For the mother:
Right after birth, breastfeeding helps contract the uterus. Over the
next few months, breastfeeding helps shed the extra pounds of the
pregnancy and releases hormones associated with a general feeling
of well-being and contentment. Decades after the child is weaned,
the mother is still reaping benefits. As they age, women who have
breastfed for many months have significantly lower rates of breast,
ovarian and uterine cancers, urinary tract infections and osteoporosis.
- For the planet:
Human milk is delivered to the consumer without any pollution, unnecessary
packaging or waste. Producing, packaging, shipping and preparing canned
formula, on the other hand, produce tremendous ecological waste. For
instance, the 80,000 US mothers who breastfeed their babies for six
months save 17,200 tons of tin that would have been used just for
formula containers. On the other hand, 74% of babies are being fed
formula at six months, which results in more than 44 million cans
of formula that have to be produced, transported and then piled into
landfills.
Sharing This Information
Leaders work hard to help
new mothers with the "how-tos" of breastfeeding. As more and
more experts, in more and more specialties, address breastfeeding, they
provide Leaders with new information to convey the "why-tos"
of breastfeeding. These "why-tos" may convince new mothers
who are already breastfeeding to continue longer and new mothers who
are saying no to breastfeeding to at least try it. The job of the Leader
is more complicated today than it ever has been, but she has more resources
than ever before. The following comments are observations I've collected
as I compile my new anthology, Breastfeeding: For Your Baby, Your
Body and Your Planet.
Empowering Women to Breastfeed
Longer
The Pump Problem The
biggest factor influencing breastfeeding rates is the return of mothers
to their workplaces following the births of their children. Women are
participating in the workforce in record numbers. Two-thirds of America's
mothers breastfeed their babies at birth, but by the time three months
have passed, only about a quarter of the mothers are still breastfeeding;
many stopped because they were going back to work full time.
A widespread yet incorrect
assumption today is that it is neither possible nor reasonable to combine
breastfeeding and employment. This view is held even by women who are
aware of the American Academy of Pediatrics guidelines stating that
babies should be fed expressed human milk when mothers are absent. Pumps
are held in low regard because they make some women "feel like
cows." Many women are uncomfortable discussing this, but a skillful
Leader will find a way to address it.
As Leaders are aware, pumping
paraphernalia are now part of the breastfeeding landscape in the USA.
There is no shortage of breast pumps ranging from the small hand-held
models to the several-hundred dollar, hospital-grade, dual-breast electric
pumps. Unfortunately, formula companies have jumped into the pump business,
often giving away cheap pumps to new mothers when they leave the hospital.
As a result new mothers may end up having problems, causing them to
abandon the idea of pumping - and perhaps the idea of breastfeeding
altogether.
Compounding the pump problem
is the fact that breast pumps usually cannot be returned. Women are
reluctant to return them anyway, assuming that poor milk supply is their
fault, not the pump's! In Congresswoman Maloney's bill, there is a provision
calling for the US Food and Drug Administration to establish pump standards
to ensure that bad pumps are kept out of hospitals. and the marketplace.
The Embarrassment Factor
Another reason women stop breastfeeding in the first few months is their
discomfort with nursing in public. A baby needs to feed often, about
10-12 times a day. Mothers unwilling to breastfeed in public are faced
with the need to pump breast milk each time they leave the house. For
many women, doing this is absolutely necessary because public breastfeeding,
for them, is intensely embarrassing. Even women who are not embarrassed
by it might have spouses and relatives who object to it.
As outrageous as it seems
to us in LLL, many people still think of breastfeeding as indecent exposure.
Although a woman has the right to breastfeed anywhere a woman has the
right to be, this has not yet changed widespread public opinion. Highly
publicized cases in some countries in which women have been harassed
for nursing in public only fan the flames.
Encouraging Women Breastfeeding
Is Worth a Try
The Myth of Equivalence
In a society where many of us were raised on canned formula, some people,
including mothers, mothers-in-law, husbands and doctors, still believe
that formula is an equivalent, perhaps even superior, infant food. They
are unaware that it is adulterated dried cow's milk, fortified in an
attempt to more closely resemble human milk. But it doesn't come close.
Recent research has shown
us that breast milk contains micronutrients, antibodies, hormones and
growth factors that cannot be duplicated in a laboratory. And unlike
canned formula, which is highly processed, breast milk contains no iodine
or aluminum, let alone broken glass particles or salmonella bacteria,
all of which have been found in commercially available infant formula
products. Additionally, there are no labels to check, no bottles to
sterilize, no measuring, no timing. Breast milk is delivered fresh,
clean and warm.
