Happy World Breastfeeding Week (and National Breastfeeding Month)!
Breastfeeding is a vital component of realizing every child’s right to the highest attainable standard of health, while respecting every mother’s right to make an informed decision about how to feed her baby, based on complete, evidence-based information, free from commercial interests, and the necessary support to enable her to carry out her decision.
-- 2018 BFHI Implementation Guidance from WHO and UNICEF
Happy World Breastfeeding Week (WBW)! Inaugurated in 1991 by the World Alliance for Breastfeeding Action (WABA), this national awareness week (August 1-7) is now observed in over 120 countries by UNICEF, WHO, and other governments and partners. By 2010, 540 events had been held worldwide by more than 79 countries with 488 organizations and 406,620 participants.
WHO and UNICEF states that children should be breastfed for at least two years of life. Breast milk is the ideal food for newborns and infants as it provides the key nutrients needed for healthy development, including antibodies that help protect them from common childhood illnesses like diarrhea and pneumonia, the two primary causes of child mortality worldwide, and SIDS. WHO highly recommends exclusive breastfeeding for the first six months of life. At six months, solids can be introduced to complement, not substitute, breastfeeding for up to two years or more. In addition, they advise that breastfeeding begin within one hour of birth, should be "on demand", as often as the child wants day and night, and that bottles, teats, and/or pacifiers should be avoided at all costs.
Despite it's importance, various factors do impact and/or hinder the way breastfeeding is implemented, whether due to common misinformation, lack of postpartum support, the need to return to work, cultural taboos, or the booming business of the formula industry. With the help of initiatives like WBW and La Leche League, and the work of lactation consultants, doulas, and books, perhaps we can move toward a wider dissemination of knowledge, making families aware of the power within.
While this post serves to recognize breastfeeding as the foundation of life, I honor that it may not be possible for everyone.
On the Benefits of Breastfeeding
As a global community, we must promote breastfeeding as the first and healthiest option for babies; WHO studies show that by improving breastfeeding practices, the lives of 823,000 children under the age of five could be saved every year.
Benefits for Mami:
Studies show that for each year that a woman breastfeeds, the risk of breast cancer declines by 4% and that breastfeeding for at least 12 months or more lessens the risk for developing high cholesterol, high blood pressure, as well as other cardiovascular diseases, ovarian cancer, type II diabetes, and postpartum depression (PPD). Exclusive breastfeeding is also associated with a natural method of birth control (98% protection in the first six months postpartum).
Nursing is crucial in developing and sustaining mother-baby bonding. As the baby suckles at the breast, oxytocin and prolactin are released which send signals to the brain of calm and relief. Moreover, suckling tells the mommy brain to continue producing more milk; if babies stop breastfeeding, milk supply will diminish. Another added benefit of breastfeeding is it's aiding in postpartum recovery. While babies nurse, each suckle sends oxytocin through the body, which contracts the uterus. Studies have shown that mothers who breastfeed more often have a faster rate of uterine involution (meaning, their uterus returns to it's pre-pregnancy state faster).
Benefits for Baby:
Before breastmilk there is colostrum, née liquid gold: the orange/yellow secretion from the mammary glands that is rich in vitamins, nutrients and antibodies, or, in other words liquid gold that comes in about one to two days post birth. Think of it as your baby's first vaccine. Then comes breastmilk, which contains anti-infection and anti-inflammatory agents. Exclusive breastfeeding for the first 6 months of life prevents undernutrition and promotes brain development. Due to it's highly nutritious composition, babies who are breastfed are less likely to be overweight or obese and less likely to have type 2 diabetes later in life.
In her brilliant book The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding, author, award-winning journalist, media commentator, and breastfeeding advocate Kimberly Seals Allers delves into the importance of breastfeeding and it's undermining by Big Pharma, the dairy industry, and the government. Speaking on the need for breastfeeding, Seals Allers quotes Keith Hansen, Global Practices Vice President at the World Bank and his promotion of breastfeeding:
"We are emphasizing breastfeeding more and more in our support to countries, not just as a health investment but a true powerful economic investment in their futures...the gains from early childhood nutrition are forever. And to a large extent, many of them are free because they have come prepackaged in this unbelievable intervention called breastfeeding...Children who breastfeed are not only much more likely to survive but also to stay in school and are therefore more likely to escape poverty--about 33 percent more likely on average. And their wages are anywhere from 5 percent to 50 percent higher than their peers who were not able to escape. These data are from very rigorous longitudinal studies...that have been done over decades now with fairy substantial cohorts and very robustly tested, and the impact, correlations, and causations are very strongly established."
-- Seals Allers, The Big Letdown, 77-8.
