Impact Ethics by Martha Paynter 19 July 2018
This month we learned the United States tried to squash a World Health Assembly resolution to encourage breastfeeding. Why? As Dr. Alison Stuebe joked in the Breastfeeding Medicine blog, “Every time a baby goes to breast, the $70 billion baby food industry loses a sale.”
Apparently, Ecuador was slated to introduce the resolution, but when the United States threatened to withdraw trade and military aid, Ecuador stepped back. Only Russia had the power to bring the resolution forward, and tellingly, the United States made no threats against them. In the end, 18 countries, including Canada, backed the resolution, and it passed.
The United States’ actions horrified diplomats, journalists, clinicians, and parents. All were stunned that the United States would place the interests of formula manufacturers over the health and well-being of infants. This action is consistent with past practices, however. For example, the United States failed to support the 1981 International Code of Marketing of Breastmilk Substitutes, which has restricted advertising of formula for almost 40 years.
By dozens of metrics, the United States trails behind many other nations in maternal and infant health. It has the lowest paid maternity leave allowances and the highest rate of infant mortality among high-income countries. Only 79% of mothers initiate breastfeeding in the United States and only 18.8% are exclusively breastfeeding at six months, which is what the World Health Organization recommends.
The harms to women and children of not breastfeeding include obesity and chronic diseases such as diabetes and breast cancer. The United States has some of the highest rates of obesity and chronic disease in the world. Nineteen percent of all children are obese. Half of all adults have at least one chronic disease. One in eight women develop breast cancer. Globally, not breastfeeding is estimated to cost our economies $302 billion due to lower cognitive outcomes, increased childhood morbidity, and environmental waste associated with formula feeding.
How did the United States justify its opposition to the breastfeeding resolution? Promoting choice. A United States Department of Health and Human Services official claimed “women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”
We need to be critical of “choice.” Families rarely choose formula. Families are pushed into a corner. They lack access to prenatal education about breastfeeding skills, lactation consultants with clinical wisdom, and family and friends with enough experience and confidence to cheer them on through challenges. Almost every family initiates breastfeeding, and yet only two-thirds leave the hospital with the baby exclusively breastfed. The rates drop quickly after hospital discharge. Social stigma, isolation and exhaustion make it difficult for families to proudly, successfully and publicly feed their children human milk.
As a maternity nurse, I often hear well-meaning friends, family, or clinical staff tell new parents who are attempting to breastfeed “You don’t need to be a hero.” No, they don’t…but perhaps we do. We need to step up and make breastfeeding the focus of both postpartum care and postpartum life.
Early this July, the maternity hospital where I work was up for accreditation as a “Baby Friendly” Hospital, compliant with the UNICEF/World Health Organization’s Ten Steps to Successful Breastfeeding. The Ten Steps document includes recommended policies and procedures for supporting breastfeeding. As clinicians, we must strive to improve our support for breastfeeding by developing our knowledge, patience and skill and creating breastfeeding-friendly clinical environments.
As a public “stunned” by the United States opposition to encouraging breastfeeding, we should take a moment to examine our own actions. Do our public spaces, community organizations, and businesses welcome breastfeeding? Do we give new parents time and space to be physically skin to skin with their newborns for the first days, to establish breastfeeding? Breastfeeding is protected by Human Rights codes in Canada. Consider where you work: Is there a comfy chair and a conspicuous sign of a baby at breast? Do you have a policy all employees can easily find that assures them of their right to accommodation to breastfeed? If there is such a policy, is it enforced and upheld?
Residents of the United States would be wise to write their elected representatives and make clear their own horror at the administration’s approach.
That said, we all have work to do: breastfeeding is not a small thing. It is an incomparably valuable practice, for emotional, physical, and environmental health. It must be a bigger deal in our everyday lives. We can support the World Health Assembly’s resolution and make changes in our places of work and play so that families are surrounded by education, care, concern, encouragement, positive reinforcement, relief, and pride about breastfeeding.
Martha Paynter is a Ph.D. student in the School of Nursing at Dalhousie University and a Registered Postpartum Nurse at the IWK Health Centre.