My Milk Isn't Good Enough
So often, Leaders hear women stating that their diet precludes them
from producing nutritious breast milk. Whether they live on fast food
burgers and candy bars, enjoy a beer with dinner or frequently skip
meals, the myth persists that mothers with less than perfect diets produce
inferior milk. Leaders need to assure these women that they can
breastfeed. Ideally, a breastfeeding mother should eat a balanced diet
and minimize alcohol consumption - and so should everyone else. However
the notion that everything a woman eats is transferred directly to the
milk she feeds her infant is simply wrong. The body processes what she
eats, nutritious or not, to create wondrous milk for the baby. An occasional
alcoholic beverage is not contraindicated by any means. Breastfeeding
should be enjoyable. Unreasonable dietary restrictions are a waste of
time and effort and can discourage a mother from breastfeeding.
Launching the Future
Breastfeeding is a miraculous
process whereby mother and baby work together to produce a food that
benefits both. It is important to ensure that breast milk does not become
separated from breastfeeding. Breast pumps may have their place in a
breastfeeding mother's life, but embarrassment and shame do not. Every
time a mother breastfeeds in public, she is showing the world that breasts
are utilitarian vessels of abundance, not sexual toys.
You could isolate the parts
- the skin-to-skin contact, the eye-to-eye contact, the warmth of the
fluid, the nutrients consumed, the steady sound of the mother's heart,
the calmness that comes with sucking - but it is not the parts that
we care about. It is the whole - the whole process that is breastfeeding.
It is said that breastfeeding is an unsentimental metaphor for how love
works. You don't decide how much or how deeply to love, you simply respond
to the child and give with joy exactly as much as he wants.
Most women who nurse their
babies learn that breastfeeding is love. By providing encouragement,
support and accurate information, Leaders help empower mothers to try
breastfeeding and nurse as long as they choose. Compiling my anthology
has shown me, yet again, that everyone who has taken the time to look
at breastfeeding carefully agrees that it is the launchpad to a better
future.
Sidebar: The Business of
Formula
For most of humankind, the
alternative to human milk was infant death. Almost all attempts at feeding
human infants the milk of other animals or human milk substitutes resulted
in death. It was the lucky babies who, when mother's milk wasn't available,
had wet nurses to keep them alive. But most foundlings and sick babies
paid for the lack of a bosom with their lives.
Formula was invented to give
foundlings and sick babies a chance at life, and to this day, human
milk and infant formula are the only substances capable of sustaining
a newborn until he is old enough to eat solid food.
But formula quickly changed
from a life-sustaining substance to be used when mother's milk wasn't
available to a replacement for mother's milk.
The incentive for the switch
came from the incredible profits that manufacturers could make by selling
a concoction that replaced something priceless. The main ingredient
in infant formula - dried cow's milk - is fairly inexpensive; infant
formula is not. It has been calculated that for every wholesale dollar
charged for formula, production and delivery costs are only 16 percent.
The more formula that can be sold, the more profit that can be realized.
If women can be convinced
that they don't have enough breast milk, that their milk isn't good
enough, that their milk may be contaminated, that breastfeeding is obscene-in
short, that breastfeeding isn't worth the bother-cash registers ring.
A woman who formula- feeds her baby will spend more than $100 (US) each
month on formula, and that's only if she buys the least-expensive concentrated
powder. Those dollars add up. In the US alone, the formula industry
is worth well over a billion dollars a year. Worldwide, it generates
revenues of $22 million each day!
Formula companies that increased
sales of their products through misleading marketing and advertising
techniques did not act alone. From the outset, doctors and pharmacists
participated in the effort to convince consumers to switch. It was downright
dangerous that formula cans were widely distributed with no instructions
whatsoever. The cans simply advised consumers to consult their doctors,
who would give them the directions-for the price of an office visit.
At the time, it was portrayed as a great partnership of learned men
working together to show women an enlightened approach to infant feeding.
The fact that this enlightened approach also lightened the wallets of
families got lost amid the hype.
As formula sales climbed-and
climb they did-it was the babies who paid the price. By the early 1970s,
breastfeeding initiation rates had plummeted and bottle-feeding was
considered the norm. It took another two decades until there was enough
biochemical, micronutrient and medical analysis for doctors to be convinced
that breast milk was the superior infant food.
Ironically, it was at the
same time that doctors were jumping on the breastfeeding bandwagon that
pharmaceutical companies in the USA decided to bypass them and market
directly to consumers. The pharmaceutical industry discovered that it
could be more effective influencing consumers to ask their doctors for
certain products instead of focusing all their marketing efforts on
the doctors themselves. Suddenly, television commercials, direct mail
and product coupons were standard marketing techniques. Consumers appreciated
being talked to directly, making them feel like partners in their own
health care.
In societies that idealize
consumerism and technology, women are now being led to believe that
they not only need to buy formula, but that they also need to buy technology
in order to breastfeed successfully. Whether it is in an attempt to
measure the amount of breast milk produced, to increase milk supply
or to express milk to use when mother and baby are separated, breast
pumps, and with them a host of assorted paraphernalia, are now part
of the breastfeeding landscape.