Disparities in Breastfeeding: the Intersections of Race, Class, and Capitalism in the United States
Although "idiocy" and "embarrassment" are not new terms to describe our current state of affairs, the United States managed to shock the world last month when it tried blocking a World Health Assembly International Breastfeeding Resolution. Hundreds of delegates from the world over gathered to put forth the Resolution, which states that breastmilk is healthiest option and countries should strive to limit the "inaccurate or misleading marketing of breast milk substitutes." Backed by formula companies, the U.S. delegation, fought to water down the resolution, demanding the removal of a clause calling governments to "protect, promote and support breast-feeding." When that failed, the U.S. resorted to threatening smaller nations. Ecuador, who was set to introduce the resolution, was met with intimidation by the States, who threatened to withdraw military aid and "unleash punishing trade measures." Intimidated, Ecuador stepped away. The accounts that unfolded were recounted to the New York Times by various countries, all who requested anonymity because "they feared retaliation from the United States." The Assembly struggled finding new countries to introduce the resolution, as most feared the States, and in the end, Russia stepped in and introduced the resolution. The U.S. stepped back.
As the Leader of the Free World, we still have so far to go regarding health, breastfeeding included. I mean, it only became legal to publicly breastfeed across all 50 states this past June! While national rates increase, there are still issues adhering to WHO-recommended practices. When looking at breastfeeding in the U.S.. A CDC study analyzing breastfeeding patterns in children born 2009-2015 shows that although approximately 81% of moms across the nation reported breastfeeding, the number drastically decreases to about 22% when looking at exclusive breastfeeding for six months. In 2013, only 31% of American woman breastfed at one year.
Another American phenomenon is the intersection of class and race. The CDC disclosed that among infants born during 2010–2013, only 64.3% of Black infants started breastfeeding, compared to 81.5% of white infants. Poverty, lack of medical and familial support, a shortage of lactation consultants, and stereotyping (age, ethnicity, race, religion, or socioeconomic status) are among the various factors that contribute to the issue. (Not to mention the Black Maternal Mortality Crisis, where Black mothers are 243% more likely to die from childbirth/related causes than their white peers.) Due to a higher connection and cultural tie to their respective homeland(s), breastfeeding practices are higher in Latin@ and Black (im)migrant communities within the States.
Adding insult to injury is Paid Leave, which affects many mothers' and families' decisions to breastfeed. During the Clinton presidency, the Family and Medical Leave Act was issued, giving workers 12 weeks of unpaid leave to care for a new child. Unpaid. Out of the world's 196 countries, the U.S. is one of only four that has no policy to give new parents paid time off (the other three are Swaziland, Lesotho, and Papua New Guinea). To compare, mothers in Finland can start maternity leave seven weeks before their estimated due date; an additional 16 additional weeks of paid leave is covered through a maternity grant as well as eight weeks of paid paternity leave. After a child turns three, parents can also take partial care leave (splitting time between home and work) which lasts until the child starts second grade. Parents in Sweden receive 480 days of leave at 80% of their normal pay, on top of the 18 weeks reserved for moms. Sweden also provides fathers with 90 paid paternity days. Lithuania has enacted policy that gives mothers 18 weeks of fully paid leave, fathers four weeks, and together parents receive an additional 156 weeks to share. For the shared portion, they decide whether to have it paid out at 100% for the first 52 weeks (until the child is turns 1) or 70% for the first 104 weeks (until the child is 2 years old). While some states have made positive strides, like New York, American mothers remain entitled to zero weeks of paid leave under federal law.
Global Breastfeeding Initiatives
According to a recent report by WHO and UNICEF, an estimated 78 million babies – or three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease and making them less likely to continue breastfeeding. While we are internationally making strides, we still have a long way to go. Here are 8 fast facts from around the globe.
- Globally, only about 3 out of 5 of all newborns breastfeed within an hour of birth and only 40% of children under six months of age are exclusively breastfed.
- Australia's federal Sex Discrimination Act 1984 declares breastfeeding as a right, not a privilege. It is against the law to prohibit a mother from breastfeeding in any place she is legally able to be and to discriminate against a her for breastfeeding.
- The Philippines has various laws protecting breastfeeding, including the Expanded Breastfeeding Promotion Act of 2009 and the Milk Code. Employers must allow a 40-minute lactation break to breastfeed or pump; offices and public places are also required to provide lactation stations which must be separate from the bathrooms.
- In 2014, the United Arab Emirates passed a law that requires all mothers to breastfeed children until they are two-years-old. All government offices must provide a nursery so working mothers can breastfeed. If due to health conditions a woman cannot breastfeed, the Emirates’ Federal National Council will provide a wet nurse to her.
- The Khyber Pakhtunkhwa Protection of Breastfeeding and Child Nutrition Act 2015 in Pakistan mandates formula manufacturers to write on their containers in bold: “Mother's milk is best for your baby and helps in preventing diarrhea and other illnesses.” The law also bans health workers from promoting any bottled or packaged milk to infants up to the age of twelve months.
