The not-so-hidden price of breastfeeding

A recent study In the Journal of human lactation found that American women, by and large, were falling short of the goals of initiating and continuing breastfeeding set for them in the Healthy People 2010 project, a government initiative which attempts to define the methods through which good health can be enjoyed by Americans of all socioeconomic and ethnic groups, and spells out the means to achieve them. The idea was to have 75% of women initiate breastfeeding, have 50% of them still breastfeeding at 6 months (half of those exclusively), and 25% still nursing their infants at the age of one year.

Using data gathered by the CDC’s 2003 and 2004 National immunization surveys, they found that though nearly 71% of women started out breastfeeding their babies, this number dropped precipitously to 36.4% by 6 months (of which less than half – 15.5% – were breastfed exclusively), and only 17.7% were still nursing their babies at a year. In fact, the only demographic group which managed to meet all three of Healthy People 2010‘s breastfeeding goals were college-educated women. The young, unmarried, poor and less-schooled lagged behind. While it would be tempting to attribute the difference entirely to better knowledge of the benefits of breastfeeding in the educated group, the study notes that even lower-income women receiving help from the WIC program seem well-informed in that regard. The authors note in passing that

In addition, employment can be an obstacle to breastfeeding for low-income women, particularly if employed full-time

But it seems to me they consider this a minor factor, given the solutions they ultimately suggest to correct the low breastfeeding rates – as if a full-time working woman for minimal wage and rare bathroom breaks can, if only she had enough “support” (this being a term for being lectured to about the wonders of breastmilk by family, healthcare practitioners and social workers), breastfeed successfully for a year or more. In other word, the woman is expected to deal, pretty much alone, with the realities of combining long hours of physical work and feeding her baby. It’s not really surprising that many such women simply find the price too steep, and resort to using the almost-as-good Mommjuice replacement.

A well-educated woman (presumably married to an equally well-educated man) in a professional setting usually has the ability to take ample time for pumping breaks in a private office. She can also pony up the $200 or so it takes to buy an efficient breastpump. If she finds it all too much (and take from one who’s been there – she may very well do so!), she may be able to negotiate with her boss to get flextime, telecommute, or go whole hog (with the blessing of LLL) and quit, living on hubby’s salary. All of these are options not available to a young, single mom making minimum wage at the local burger joint.

“Support” in the form of providing moral encouragement and help regarding the mechanics of breastfeeding will only take you so far, US government. If you really want the US’s breastfeeding rates to approach Norway’s, you need to provide the social policy to match, meaning:

* Extended, universal, paid maternity leave (inclusive of health insurance benefits)
* A worker’s rights package that includes mandatory pumping breaks and provision of places to pump (perhaps even a hospital-grade pump that women can use when necessary)
* Security that no woman will stand to lose her job because she takes advantage of the above two.

You might also want to consider whether the Healthy People 2010 breastfeeding goals are really going to reap the expected health dividends as opposed to more modest goals and perhaps set your sights a wee bit lower, but that’s secondary, IMO.

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10 Responses

  1. I find it interesting how many people bring up the fact that less-educated/lower-income mothers don’t tend to breastfeed as frequently, but they don’t seem to blame in on the employment issue. Most everything I’ve read blames it on government programs (like WIC in the US) that provide formula for low-income families. Many women ignore the fact that just because businesses are legally required to let lactating moms take pumping breaks, doesn’t mean that it’s a good location or that the mom can even successfully pump in the first place.

    I like being able to breastfeed my daughter, but if I were to have a job, I think I would formula feed. I hate pumping, it’s time-consuming and inconvenient, and formula really is a good substitute regardless of what the lactofanatics (by the way, I love your word…) claim.

  2. if only she had enough “support” (this being a term for being lectured to about the wonders of breastmilk by family, healthcare practitioners and social workers),

    lol. Ain’t that the truth!

    If they want to improve the health of babies and children, how about providing free healthcare to everyone under 18 in the U.S. That would have a much, much bigger impact than breastfeeding.

  3. I have read that Paid parental leave – would cost approx 2% of GNP…. if not less.

    Wouldn’t the health of the next generation (the workers, of tomorrow) be something worthwhile investing in.

    Government policy defies logic on this one.

    Support NEEDS to include financial support, not just literature, and information. (Anyone can find great Breastfeeding and nursing books in a library) What they can’t find, is a way to stay home and nurse their children.

  4. In order to promote and support breastfeeding we’d have to become more like those godless, socialist Norwegians??! What would happen to baseball and apple pie?

    The US has a pretty aggressive advertising campaign for breastfeeding. It features some soulful singing by the now deceased Isaac Hayes. I always thought it odd that the Bush administration was so into this as they couldn’t care if kids can read, but now I see it as measures in lieu of a decent health care system.

