Thursday, June 15, 2006

Guilt about breastfeeding: Who should be experiencing it?

Recent articles (Breast-feed or Else, NYTimes 13 June 2006) and news coverage (NBC 14 June 2006) have been emphasizing the guilt “imposed” on women who choose not to breastfeed. Where is this coming from, and why, when guilt is slathered on if obese persons don’t exercise and diet, or if women smoke or drink during pregnancy, is the issue considered so negative only in the breastfeeding arena?

While the Center is preparing an academic article on this subject, please allow me to share some preliminary thoughts.

Lack of breastfeeding, especially early and exclusive breastfeeding, in the US is associated with excess disease and mortality. Indeed, there should be feelings of guilt that we are allowing excess disease and death in the United States, when we know how to avoid it. So wherefore do we always hear the cry against “guilt”? No doubt, this is a huge issue, but it is also misused to a great extent in discussions about breastfeeding support.

Guilt occurs when you do something you know you should not, or when you do not do something that you know you should. Guilt is a major motivator to do the right thing.

Concerning breastfeeding, however, it is not mother who should be experiencing the guilt, but rather the guilt should be experienced by a mix of health care systems, third party payers, workplace and society that makes it nearly impossible for a mother to succeed in breastfeeding: we have virtually no guarantee of paid maternity leave for most workers, professional lactation consultant services are rarely covered by health insurance, and we are bombarded with slick ads for the ease, perfection, and father-friendliness of commercial formulas.

As to fear of making women feel guilty by telling them that breastfeeding is normal and protects them and their babies against disease – what is the alternative? Should we deny new mothers correct health information and guidance?

My congratulations to every mother in the United States who succeeds with doing the best thing for her child by early and exclusive breastfeeding! She is beating the odds. And my support, respect, and encouragement for women who attempt to breastfeed, but who are beaten down by the constraints and obstacles that our society sets out for her. She should not feel guilty, but rather should feel proud of her efforts.

Fostering the idea that supporting breastfeeding is bad because it makes women feel guilty is blaming the victim, and then denying her solace. Instead, our society, our legislators, our workplace standard-makers, and our health system should be the bearers of the guilt in this case. Rather than a guilty mother, we should have a supported mother, and if not supported, than these other entities should be the guilty ones.

The answer is to truly support and enable every woman to succeed with the feeding approach that is best for her and for her child. With social, workplace and health-worker skilled support, for most, this will be to exclusively breastfeed. Unfortunately, in the United States today, societal realities still make it necessary to take on the short and long term health risks and therefore, to not breastfeed, or only partially breastfeed. In every case, complete and accurate information and support is every mother’s right, so that she may reach her decision free of guilt and free of commercial bias, and enabled by her workplace and society.

Action is needed at every level of our society, if we truly wish to enable each woman to make an informed choice and then to succeed with that choice. The following areas of action were just reconfirmed by the 59th World Health Assembly (WHA59.21, Agenda item 11.8 27, May 2006, “Infant and young child nutrition 2006”) at the World Health Organization, based on the 1990 and 2005 international Innocenti Declarations. The major actions called for worldwide equally apply to the United States, and include a call, with urgency, for:

  1. Renewed support for Baby-friendly Hospital Initiative, which requires all health workers in contact with mothers and babies to have at least basic training in breastfeeding support,
  2. Renewed support for the International Code of Marketing of Breast-milk Substitutes, which call for ethics in commercial marketing of infant formulas.
  3. Attention to maternity protection by the workplace, including paid leave and related support.
  4. Consideration of additional policy, law and regulations that would enable women to succeed in optimal feeding.

These documents also raise the issue of fostering societal and community support through social marketing, such as the US Campaign, and including breastfeeding skills and knowledge in the education of all health workers.

These actions are do-able, and would be a logical response on the part of our society to relieve itself of the guilt it should experiencing for creating obstacles to the best health choices for women and their infants.

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