Breastfeeding? Fine - just don't do it here24th November 2006
I was intrigued to read the article in hc2d on the 27th October, citing a recent study on breastfeeding published in the International Journal of Epidemiology. The study showed that mothers delivering in a UNICEF UK Baby Friendly accredited maternity unit, are more likely to start breastfeeding than those delivering in certificated units or those with neither award.
This is of course encouraging news, as the UK has one of the lowest breastfeeding rates in Europe with only 22% of UK babies receiving any breast milk at age 6 months compared with for example 72% in Sweden. The slightly less encouraging aspect however, is that this effect was short-lived and mothers delivering in such facilities were NOT more likely – compared to any other woman in the UK – to be breastfeeding at 1 month after birth.
So – in spite of contributing to an increased number of women starting to breastfeed, the UNICEF UK Baby Friendly Initiative that was introduced into UK maternity services in 1993 is in isolation unlikely to be effective in extending the duration of the breastfeeding period. The paper highlighted the importance of provision of support to mothers after they leave the maternity unit and also suggests that additional health service policy changes will be required in order to increase the proportions of infants in the UK who are fed in accordance with WHO recommendations.
At this point I have to state my complete lack of expertise in this field, but nevertheless I would like to express an opinion with respect to the nature and usefulness of health service policies and strategies alone.
As an immigrant from Norway I come from a culture where breastfeeding is the norm and totally accepted in public life, at least until the baby is one year old. As many as 85 – 90 % of Norwegian babies are still being breastfed at 3 months old and I never thought anything of it until moving to England 10 years ago. Having spent some time here I have realised that breastfeeding is chosen by considerably fewer women but I’m not sure that policy changes will do the trick alone. I think there are important policy lessons to learn from countries like Norway with a high breastfeeding rate. As examples I can mention maternity leave for all for one year with 80 % pay (or you can choose to take full pay for 42 weeks) – and notably this is not paid by the employer but by the state, and therefore does not penalise employers with a high level of female employees. Another motivating factor is the right to have fully paid time off every day in order to breastfeed – 2 hours daily for someone who is in full time employment and 1 hour for those in part time employment.
I think policy initiatives like those above are very important in facilitating circumstances conducive for breastfeeding, but I also think that these will have limited impact without a change in society with regard to attitudes as well as practical arrangement for breastfeeding. Maybe more than anything, the attitudes towards breastfeeding women must change in society and it must become socially valuable as well as acceptable to breastfeed children both at home and in public.
When I say ‘in public’ though, I don’t mean in a demonstrative way like I have seen examples of in British media in the recent years. Thinking back, I have seen two programmes on British television with a focus on women advocating breastfeeding. The problem is – both of these programmes demonstrated such extreme views and practices that frankly I think they must have had the opposite effect than was intended. One of the programmes focused on extended breastfeeding and featured mothers discussing their decision to continue breastfeeding as long as their children wanted it – in one case the child was 8 years old and still being breastfed occasionally. Another programme followed a group of women apparently campaigning to gain support for breastfeeding by displaying what could only be described as provocative behaviour, such as breastfeeding at the same time as loading the shopping and paying at the checkout in a supermarket.
Considering that breastfeeding requires a higher level of social acceptability in order for more women to pursue it, I think programmes like these damage the cause rather than support it, but regrettably this style of provocative media coverage seem to be what we – the public – want, as it certainly seems to be what sells.
During my entire life in a breastfeeding friendly society, I have never seen any behaviour of that kind, and believe that it is easily possible to breastfeed children without being offensive to others. Of course it would help if public places provided suitable facilities for mothers to breastfeed in more private surroundings, and hopefully this is something we will see more of in the years to come.
I hope that the combination of changes in policy AND social attitudes will motivate mothers to feel more able to offer what is considered worldwide to be the best start to a child’s life.
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