- 99% of Norwegian women breastfeed at birth and 70% still exclusively breastfeeding at three months. Mothers are given 36 weeks of 100% paid leave or they may opt to take off 46 weeks with 80% pay.
- In the past 20 years, Brasil's infant mortality rate has been cut back by more than two-thirds, which is highly credited to an increase in breastfeeding (and the country's 214 milk banks). Moreover, businesses or organizations that ban women from breastfeeding in public will get fined.
- According to Dr. Garima Jain, Senior OBGYN at Apollo Cradle in Bengaluru, only 44% of Indian women are able to breastfeed their newborns within an hour of birth and only 55% of all babies born receive breastmilk exclusively in the first six months, ranking India the lowest in breastfeeding practices in South Asia.
Maternal Support and Resources
Breastfeeding is a natural occurrence, but it does need to be learned and many new mothers initially encounter difficulties. Thus, it is important to create space for support and understanding. Sadly, that isn't the case; many routine practices, from the separation of mother and child to the coercion of formula-feeding, inhibit breastfeeding. Fortunately, health facilities and various organizations have began eradicating these unhealthy (yet widely perpetuated) norms, like the invent of the Baby-Friendly Hospital Initiative (BFHI). Founded in 1991 by the WHO and UNICEF, the BFHI was launched as a global program with the goal of encouraging hospitals to implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes.
The Ten Steps are:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give infants no food or drink other than breast-milk, unless medically indicated.
- Practice rooming in - allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
The BFHI assists hospitals in providing accurate support and assistance to mothers, providing them with information and necessary skills before departing the hospital. Thanks to the Baby-Friendly Hospital Initiative and government support, there are over 20,000 maternity facilities that are "baby-friendly" in 150 countries. In 2007, less than 3% of U.S. births occurred in approx. 60 "baby-friendly" facilities; however, in 2018, the numbers have, thus far, risen to over 25% of births in more than 500 Baby-Friendly designated facilities! These centers can be found in every state and Puerto Rico. This initiative and 10-Step Program is endorsed and promoted by:
- American Academy of Family Physicians
- American Academy of Nursing
- American Academy of Pediatrics
- American College of Nurse-Midwives
- American College of Obstetricians and Gynecologists
- Academy of Breastfeeding Medicine
- The U.S. Surgeon General
- National WIC Association
- The CDC
- Academy of Nutrition and Dietetics
- Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
- U.S. Breastfeeding Committee (USBC)
- U.S. Preventive Services Task Force
Here are various resources for online support and guidance:
- La Leche League: The forerunners in maternal health, education, and support, La Leche League's site is a wonderful resource. Check out their extensive Breastfeeding Info page, multilingual links to resources in emergencies of infant feeding, and webinars. I suggest buying a copy of their outstanding book, The Womanly Art of Breastfeeding.
- Kelly Mom: This site covers all-things parenting, from breastfeeding to ages and stages.
- The Bump: Tons of articles, videos, and pregnancy breakdowns by trimester.
- The Academy of Breastfeeding Medicine: This organization leads in news and research in regards to breastfeeding.
- Low Milk Supply: This site is dedicated to helping women work through issues in milk supply.
- Women's Health: The United States Office on Women's Health has various resources including easy-to-read PDFs and a helpline (1-800-994-9662) operating 9am-6pm ET, Monday-Friday.
- ACOG: The American College of Obstetricians and Gynecologists has compiled a list of breastfeeding websites, articles, and archived webinars.
- CDC: The Center of Disease Control has an extensive library of breastfeeding stories, related links, reports, toolkits, and fact sheets.
- Baby Center: This is what my mother used to track the development of my little brother. It's a super useful tool with tons of infographics.
- Find local support groups near you.
Reflections from Mama
Karma Tudor, New York
“Not breast feeding was not an option. My mother in law at the time said to me, ‘You are breastfeeding right?’ Well, since she put it like that, ‘Yes of course!’ I was 24 when I was pregnant, my mom was living in another state, and my husband at the time’s family all but adopted me…After Logan was born, I took a breastfeeding class in the hospital [where] they advised me that colostrum was enough to feed the baby until the milk came in. Breastfeeding was difficult at first: I tried to nurse him, changed his positions, but I couldn’t get him to latch on and had NO CLUE what I was doing. So, I popped open one of those free-formula samples and fed my baby. But I did NOT give up. I did all the research I could and refused to be considered a “failure” because I sucked at breast feeding. Two days later, the milk came in and whoa, did it come in! During my first visit to the W.I.C office, I met with a lactation consultant. I all but cried in her office, trying to explain all of the woes. I felt like less of a mom because I was not nursing as I planned and was not producing as much milk as before because I wasn’t nursing as much. The lactation consultant showed me how to nurse and got me approved for an electric breast pump. Once I got the hang of using the pump, I learned to relax and experience the let down. I no longer needed to pump and nursing became my and Logan’s favorite pastime. I nursed Logan for 9 months and wished I nursed him longer, but I returned working at a very stressful job and was no longer producing much milk. I did have a freezer full of breast milk that lasted until Logan turned 1 year-old. I will never forget that lactation consultant: she was all that I needed to help me feel like a complete, new mom. I wanted to become a lactation consultant to help young mothers such as myself. I am not sure why I stopped pursuing that dream, but as I write this I know it's time to begin the process of studying to be a lactation consultant.”
