Sunday, 14 June 2009

What is often overlooked in the breast feeding debate

In recent weeks, the old heated discussion about breastfeeding or not has been making the rounds in the mummy blogosphere. There have been numerous (let's call them pro-choice) posts, such as Little Mummy, and over at Perfectly Happy Mum other bloggers are keen to help everyone breast feed who is able to do so and are sick of being called the breast feeding police (and I apologise having used the term myself, even if jokingly). There are also those pregnant unsure what to do, or new mums struggling with a constantly feeding babe such as Metropolitan Mum (oh I know how bad it can be!).

Something has been overlooked in the debate. And this is where I dare to chip in (of course I also went through a rather horrible and beautiful time breast feeding and touched the formula carton for the first time when Cubling was 12 weeks but that really is another story). Breastfeeding, or rather lack thereof, is linked to poverty (see this breastfeeding and poverty bloggers' carnival), social class and basic health. " poor mothers are less likely to breastfeed and this association remains after controlling for other factors. Also after controlling for other factors, cohabiting and lone mothers, lack of qualifications, being a young mother, having more than one child, being white and living outside England are all associated with significantly lower rates of breastfeeding." (source)

The reason why the "breast is best" message is pushed by the UK health services, government, local authorities and community planning partnerships is little different to the reasons that breast feeding is a life saver in developing countries. In the UK, low breast feeding rates are firmly linked to poverty. That's child poverty, inter-generational poverty, long term, people-can't-manage-to-get-out-of-it poverty. Poverty as persistent as we haven't seen it in a long time.

You see, the breast is best message is not actually aimed at us middle class mums, who are well informed and are able to make up our minds. Mums who, if they decide not to (or end up not being able to) breast feed, will make up for this with hundreds of other ways of being an excellent parent. It's also not meant to send us on a guilt trip if things don't work out. Actually, nobody cares what choices we middle class, secure in our little houses with two disposable incomes or one big one decide to do.

The "breast is best" message is aimed at people in the UK who live below the poverty line and in communities of multiple deprivation, where breast feeding rates are shockingly low, and where people move from not breast feeding to feeding their kids on junk food, causing obesity, health issues and the much quoted difference of 20 years of life expectancy between Shettleston in Glasgow's East End and Bearsden in Glasgow's North West. A life expectancy in the case of Shettleston which is similar to that of developing countries. And I'm not labelling these parents as bad parents, the reasons for this pattern are very complex.

So, government, local authorities, everyone really have looked into how to change this cycle of disadvantage. There are overall aims and objectives, and a vast number of indicators which serve to show that change is taking place. One of these indicators is breast feeding rates at 6-8 weeks postpartum, specifically for instance in aim 12 of the government's 2007 public service agreement to improve children's and young people's heath and well-being, as well as ESD indicator NI53, where breast feeding is linked to higher access of maternal services which in turn means that women who breast feed are more likely to access services. In turn, supporting breast feeding also provides an " impetus to enhance health and children's support services to mothers to sustain breastfeeding and thus give children a good start early in life."

Now I'm not arguing that you eradicate poverty by increasing breast feeding rates. That would be ridiculous and naive. However, if breast feeding rates go up, other stuff has happened which indicates that there are changes in behaviour which, along the line, means that people are enabled to get out of poverty, by themselves or by taking up help to get them there.

If breast feeding rates go up, this tells us a lot about the effectiveness of maternal support services. Again, I'm not talking about 100% breast feeding rates, but something which is better than the 13% in the area where I work for instance. The WABA (World Alliance for Breastfeeding Action) 2005 Progress Report succinctly states that:
"Therefore, we believe that breastfeeding outcomes can be an indicator of a woman’s quality of life throughout childbearing. Does she get adequate food and rest, good health care, maternity protection at work? Is she free from violence and discrimination? Support for breastfeeding demands that we pay attention to the well-being of the woman behind the breasts." It's about supporting the woman, protecting her and enabling her to find suitable support. Where breastfeeding rates are low, this support may not be accessed. It is not about women who do access services and are doing reasonably after giving birth (and may or may not choose to breast feed or bottle feed).

That's why the breast is best message is necessary and in my opinion should continue to be pushed. If we're middle class mums who have had problems with breast feeding of a medical nature, a comfort nature or any other nature feel pushed a tad too hard, please get over it and look at the bigger picture. The UK has the lowest breast feeding rates in the EU, and one of the lowest child wellbeing rates, with one in 3 (please stop and read this stat again!!!) children growing up in poverty in the 5th richest country of the world. There is a link, even if it is a complex one, but if we want to be serious about ending this lamentable state of affairs, it's important to start pushing at all ends.

