E-NEWS ARTICLE: Why Social Workers Need To Care About Breastfeeding

By: Rebecca McCloskey, MSW, LCSW

(Editor’s Note: August was Breastfeeding Awareness Month. This article is being published exclusively in the Social Work E-News September 2012 edition

and on The New Social Worker Online Web site.)

Recently, there has been a resurgence of news stories that pass judgment on mothering and parenting styles, fueled by the controversial TIME magazine article on attachment parenting (which shows a 3-year-old breastfeeding on its cover) and an upcoming reality show that focuses on "extreme parenting," where so-called extended breastfeeding is being profiled (and likely exploited and labeled as radical and abnormal). Additionally, you may have heard NYC Governor Michael Bloomberg come under sharp criticism for his “Latch On NYC” initiative, to support mothers who choose to breastfeed and limit practices that interfere with that choice (including putting limits on the promotion and distribution of infant formula in hospitals). This kind of media sensationalism, while bringing needed attention to important topics like breastfeeding, also fosters a divide between mothers, promotes judgment rather than understanding, and omits important facts about the real issues, all in the favor of increasing viewership and profits.

So, what are some of the real issues at stake here in regard to breastfeeding, and why is it important for social workers to understand them to best advocate for and with mothers and babies?

Let’s start with the fact that experts (i.e., the World Health Organization (WHO), American Academy of Pediatrics, United Nations Children’s Fund (UNICEF), and others) recommend breastfeeding for at least two years, with exclusive breastfeeding (no cereal, juice, or other foods) until six months of age. And, if for some reason a mother’s own breast milk isn’t available, the World Health Organization says the next best option is another healthy woman’s breast milk, not formula! This is because human milk is the biologically “normal” food for babies and children, and there are negative consequences to not receiving human breast milk.

Numerous human rights documents ensure the health and well-being of mothers and babies, including the Constitution of the World Health Organization, the Universal Declaration of Human Rights, the International Convention on Economic, Social, and Cultural Rights, the Convention on the Rights of the Child, and the Convention on the Elimination of All Forms of Discrimination Against Women. These documents promise the highest available standard of health and well-being, appropriate services during pregnancy, birth, the post-natal period, adequate and nutritious food, maternity leave, provisions for the reduction of infant, child, and maternal mortality rates, and access to information and support related to breastfeeding. Of course, it is interesting to note that the United States has not ratified many of these documents, demonstrating its lack of respect and attention to the proper care of mothers and children in our country.

Sadly, despite the vast knowledge that breastfeeding is the natural and normal way to feed an infant; provides a unique and strong physical, biological, and emotional foundation for childhood development; and is the best for the health of children and their mothers, many women do not reach their breastfeeding goals. According to a study published in the July issue of Pediatrics, greater than 85% of mothers intend to breastfeed for three months or more, but only about 32% actually do so. And 15% of mothers stop breastfeeding by the time they are discharged from the hospital. We also know that mothers who are married, have given birth to other children, and who are white are more likely to reach their breastfeeding goals.

Some reasons women do not reach their breastfeeding goals are lack of familial and institutional support. Most mothers do not receive the educational and practical support that is often required to breastfeed successfully. Many routine hospital interventions also have a side effect of negatively interfering with breastfeeding. Some of these include the induction of labor, C-sections, and use of formula supplementation and pacifier use during the hospital stay. Additionally, lactation consultants may not be easily available or accessible by most women in hospitals, and most nurses and physicians do not receive adequate education and training on how to support women in learning to breastfeed.

There are often more obstacles to breastfeeding once a mother returns home with her baby. The United States is the only country in the industrialized world without a national paid maternity leave policy. Many women have to return to work before their milk supply is fully established, and while mothers can take breaks to nurse or pump, employers are not required to pay them for this time.  Most women are often not supported to nurse their children in public. In addition, the United States has not implemented any of the provisions from the International Code of Marketing of Breast-Milk Substitutes into law, health policy established by the WHO to protect mothers from commercial efforts to sabotage breastfeeding (through regulating the promotion of bottles, teats, and breastmilk substitutes (i.e., formula) and to encourage the transmission of accurate information on breastfeeding. For these reasons, and related others, the Save the Children’s 2012 State of the World’s Mothers report ranked the United States last in breastfeeding policy and support in the world. Thus, women are not to blame for not reaching their breastfeeding goals; our broken system is.

