Women who struggle to continue breastfeeding often blame themselves and feel a sense of failure. However, current research suggests that it is society who has failed to support them. For decades, the public health message has been made abundantly clear, the literature is indisputable and opinion is unequivocal: ‘Breast is best’. But with breastfeeding rates in Australia falling well short of both international and local recommendations when it comes to duration, it leaves us to question what we are doing so differently. We explore some of the reasons why Australian babies hit the bottle so soon after birth and examine what we can give breastfeeding women in order to support them through a longer breastfeeding relationship with their babies.
The World Health Organisation recommends exclusive breastfeeding to six months, at which age suitable complimentary foods may be introduced with continued breastfeeding until two years and beyond. The WHO’s breastfeeding code highlights the disparity amongst OECD nation’s current breastfeeding practices and raises many questions about our dramatically low breastfeeding duration rates, as one of the most educated and affluent nations in the world. 98% of Australian mothers initiate breastfeeding, however breastfeeding rates fall dramatically within the first three months post-partum. By 5 months of age, only 15% of babies are exclusively breastfed and by 18 months only 9% are receiving any breastmilk at all.
In popular culture of late, there has been an attempt to shift thinking from ‘breast is best’ to ‘breastfeeding as a physiological norm’. This may be a nuance to some, however the difference carries an overwhelming weight because the physiological norm is what breastfeeeding is, though it appears we fail to realise this in our current cultural paradigm. Despite popular attitudes, there is no denying that we are anatomically and physiologically designed to nurture our young and propagate our species through nothing other than the milk we produce without effort, like every other incredibly well-orchestrated process that occurs in our bodies on a daily basis. It appears that Australian women are cutting their breastfeeding relationships short, despite understanding on some level how this may jeopardise their own health and the health of their children.
It’s virtually impossible to ignore an overarching issue when it comes to breastfeeding in the OECD world: we have created meaning for breasts, far beyond the purpose for which they were intended. Research implicates a woman’s lack of confidence in herself as a major issue in premature breastfeeding cessation Meedya, S, Fahy, K & Kable, A. Factors that positively influence breastfeeding duration to 6 months: a literature review’. 2010. Women and Birth, 23: 4, 135-145. One simply must question how popular media and advertising’s portrayal of the breast reverberates so hauntingly in a woman’s belief in her ability to nurture her own infant. Support from the birth mother’s partner is crucial Forster DA, McLachlan HL & Lumley J. Factors associated with breastfeeding at six months postpartum in a group of Australian women. Int Breastfeeding Journ. 2006. 2996; 1, however in our misogynistic popular culture, we need to question whether our message around breasts sets a fledgling father up for failure.
Other major reasons for early cessation of breastfeeding include a perceived lack of milk supply, age, parity, education, non-partner support, socio-economic status, return to work and post-natal depression. With the exception of post-natal depression, the question must be asked whether these factors could be overcome, or assisted in some part, by access to education for the breastfeeding mother. Attempts to educate new and prospective parents about breastfeeding is futile, however, if they are misunderstood and undermined by wider society.
Antenatal education for breastfeeding is minimal. Most public hospitals run a basic introduction, however birth in a private hospital requires parents to be out of pocket by sometimes hundreds of dollars in order to attend breastfeeding education classes. Schools generally do not include education specifically about breastfeeding in their curriculum at least until upper school sex-education and even so, it is minimal. The Australian Breastfeeding Association is a volunteer organisation which staffs a 24 hour mother-to-mother support hotline to assist mothers with all aspects of breastfeeding and does an incredible job of supporting mothers through many circumstances. However, they receive limited funding and rely on donations from the public in order to continue their support. Lactation consultants are highly specialised allied health staff who practice in breastfeeding physiology. Many public hospitals have them on staff, however they are few and far between and establishing breastfeeding often requires many hours of one on one support in order to be effective. Postnatally, many mothers must face out of pocket expenses to pay a private lactation consultant should they encounter problems with breastfeeding, which for a natural process, occurs far more often than new mothers sometimes realise.
There have been many campaigns in the media of late to help normalise breastfeeding in the belief that sharing images of women breastfeeding as well as encouraging women to breastfeed in public will boost the number of women breastfeeding their babies and for longer periods. Campaigners believe that getting women in the public domain, being seen breastfeeding their babies, will allow us to reattach our infant feeding ideals back to the breast and thus be better able to support breastfeeding mothers as a society. These campaigns are an excellent way to put breastfeeding on the social map, however images of women breastfeeding must compete with the sexualised images of women that saturate our media, in order to reset the message.
Despite the evidence pointing to education and support as the major factors in breastfeeding continuation, there is a large gap in the resources available to Australian women. Educating the breastfeeding woman is only as efficacious as the strategies we use to educate those around her. Breastfeeding awareness will ultimately lead to its normalisation and needs to start at a young age in order to make breastfeeding the conventional way of feeding our young. In order for breastfeeding to be normalised, we must collectively educate and be educated about the importance and biological significance of breastfeeding so that breasts can be realised for their biological purpose.
As nutrition professionals, it is imperative that we have the most recent evidence based knowledge relating to breastfeeding, so that we can support and educate individuals and the wider public. Further information about breastfeeding education for the health professional can be found at the Australian Breastfeeding Association’s website.
References [ + ]
|1.||⇪||Meedya, S, Fahy, K & Kable, A. Factors that positively influence breastfeeding duration to 6 months: a literature review’. 2010. Women and Birth, 23: 4, 135-145|
|2.||⇪||Forster DA, McLachlan HL & Lumley J. Factors associated with breastfeeding at six months postpartum in a group of Australian women. Int Breastfeeding Journ. 2006. 2996; 1|