Is it wrong to talk about the public health importance of breastfeeding?

[RanaAurora]

Is it wrong to talk about the public health importance of breastfeeding?

So there was this article in Pediatrics that estimated there are 911 preventable deaths a year in the U.S. due to lack of breastfeeding.

Should we not say that? The comments sections of a lot of the media coverage of this article, and several bloggers, think so. Apparently, saying that lack of breastfeeding has real public health consequences is making women feel bad. Because there are a hundred ways in which women in this country get poor support and/or have their breastfeeding attempts outright sabotaged, a lot of women don't manage to breastfeed successfully. So we should stop saying that breastfeeding has important public health effects, because then some women will feel guilty that breastfeeding didn't work out for them. Do you follow? I don't. I really, really don't.

I see an implication in those comments that no one is grappling with the structural issues that affect breastfeeding success, that breastfeeding advocates are not interested in those issues. I beg to differ. At the Breastfeeding & Feminism conference (which was awesome, and I only wish I had the time and brainpower right now to talk about the many facets of awesomeness) you could meet dozens and dozens of people who grapple with these issues in a vital part of their academic, professional, and/or personal capacity. If you feel like all breastfeeding advocates are doing is trying to guilt or shame women into breastfeeding, you aren't looking very hard at breastfeeding advocacy in this country.*

Just at my university and the associated hospital, I can think of the following breastfeeding advocacy projects happening right now: improving child care centers' breastfeeding-friendliness, working for the hospital to go Baby-Friendly, getting funding for free pumps for NICU moms, providing breastfeeding support training for physicians and medical residents, improving lactation room information and access on campus, encouraging businesses to identify as breastfeeding-friendly, training lactation consultants, teaching prenatal breastfeeding classes, referring to local WIC peer counselors, providing discounted pumps to university students & employees, offering a local breastfeeding support group for African-American moms, and studying the impact of each Baby-Friendly step on hospital breastfeeding rates.

With all of that work to facilitate people reaching their breastfeeding goals on a structural and community level, you can understand why I'm so frustrated when articles like the one in Pediatrics get the reception they do. Which of those activities is targeted at making women feel guilty? Which is just about trying to control women's bodies and tell them what to do?

In fact, let's take a look at the conclusions section of the article itself which reads, in its entirety:

"By being incredibly selfish and not trying hard enough, 911 American mothers kill their babies every year by not breastfeeding. Clearly, public health and medical authorities have failed to make women feel guilty enough for not breastfeeding. Further efforts are required to make all mothers feel shame for any amount of formula that they offer their babies, regardless of their individual circumstances."

Oh, whoops! That wasn't the actual conclusions section. I got confused there for a moment. Here's the real one:

"By allowing breastfeeding rates to continue at their current levels, rather than implementing supports to help more families follow medically recommended guidelines, the United States incurs billions of dollars in excess costs and hundreds of preventable infant deaths. Action to improve breastfeeding rates, duration, and exclusivity, including creation of a national infrastructure to support breastfeeding, could be cost-effective."

I don't see a single mention in there even of education targeted at consumers. I don't even see individuals mentioned. I hear talk about "implementing supports" and "creation of a national infrastructure". I see an admonishment to our country to facilitate breastfeeding success. When people talk about "articles like this making women feel guilty because a lot of women can't breastfeed" and "don't they know that breastfeeding is hard", my jaw just drops. The whole point of articles like this is to point out that we need to do better at making breastfeeding less hard, at enabling more women to overcome breastfeeding difficulties, to illustrate to policymakers and public health authorities that those efforts are worth it for very concrete human and financial reasons. To make them feel guilty for the piss-poor job we do of supporting breastfeeding specifically, and mothers in general. If we don't talk about the reasons breastfeeding is important, how can we advocate for system change?

There are hundreds if not thousands of public health professionals out there trying to make the system changes that people responding to these articles often point out. How can we support breastfeeding if we're not supposed to say WHY?


*Let's note that "looking hard" does not mean "reading blogs and comment sections". Can I bait a flame-war about breast vs. formula with people getting obnoxiously self-righteous on both sides? Yes; I can also start one about Pepsi vs. Coke, but that doesn't mean Pepsi is actually putting out ads calling Coke drinkers elitist jerk-offs.

Again, not written by me. 

[science_spot]

Apr. 8, 2010 at 6:25 AM

Yes absolutely we should be talking about it, the same we are addressing obesity in this country.

You are doing a wonderful service to the cafemom community by spreading the word.  Thank you!

[mamalinzie]

Apr. 8, 2010 at 8:52 AM

This whole "debate" just blows my mind!!

[HistoryMamaX3]

Apr. 8, 2010 at 9:04 AM

People don't want to think that the choice they made was not the best one. Others feel bad because they legitimately could not. Either way, it is easier on their conscience to defend their choice- rather than helping the other women out there sharing the same frustrations and concerns that pushed them away.

[wendy46121]

Apr. 8, 2010 at 9:20 AM

Of course we should be talking about it.  People chose to feel guilty and defend their choices rather than just say "crap I didnt know! let me learn more so I can do better next time."  No they say "How DARE you insinuate that i didnt make the absolute best choice!"  

*sigh* We're not even trying to make them feel guilty, we just want to get the message out about this VERY IMPORTANT HEALTH ISSUE.  

[evwsquared]

Apr. 8, 2010 at 5:23 PM

This whole argument requires people to be able to think in the abstract, and not about themselves. Personal anecdote means nothing when dealing with statistics. I was lucky---I gave birth in a certified Baby-Friendly hospital and my employer is extremely pro-breastfeeding, providing not only lactation rooms but hospital grade pumps, a lactation consultant on staff, and a breastfeeding support group moderated by an IBCLC. That's my personal anecdote. What does it have to do with this story? Nothing. Absolutely nothing. That's the value of personal anecdotes when discussing public health issues.

The article does not say that women who chose to formula feed contributed to the deaths of those 911 children. I think that the only response that it asks for from all women is to say that we can do better than that, and we've got the resources as a nation to provide the proper infrastructure so that no woman has to go through the heartbreak of losing her infant.

[Crystal8327]

Apr. 9, 2010 at 12:15 AM

Why do people think wic counselors are pro breastfeeding? Well not where I live they are formula pushers.

[RanaAurora]

Apr. 9, 2010 at 12:20 AM

They're supposed to be, Crystal.  Especially with the changes in October to encourage them to be even more pro-breastfeeding after statistics showed that with the old method, people were LESS likely to breastfeed if they knew they could get formula from WIC.

(Original Poster)

[ethans_momma06]

Apr. 9, 2010 at 1:03 AM

Thank you thank you THANK YOU for posting this. This is what I and so many others have been trying to get at for the longest time.

It's time we fix the boken system.

[tyrelsmom]

Apr. 9, 2010 at 2:21 AM

It's not wrong.  It's just a subject people get extremely defensive about, though.

[Squirrell34]

Apr. 9, 2010 at 6:05 AM

I completely agree.  I commented on your post earlier this week with my thoughts.

I am pro-breastfeeding.  But I am not on any CM groups about it anymore, as my questions were not taken seriously and many replies were catty & mean  (The group may have changed in 2+yrs).  Even on this site, women who wish to learn more about breastfeeding and try to make it work are treated very harshly, leading to an environment of failure.

And for those who discount the posts saying "I tried to, but I couldn't."  If you truly want to change the system, instead of just dismissing their posts, read WHY they failed.  And that will target where we all need to focus our efforts.