Mayor Bloomberg’s “Latch on NYC” is one recent initiative that attempts to level the playing field a bit for mothers by reducing the advertising, promotional materials, and pressure to supplement with formula, unless medically indicated. Mothers can still use formula, if they request it, but it is not given out routinely. This is based on studies that show that mothers who leave the hospital with formula samples (even if breastfeeding) are less likely to reach their breastfeeding goals, than those who do not receive the samples and promotional materials. Simply speaking, formula campaigns undermine mothers who choose to breastfeed.

In addition to breastfeeding being a matter of human rights and personal choice, it is a public health issue. Numerous studies have documented the risks of not breastfeeding to both mother and baby. For example, breast, ovarian, uterine, and endometrial cancer risks are higher for women who do not breastfeed. Formula-fed infants and toddlers have higher rates of cancer, obesity, diarrhea, IBD, ear infections, respiratory infections, allergies, asthma, reflux, and even death (among other things). Tragically, our society does not provide enough support to mothers and their efforts and desire to breastfeed. This needs to change.

Our families, our communities, and our global health requires social workers’ attention to maternal/child health and breastfeeding outcomes in the United States. In fact, the 2011 Surgeon General’s Call to Action to Support Breastfeeding specifically names social workers as professionals who care for women and children and who, therefore, should receive adequate education and training in breastfeeding to support mothers and their families. Here are some ways you can get involved to make that happen.

·         Learn about and join coalitions that support the Mother-Friendly Childbirth and Baby Friendly Hospital Initiatives.

o    The Mother-Friendly Childbirth Initiative (MFCI), http://www.motherfriendly.org/, created by the Coalition for Improving Maternity Services, outlines ten evidence-based steps for hospitals, birth centers, and home-birth programs to improve birth outcomes, reduce costs, and supports women’s self empowerment in making informed choices for themselves and their babies during pregnancy, birth, the post-partum period and in breastfeeding.

o    The Baby-Friendly Hospital Initiative (http://www.babyfriendlyusa.org/), which is supported by the MFCI, outlines ten steps developed by the WHO and UNICEF to promote successful breastfeeding. See if your local hospital has been designated as “Baby Friendly” and write to your medical providers asking them to join this initiative. Only about 2% of hospitals in the country are certified as “Baby Friendly.”

·         Ask your local hospital to “Ban the Bags.” Ban the Bags (www.banthebags.org) is a national campaign to stop the promotion and marketing of formula to hospitals. Hospitals can make a pledge to ban the free formula samples and gift bags. So far, all hospitals in Rhode Island and Massachusetts have voluntarily eliminated formula company bags routinely given to mothers at discharge.

·         You can “like” these organizations’ Facebook pages and/or sign up for their news and action alerts, as they’ve made a commitment to improving maternal/child health outcomes and breastfeeding rates and support programs: Save the Children, US Breastfeeding Committee, Birth Network National, ImprovingBirth.org, La Leche League International, UNICEF, WHO.

·         The House Appropriations Subcommittee on Agriculture, Rural Development, FDA, and Related Agencies passed a fiscal year 2013 bill that would cut all funding for Women, Infants, and Children (WIC) breastfeeding peer counselors. Follow this link to tell your representatives that breastfeeding peer counselors are needed for individual and public health, and especially for those in lower socioeconomic brackets: http://org2.democracyinaction.org/o/5162/p/dia/action/public/?action_KEY=10969

·         Show support for the Affordable Care Act which includes increased support for breastfeeding, including requiring employers to give mothers reasonable break-time to express breast milk, increased coverage for preventative services, including breastfeeding support, and strategies to increase the number of Baby-Friendly Hospitals, and policies to support breastfeeding.

·         Ask President Obama and the United States Congress to adopt The International Code of Marketing Breast-Milk Substitutes as law. Most countries have adopted all or at least some of the code as law and we know that formula companies’ marketing strategies impact breastfeeding success.

·         Lastly, we are in an election year. Many polls show us that the race is tight and every vote counts. Do your research about the presidential candidates and where they stand on these issues. Consider the links between them and powerful vested interests, like formula and insurance companies that ultimately impact the care and support that mothers and babies receive. Do these things for your family, for those families you work with, and for the public health and well-being of our community.

Rebecca McCloskey, MSW, LCSW, is a Specialist Professor at Monmouth University. She received her bachelor's degree in psychology from Seton Hall University and her master's degree in social work from The Ohio State University. She is a volunteer administrator for Human Milk for Human Babies, New Jersey. Her areas of practice and activism include maternal and child health, informed consent and the rights of mothers and children related to childbirth and breastfeeding, community building through breast milk sharing, early intervention/developmental concerns of children aged 0-3 years, and chronic/life-threatening illness in children/adolescents.