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.
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.