  5. I would say you’d need paternity leave for just as long, otherwise women won’t be hired as often.

  6. Would the goal of achieving a higher rate of successful breastfeeding in the country be met if we ignored the percentage of those poor, single women who don’t have the resources to successfully breastfeed while working? I wouldn’t struggle to make breastfeeding happen if I were pulling 8 hour shifts as a grocery store clerk, and I don’t expect those women to, either.

    What percentage of new mothers with supportive husbands, the ability to stay home, the privilege of jobs conducive to pumping, or who aren’t otherwise struggling to make ends meet still aren’t breastfeeding for the first year?

    Advertising campaigns won’t magically fix the hardships faced by many mothers in or near poverty , but it may encourage or normalize the notion of breastfeeding. While mothers shouldn’t be guilt-tripped into breastfeeding, maybe making it look like a normal, shame-free way of feeding a baby will help increase the breastfeeding rate among those who are educated, middle-class, average moms.

    My point is that poverty isn’t the only reason new moms aren’t breastfeeding.

  7. RedOne – do you think the mothers who have the financial ability to breastfeed view breastfeeding as shameful or abnormal?

    The stated goal of Healthy people 2010 goes exactly against ignoring the percentage of women who can’t afford to breastfeed – they want to provide equal access to healthcare resources in order for good health to be enjoyed by all, regardless of socioeconomic status. For that to happen vis-a-vis BF, though, they need to acknowledge the financial toll and legislate appropriately – putting their money where their mouths are.

  8. I’m one of the people who bang on about “support” and I don’t mean lecturing (because, you know, that’s not very supportive). Breastfeeding support, at the hospital where I gave birth, meant that 2 of the midwives (who only worked weekdays, and had a normal patient load too) had extra training. However, that training pretty much only extended to getting the baby to latch on. If you had any problems beyond that–which I did–they were helpless. In many cases, they give bad advice (older British midwives and health visitors are convinced every woman is about to suffer low supply, then they give advice that achieves it–telling them to schedule feeds, saying that the baby is big so they can’t make enough milk, etc).

    American women like to bang on about maternity leave. It’s necessary, but not sufficient. If that were the only determinant, the UK (with 9 months paid leave, and no one goes back in 6 weeks unless they’re wealthy enough to hire a nanny–daycare simply won’t take babies that young) would have better breastfeeding rates than the US. It doesn’t. In fact, they’re worse. “Initiation” rates are meaningless–all they have to do is get you to latch on in recovery. Since most British women leave the hospital as quickly as possible, rates on discharge aren’t very meaningful either. When ANY problem develops, the answer is usually formula. Baby doesn’t sleep? Give them formula so they sleep longer.

    Support–or at the very minimum, making sure that when a woman asks a question, the answer is correct–matters a lot. I’ve seen people carp about “lactivist” IBCLCs in the US, but the standard of advice given seems to be substantially higher.

  9. “RedOne – do you think the mothers who have the financial ability to breastfeed view breastfeeding as shameful or abnormal?”

    Yes, I am surprised by the number of people that think it’s weird or gross that I’m still breastfeeding my kid who is only one year old. Even my sister thinks it’s gross that I b-f my son because he might have memories of it later. As someone much more educated than my sister, my OB even told me I needed to stop breastfeeding my year old baby when I became pregnant with my third child. (Weaning happened on its own before the baby came, anyway.)

    There are many people I hear from who are not comfortable breastfeeding in public because they think it’s weird. Face it, people who won’t breastfeed in public must either stay home a lot or use formula a lot. I know you’ve already visited the NIP topic; I just wanted to comment that I have talked with many women who are embarrassed or otherwise uncomfortable with nursing babies.

    “The stated goal of Healthy people 2010 goes exactly against ignoring the percentage of women who can’t afford to breastfeed – they want to provide equal access to healthcare resources in order for good health to be enjoyed by all, regardless of socioeconomic status. For that to happen vis-a-vis BF, though, they need to acknowledge the financial toll and legislate appropriately – putting their money where their mouths are.”

    I agree, but is it a lost cause? After all, formula is still food, not poison.

  10. Alexis – I agree that maternity leave alone isn’t much of a solution. But IMO having enough time to stay home, establish BF and, even more ideally, getting the baby to the solid food stage provides a basis for Healthy People 2010’s goals. Of course, BF problems should be addressed correctly and competently.

    RedOne – if you posit that BF is a more important health determniant than it actually may be, and that all babies should have equal access to their mother’s breastmilk, then you can’t just dump the problem of providing it in the women’s laps. I don’t happen to think that formula vs. breastmilk makes a huge difference in health outcomes, but the people who designed Healthy People 2010 obviously do.

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