Entire catalogues of merchandise
are now marketed to breastfeeding mothers, selling items such as expensive
pumps, pumping bras, weight scales, pillows, ergonomically designed
bottles, orthodontically correct nipples, bottle warmers and freezer
bags. There is no shortage of breastfeeding accessories-available for
a price. Unfortunately, these "necessities" for breastfeeding
cause two problems. On an individual level, they increase the likelihood
of shortened breastfeeding duration. On a societal level, they increasingly
allow for political decisions based on the allegation that mothers don't
have to actually spend any time with their babies in order to provide
them with breast milk.
It is the Leaders' example
and education that can show women that they can breastfeed on their
own and that these aids are just that-aids. To counteract the television
advertisement, hospital promotions and peer pressure a new mother faces,
Leaders need to empower new mothers to trust themselves and Mother Nature.
Sidebar: The Motherhood
Choice
Historically women never
thought twice about nursing their children; today's mothers have a choice.
But many of them can't be bothered because breastfeeding means spending
time with your child. It may require postponing career goals or other
plans.
Choosing to breastfeed means
making a commitment to your child. You are the one who may miss the
opera, who may eat a restaurant meal cold, who may have to postpone
a romantic weekend in the country because breastfeeding means being
there for your baby now when he needs you most. No one else can give
him the optimal beginning in life.
Motherhood today is about
choices. For most of the time, women worked in their family businesses
and raised children. Women didn't choose between work and children,
they simply took care of both. Motherhood was a way of life-almost a
calling- and anything a woman did, she did with her children by her
side. It wasn't that women work now and didn't work then, as many people
think. It was that mothers and babies "worked" together.
Then a number of factors
- changes in the workplace, urbanization, increased life expectancy,
effective birth control and dramatic increases in the safety of birth
and survival rates of children - reshaped the mothering landscape into
one where childrearing, for most women, became a temporary job. Not
only were women spending less of their lives raising children, but in
order to lead an adult life, they were spending more time away from
their children. The adult world and the child's world became segregated.
Mothers were expected to be away from their babies routinely and women
were told they needed to choose between being a mother and having an
adult life. Suddenly mothering was in competition with careers and personal
growth as a source of a woman's identity. Motherhood was something to
be squeezed into an adult life. Motherhood was about choice.
It was precisely this notion
of choice that allowed formula to make huge strides into the world of
baby foods. Freedom was proclaimed as everyone's goal in familiar slogans
such as, "You've Come A Long Way, Baby," or "Better Living
Through Chemistry." The message became loud and clear: a powdered
concoction in a can was a woman's ticket to freedom. Formula, and with
it the ability to leave your child, was presented as a feather in the
cap of women's liberation. It was the ticket to an independent life
free from encumbrances. Why choose to "be a cow" when you
could be in the corporate boardroom, in a swank restaurant or walking
by the seaside at sunset?
The use of infant formula
offered mothers a chance to live a life as no generation had ever done
before. It was a chance to have it all. Women were more than willing
to pay for canned formula, but they had no idea how much those cans
of formula really cost.
Additional Legislation in
the US
Breastfeeding is getting
more attention in the US Congress these days. To date, 13 states have
passed laws protecting the right of women to breastfeed in public. Getting
this kind of
protection has been a piecemeal
process since the federal government does not have jurisdiction over
this area. But in September, Congresswoman Maloney ( New York) and Congressman
Shays (Connecticut) took things one step further, introducing legislation
to ensure a woman's right to breastfeed in public on any federal property
where she and her child have the right to be.
As Maloney began gathering
stories in support of her first piece of breastfeeding legislation protecting
breastfeeding mothers in the workplace, it became clear to her that
many instances of harassment have occurred on federal property. In one
instance, a woman was asked to leave a federal park. Another incident
took place inside the Capitol building, yet another inside the Holocaust
Museum. In light of these events, the "Right to Breastfeed Act"
was created. The bill is very simple and, so far, is getting bi-partisan
support.
To find out more about the
right to breastfeed on federal property or follow the progress of these
bills, go to www.house.gov/maloney
or contact the National Alliance for Breastfeeding Action (NABA), 9684
Oak Hill Drive, Ellicott City, Maryland 21043-6321 USA, 410-995-3726
(phone) 410-992-1977 (fax), BarbBl3 at aol.com
(email). Contact your congressional representatives to let them know
that you want them to support HR 4628 The Right to Breastfeed Act.
References
American Academy of Pediatrics
policy statement on breastfeeding and the use of human milk, Pediatrics,
December 1997: 100(6): 1035-39.
Baumslag, N., Michels, D.
Milk, Money and Madness: The Culture and Politics of Breastfeeding.
Bergin & Garvey, 1995.
Horwood, J., Fergusson, D.
Breastfeeding and later cognitive and academic outcomes. Pediatrics,
January 1998: 101(1):e9.
Page last edited Sun Oct 14 09:31:32 UTC 2007.
