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Breastfeeding: personal or political?

Mothers feed their babies during a breastfeeding campaign in Indonesia. Pic: REUTERS/Dwi Oblo

Mothers feed their babies during a breastfeeding campaign in Indonesia. Pic: REUTERS/Dwi Oblo

Published Oct 18, 2012


London - About 10,000 fewer young children a year would require hospital treatment if more women breastfed their babies, a charity says. Increased breastfeeding would save the NHS £40m, it is claimed.

Breast milk gives babies the best start in life, boosting their immune systems and providing protection from infections, but many women give up after a few weeks because they are not getting the support they need. The UK has one of the lowest breastfeeding rates in the world in terms of duration. More than four out of five women start breastfeeding but fewer than half are still doing so at six weeks, according to Unicef UK.

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Calculations based on five illnesses show that increased breastfeeding could have a dramatic impact on the nation's health.

Breast milk is thought to provide protection against over 50 illnesses in baby and adulthood. No other foodstuff can ward off gastroenteritis, respiratory illness and ear infections - to name but three - to the same degree.

But babies are getting too little of it for too short a time. Six months is the recommended length of breastfeeding but only 25 percent of babies are still breastfed by that milestone.

Although more than 80 percent of mothers start breastfeeding the figure drops to 48 percent at six weeks.

The Unicef report suggests that if the level at six weeks could be maintained for a longer period of four months - a threefold increase which the report describes as “moderate”- there would be over 3,000 fewer hospital admissions of babies with gastroenteritis and almost 6,000 fewer admissions with respiratory illness.

In addition, there would be over 50,000 fewer GP consultations. Mothers would also protect themselves, as breastfeeding reduces the risk of breast cancer.

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Anita Tiessen, deputy director of Unicef UK, said: “We know that 90 percent of women who stop breastfeeding in the first six weeks discontinued before they had wanted to. As a society we are failing mothers and babies. Low breastfeeding rates in the UK are costing the NHS millions of pounds each year as well as causing untold distress and suffering for families.”

Campaigns to boost breastfeeding have lifted the proportion of mothers who start. But figures to be released soon are expected to show no significant increase in the numbers continuing to breastfeed beyond the early weeks since the last survey in 2005.

The report says care is patchy across the NHS and a lack of support means many breastfeeding mothers give up when they encounter problems instead of persevering.

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Tiessen said: “We want to see breastfeeding recognised as a major public health issue from government level through to local children's centres, and appropriate investment and legislation put in place to give mothers a better experience. The good news is that our research shows money invested to help women breastfeed for longer would provide a rapid financial return.”

Professor Mike Kelly, director of the Centre for Public Health Excellence at NICE, said breastfeeding offered an opportunity to tackle two of the NHS's most pressing challenges - reducing health inequalities and saving cash.

“In a nutshell, it promises to do both,” he said. “The idea is simplicity itself.”

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Sue Ashmore, Unicef UK baby friendly director, said a change of approach was needed to remove barriers to breastfeeding with greater support for mothers.

“We want breastfeeding to become unremarkable, something that we see mothers doing all around us every day, so that breastfeeding skills are passed on socially,” she said.

Rosie Dodds, from the National Childbirth Trust, said: “We support all parents however they feed their baby. However, nine out of 10 mothers who stop breastfeeding in the first six weeks stop before they wanted to.” - The Independent


With good support I breastfed for 13 months

Charlotte Harvey, mother of Malachi, 3, and Elijah, 11 months

Malachi was delivered by emergency caesarean section at 35 weeks and taken to the intensive care unit where he was fed infant formula through a tube into his stomach. I was put on a ward with him after 24 hours and soon after put him to the breast.

Unfortunately every three hours a different midwife or nurse would come and tell me to attach [him] a different way in a different position.This ended with me and the baby becoming very distressed.

We could see that Malachi was tongue tied [a birth defect in which a tight piece of skin under the tongue holds it to the floor of the mouth] but were repeatedly told it would not affect breast feeding. However, he couldn't latch on.

It was only after we were discharged that the health visitor referred us to have the tongue tie snipped. She provided lots of support and advice and I successfully breast fed for 13 months.

When Elijah arrived the midwives were lovely but gave no breastfeeding support at all, assuming I would just get on with it being a second timer. It's amazing how rusty I was.

After about 10 days, breastfeeding wasn't getting any more comfortable and I was very sore. Eventually Elijah had the [same] separating procedure done, though he was not as badly affected as Malachi. The health visitor continued to provide support until breast feeding him became second nature again and pain free. -The Independent



It's long been a tendency in British policy-making to suggest that mothers' decisions over how they feed their babies are the cause of wider social problems. That, the argument goes, means that intervention is justified to serve a social good - in this case, to save taxpayers' money. More serious factors like class, education and housing provision get pushed out of the picture. And feminists won't be surprised to see in this report another way of blaming women for these inequalities.

No one would argue with the need to support parents as they decide how to feed their babies. But Unicef is confusing support with advocacy: instead of helping mothers make good decisions (for them), it is blaming them for making the wrong ones (for the taxpayer).

And yet the evidence for that blame is not as solid as the report would have us believe. Breastfeeding is unequivocally promoted here as a route to better health. But numerous scholars have recently shown that, in contrast with the certainty which associates formula feeding with health problems, in many areas the evidence is varied and highly inconclusive.

Breastfeeding does protect infants against infections, but the benefits tend to be overplayed in the advocacy literature, which routinely conflates correlation with causation. Most of the time, health problems result from a combination of factors.

Even if it were true that breastfeeding were a panacea for babies, the argument that follows would be troubling. The logic, after all, is that the job of parents in raising their children is to save the NHS money. But that's a formulation that will only worsen an already tricky relationship between those who do and don't breastfeed. The same could be said for the relationship it suggests between parents (tax takers) and everyone else (tax payers).

Not only is this a reductive way of understanding parenting, it also shows how far some academics and policy makers have drifted from representing the women they are supposedly helping. Women make decisions on infant feeding according to a huge range of factors. Work, other children, and access to all sorts of “capital” affect these decisions, and this child-centred approach suggests that those things don't matter. After all, breast-feeding might seem like a “free” intervention - but that's only true if a woman's time is worth nothing.

And so, even if this report manages to represent those who don't breastfeed as “insufficiently supported” - rather than selfish or ignorant, as they've been portrayed in the past - a stigma remains. Sadly, one-sided accounts of the benefits of breastfeeding create unnecessary anxiety in mothers. In the real world, 98 percent of women don't breastfeed their babies as the report suggests. But the mind-boggling statistics it contains will only leave them feeling that they have put their child's health at risk.

To read the report, you'd think breastfeeding isn't adequately promoted. But we spend about £6m a year on it - £7 a child. How else might that money be spent? Well, we could start by recognising that this is a personal decision, and that how women feed babies is about more than statistics, financial gain or health outcomes. Mothers do need support, but it should be woman-centred, not hectoring. - The Independent

* Dr Charlotte Faircloth is a Leverhulme Trust research fellow in the Centre for Parenting Culture Studies at the University of Kent

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