I #March4Nutrition to make #breastfeeding a right, not a privilege

I #March4Nutrition because breastfeeding is a powerful predictor of health and wellbeing for mothers and infants — and yet, too many families face barriers that prevent them from achieving their own breastfeeding goals.

Families who want to breastfeed navigate a veritable minefield of “Booby Traps.” Many maternity providers have minimal training in lactation support, and providers may not ask about breastfeeding during prenatal care — or spend only seconds on the topic — missing the opportunity to address concerns and provide guidance.  Parents are inundated with misleading materials from infant formula manufacturers, promising that their product is “designed to be like breast milk” or will magically convince fussy babies to sleep through the night. Indeed, in a study, mothers looking at formula advertisements voiced concerns that their milk didn’t have added vitamins, so perhaps it would be healthier to formula feed.

At birth, too few families receive evidence-based maternity care that gets infant feeding off to an optimal start. For example, putting a baby skin-to-skin for the first hour of life increases breastfeeding duration by as much as 6 weeks — yet 28% of US hospitals do not provide such care to most women.  Skin-to-skin is one of the World Health Organization Ten Steps to Successful Breastfeeding. Hospitals that implement all ten can be designated as “Baby Friendly” – but currently, only 11.5% of US maternity centers meet that standard. It’s worth noting that we are making progress — just 2.9% of hospitals were Baby Friendly in 2007 — but 88% of families are still hobbled at the starting gates when they start their breastfeeding journey.

Once families return home, the Booby Traps continue. We serve mothers poorly in the fourth trimester: For most families, postpartum care happens in silos. A pediatric provider cares for the newborn, while a maternity provider looks after mom and a lactation specialist manages the “oro-boobular interface.”  In the best circumstances, these providers collaborate to optimize care for mom and baby, but too often, the system fails, leaving mothers, babies, and breastfeeding stranded.

Families that transcend the booby traps of baby-hostile maternity centers and fragmented postpartum care face one of the world’s worst systems for maternity leave. The US shares with Papua New Guinea the dubious distinction of being one of 2 countries without any legal right to paid maternity leave. For families that live paycheck to paycheck, this is an enormous barrier to sustained breastfeeding.  We’ve seen some important progress in the past few years, with the Affordable Care Act requirement of workplace accommodation for pumping and payer coverage of lactation equipment, but these provisions are not a panacea. Pumping breaks are unpaid — lengthening a mothers’ workday, without compensation to pay for additional childcare — and payer policies for lactation support range from excellent to dreadful. Moreover, unpaid pump breaks only apply to hourly workers, leaving out a tremendous portion of employed women.

Efforts to pay for pumps and secure break time obscure a fundamental challenge for breastfeeding families. Policies to enable breastfeeding have focused on pumping and bottle-feeding, rather than keeping mothers and babies together. As Page Hall Smith eloquently stated at Breastfeeding and Feminism 2015:

Over the past decades governmental, health care, workplace and social support for breastfeeding has risen substantially, and these supports make it possible for women to actualize their own breast-feeding goals… but one things stands out: our social solutions to the “breastfeeding problem” have sought to reconcile the biological imperative of lactation with the needs of working mothers without making substantial social change. We have moved from being a society where women do not breastfeeding because they do not want to or cannot to a society where most women want to breastfeed, but cannot, so they pump instead.

What we can’t seem to get around are two realities that are contradictory but must be reconciled: (a) for breastfeeding to be successful, mother and babies must be together, and (b) As societies develop now, being with babies reinforces gender inequities that undermine women’s economic, political and social development. The reconciliation of these tensions needs our attention.

Even when moms and babies ARE together, it’s not easy being a breastfeeding mother in the United States. Despite legislation protecting public breastfeeding in 46 of 50 states, mothers routinely face nasty comments, expulsion from restaurants and stores, and simmering hostility for having audacity to leave the house with a nursing baby. The hostility only deepens as newborns grow to infants and toddlers, even though the World Health Organization recommends at least two years of breastfeeding.

I #March4Nutrition because all mothers want the best for their children — yet for too many families, breastfeeding is a privilege that is out of reach, aggravating disparities in infant mortality, chronic childhood illnesses, and maternal health. For example, racial disparities in access to evidence-based care aggravate shameful racial disparities in infant mortality. In a recent study, hospitals in neighborhoods with ≥12% African American populations were less likely to adhere to 5 of the recommended 10 steps for breastfeeding care than those in neighborhoods with <12% African American populations.  These unacceptable disparities set up families for failure and undermine health across two generations.

For families to reach their full potential, we need to do more than simply say that women should choose breastfeeding. A choice that is not also a right is not really a choice — it’s a privilege. I #March4Nutrition because it is time to protect every woman’s right to breastfeed, for as long as is mutually desired by mother and child.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and associate professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine and of Maternal and Child Health at the Gillings School of Global Public Health. She is a member of the board of the Academy of Breastfeeding Medicine. You can follow her on Twitter at @astuebe.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.