The breast is best message is one of many ends.


Expat mum said...

One reason why breast-feeding rates are so low in the UK is that low-income mothers can get formula as part of their benefits. There is no incentive to breast-feed.
But please spare a thought for those us whose cup-size didn't increase a single centimetre during pregnancy, ( a red flag, according to my doctor) and whose babies nearly starved while trying to feed them.
It isn't always lack of effort.

Brit in Bosnia / Fraught Mummy said...

A great post with a whole load of issues that hadn't even crossed my mind. Thank you for bringing them up.

Like you say, it is very different to have access to all the facts and support and to make the right decision for you and your baby (whether breast or bottle) and to not. The more we can do to help everyone make the right decision for them and their babies the better.

cartside said...

Expat mum - don't I know. Lots of my friends were absolutely determined to breastfeed and couldn't, and boy did they try! And I had to supplement eventually - in spite of doing everything I could not to. All I'm saying is that although it's extremely distressing on a personal level if this happens, the push for breastfeeding shouldn't ever make anyone feel guilty for not doing so, whatever the reason. And nobody should get upset by people asking the dreaded question why they're not breastfeeding.

Fraught Mummy: Just my thoughts. And this is why I think once someone has made an informed decision, that's fine.

Kat said...

This is an excellent post and as always very well balanced. Few articles regarding BF take into account this aspect and as you say, it is key.

I think one of the integral problems with breast feeding failure in those who try is our missing support structure. In most other countries we would have grown up with BF as part of our experience but it seems so hidden away (and often sexualised) in our culture that for most people it seems the first child they see BF is their own. When they are not sure what to do the support is missing or poor and the known quantity of formula is heavily pushed in most pre & post natal literature as well as by medical staff (IME). Anyone who seeks to support BF is often labelled with the term 'Nazi' which, when you think about it is seriously twisted - they are not committing genocide and other crimes but trying to help people establish a free, easy and natural way of feeding their childen. Let's hope that level headed voices like your own prevail in the mêlée.

Littlemummy said...

Excellent post with some new views on breadtfeeding that I haven't heard before, off to tweet this.

Metropolitan Mum said...

I never made that link - and the stats are rather depressing. Thanks for bringing this up!

zooarchaeologist said...

I agree with this, but I do think that a blaanced approach on the part of the health authorities would be better, thus giving everyone a freer choice. I could be wrong but I wonder whether the rise in post-natal depression is due to the immense pressure that mums are put under to breast-feed at what is a vulnerable time for people. Disadvantaged people need to be made a priority for sure, but all new mums need adequate support and attention. Perhaps im naive, but im also not sure if breast-feeding would make a difference to whether someone then feeds the child junk food etc and how they talk to them. It can often also be done in ignorance for the sake of ease and cheapness and nothing to do with thoughts about a childs welfare.
This has really got me thinking though, im off to do dome more reading and to see what the stats are for my local areas.
thanks :)

cartside said...

zooarchaeologist, I agree and glad you raised some of the points I deliberately left out.

Support: I never experienced any inappropriate pushing, but had to be proactive to get the support I needed (and could have done with more), but I know that insensitive insistence on breast feeding can have a real negative impact, including pnd and that's not good. So we need good, sensitive and needs based support for all new mums, which obviously needs resources (and the NHS is too stretched to provide this support comprehensively - we are aiming at Scandinavian style services with US public budgets ...).

Link between breast feeding and later eating habbits: One thing I wonder too is if breastfeeding, because it's an indicator of poverty and loads of other stuff, is pushed for the sake of demonstrating change because it may be easier than tackling other issues, such as healthy eating amongst the whole population. Then again, changing breast feeding rates is not an easy task so it may be a good indicator for overall changes in behaviour. The question remains if it's a good indicator. I can't answer that other than it seems to work internationally and people haven't come up with a better alternative.

Dancinfairy said...

This is a really interesting post. I am expecting my first baby in three weeks and have written about my views in my post also included in the BMB carnival. You raise some interesting points that I didn't know so thank you.

I think that there is a real lack of available support, my NHS trust gave me a DVD so I could learn how to breastfeed. The nearest NHS clinic for advice when I start feeding is once a week at a hospital 30 minutes away by car. It is not enough.

Anonymous said...

Facinating post, thank you - I really didn't realise (or was trying to be politically correct) that there was such a big socio-economic effect.

Totally agree about PND and any pressure or 'shoulds' about being a Mum - that is definitely the reason behind it.

I've done a couple of posts about BF'ing recently - would be really interested in your take on them.

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