Najah Muhammad, MPA, Ohio
"Now that I think about it, I was pretty nervous about breastfeeding in public with my son. I did it, but I went out of my way to be discreet. I guess over 10 years a woman can make a lot of mental shifts. I would say the best part of breastfeeding my youngest (my daughter) was the “feel good” hormones. I was very hurt, stressed, confused, betrayed, angry with myself...you name it. Her dad told me that we would not work as a family about three weeks before she was born and I was devastated. I was trying so hard not to fully give in to the bad feelings during pregnancy (as not to hurt my baby) that after she was born I guess I allowed myself the freedom to cry and cry and cry. But, it was so amazing how I would be feeling so down, so hopeless and I’d just grab my baby without even thinking and breastfeed her and feel all the pain melt away within seconds. It was kind of amazing how I’d shift from fighting the tears to completely blissful just like that! I trust that God gives you the grace you need to make it through the rough spots—and that’s my baby girls middle name. Sahara Grace!"
Nora Jaya Maffetone, New Jersey
"I’m grateful my daughter latched. I was in labor for 3 days at home hoping to birth her there along with my husband and midwives. I wound up having a c-section and was told I potentially had an infection in my placenta. I was out on antibiotics and so was my daughter after the nurses laid her on my chest for a total of 30 seconds. They took her to the nicu after that as I laid helplessly on the operation table. I saw my husband as a blur and told him to go with her. He insisted he stayed with me but I insisted he go. I ordered him to go with my daughter so she had at least one parent there for her. I was scared and sad but also focused on keeping her safe. In the hours that followed, I had fluid in my lungs from the saline drip and my oxygen levels dropped in and out. My daughter was fed formula until I was coherent enough to fight for her to feed from me. Everything was going against what I believed in- what I wanted...but I had to stay focused. I don’t remember much but waking up my husband every two hours to help me walk to the nicu to feed her. I remember yelling at the nicu nurse to the get the pacifier out of her mouth as I had already asked 4 times before. Fortunately I had a lactation consultant in the hospital who showed me how to pump to elicit colostrum. She latched perfectly and I could feel her fighting for me as hard as I was fighting for her. From then on, breastfeeding my daughter was the foundation of my healing process. Not only from recovering from labor, surgery, and the trauma of not being in contact with her, but healing from my past as well. I never knew how strong I was until I met my daughter. Every suckle I could feel my uterus contract and I would sweat beyond measure. Toxins in every regard were leaving me and I was slowly being reborn. Breastfeeding hurt at first. It was stressful but I knew it was a blessing and still is. My daughter is 2 now and she’s my greatest gift. I’m so privileged to have been able to breast feed her and continue to at 2 years old."
Jamie Jones, New York
"I breastfed both of my boys and had very different experiences. I alternated between pumping and nursing for much of my first postpartum journey. I hated pumping, but I suffered from Postpartum Depression and really just needed the feeding assistance at times. I became slightly obsessed with having a freezer full of milk instead of just embracing nursing when I could. I still felt that incredible oxytocin release from nursing and I think that's the only reason I managed to make it through 14 months of breastfeeding during such a challenging time. I didn't feel the bonding attachment in the way I had hoped, which I know was large in part due to my depression. While I struggled as a new mom, breastfeeding came fairly easily. However, my 2nd was a totally different experience. He had a harder time latching due to a minor tongue tie, but we worked and worked on it so much that he would only nurse for the first 8 months. I got mastitis twice because he couldn't suckle enough to fully empty my breasts. I did feel all of the bonding this time around, but I also did not have the postpartum depression to battle. I breastfed him until he was 10 months and then started to supplement/wean since I was working more (also, being a mom of a toddler and breastfeeding a baby was definitely more challenging than I expected.) I miss breastfeeding. I miss the attachment, I miss knowing they were getting all the nutrients they needed from me, I miss looking down at their little faces knowing I was still their main life source! But I enjoy being able to bond with others since they don't rely on me. There is a sense of freedom once you've finished your breastfeeding journey. .