Breast Practices, revisited

[This is an expanded version of an earlier post. It was kicking around unpublished and unloved, so thought I might as well post it.]

Some weeks back Amanda Watson made an impassioned plea in the Ottawa Citizen against the Ontario government’s decision to promote of breastfeeding as the most effective way for a mother to feed her child. Watson argues that there is no scientific consensus in support of what she terms the “myth” that breastfeeding constitutes the best way to feed children.

However, health authorities around the world have concluded just the opposite: while there are studies that question some of these findings, the preponderance of evidence points to breastfeeding as the best way to feed infants. As Watson herself points out, in undertaking this campaign Ontario joins a host of other government agencies: Health Canada, the United States’ National Institutes of Health, The United Kingdom’s National Health Service, Germany’s Ministry for Health, UNICEF, the World Health Organization… the list goes on, each one adopting a stance similar to Ontario’s.

To clarify why such support cannot be so lightly dismissed, it may be helpful to recall a key adage of politics (and we are talking politics here): follow the money. Assume for a moment that these health agencies are wrong, that there is no robust scientific evidence in support of breastfeeding. Why would they all claim that there was, and use that claim to push the same wrong-headed policy? The most likely explanation would be the presence of an effective and well-funded pro-breastfeeding lobby campaign: governments under the sway of Big Breast, as it were. Basically, someone would have to be making a buck off breastfeeding.

In reality, of course, it’s just the opposite. Formula is a multi-billion dollar industry, whereas aside from a few pillow and pump makers, no one makes a dime off of breast milk. Accordingly, the recommendation to breastfeed comes in spite of, not because of, industry lobbying. Agency heads in country after country believe that it helps them fulfill their mandate: ensuring a healthier population. If anything, the question to ask is why the Ontario government took so long to announce a program like this, given how many other places already have something similar in place.

Having said all that, I hasten to add that children who are bottle-fed generally end up fine too, so long as parents have access to necessities like clean drinking water (a key caveat). While my wife breastfeeds our young son, I was bottle-fed, and I turned out all right. I’m told I’m nice enough, and good fun at parties. Well, I was before I became a young parent. Now I’m usually in bed before the party starts.

One can hold the position that breastfeeding carries distinct advantages, without also holding the position that bottle-feeding is inherently wrong in all situations. In some cases, it’s exactly right.

Some of the greatest collateral damage from the so-called Mommy Wars has resulted from the stigmatization of anything other than a “best” parenting technique. The damage is all the more widespread given that conceptions of best practice vary over time, and across jurisdictions and cultures. Moreover, the level of vitriol in such debate is often out of all proportion with the actual difference in outcomes resulting from various parenting choices. As in many things perspective remains as important as it is elusive.

In the case of infant feeding, some mothers simply don’t want to nurse. Others can’t. Their kids will still turn out all right, again assuming things like access to clean water. On issues like this, parents should be free to make such choices from a position of knowledge and support, but also tolerance.

Any campaign of the sort Ontario is now undertaking should have three basic goals:

First, give new and expectant mothers and fathers the best information available regarding the different feeding options available to them. Clarify what we know, and where the evidence remains inconclusive. In the case of breast feeding, we know that there are a variety of benefits, both nutritional and otherwise for both child and nursing mother; we also know that formula is another viable option, assuming the presence of certain requisites like purified water, even if it doesn’t provide all the same benefits as breast milk.

Second, provide parents with the resources needed to follow through on their informed choices. For all the talk of breastfeeding as the natural choice, nursing is a skill, and (so I’m told) often a tricky one at that. Many women give up on it, not for lack of knowledge or desire, but simply out of frustration or (much worse) the fear that their baby isn’t gaining weight quickly enough while mother and infant work together to first learn and eventually master the process.

In the days and months following the birth of our young son, we—admittedly, I’m using that word somewhat loosely here—worked with a fantastic lactation consultant at Vancouver Women’s Hospital’s breastfeeding outpatient clinic, a service the hospital provides free of charge without referral. Nurses at the hospital and community centre drop-ins were knowledgeable and supportive as well. That kind of accessible institutional support was incredibly important to our young family, and is vital to the success of a state-led breastfeeding campaign.

Other kinds of resources are important, too. Watson in her article quite rightly brings up the issue of mothers in conditions of working poverty. It’s a serious problem in Canada, bigger than many of us realize. However, for me the solution is not to push mothers towards more work-friendly parenting choices, particularly relatively expensive ones like formula feeding.

In my view, the right approach is to provide better financial and social support for young mothers both in and out of the workplace, to enable them to make the choices they are most comfortable with. Family allowances, progressive federal and provincial support for maternity leave, publicly funded daycare… these are the kinds of programs that help keep young mothers and their children out of poverty.

Finally, ensure the acknowledgement of, and support for, diverse parental choices.  Any government health campaign to some extent renders public what were previously solely private life choices. Whenever that happens, caution ought to be a guiding principle. In the case of infant nutrition, once parents have been informed of the options and resources available, they should be free to choose the path that best suites their particular circumstances, so long as their choices don’t endanger the child.

Parenting is hard enough without dealing with stigmatization from those who would do some things differently—a group that, as new mothers and fathers quickly learn, includes just about everyone.

photo credit: detail from genibee via photopin cc

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