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The Breastfeeding Battle
By Marielena Zuniga
After Yuriko Inukai of Japan* had her first child, she had a daily ritual. In the mornings, she expressed milk before going to her job as an IT engineer. At lunchtime, she would find the bathroom and hand express more milk, put it into a freezer bag and keep it in a portable freezer—which she had provided because her office didn’t have this kind of equipment. She would then take the milk home and give it the next day to the woman who was caring for the baby.
As the seasons changed and the temperature rose, Inukai’s portable freezer needed to work harder to keep cool, making louder noises. Her colleagues teased her but were patient, calling the freezer the “office beast.”
“Despite my freezer sounding like ‘the office beast,’ and in spite of time-consuming milk expression, I continued with breastfeeding because I never considered powdered milk an option,” Inukai says. “My milk always worked well for my children.”
Inukai was fortunate to have understanding coworkers and a sympathetic workplace. And, in Japan women are given breastfeeding breaks up to one hour per day until the baby is 1 year old.
Women in other countries aren’t so fortunate. While breast milk is touted as the best choice for infants—sharply reducing the rates of infection and possibly reducing the risk of many diseases later in life—breastfeeding in the workplace, especially in the United States, has become a two-class system. For most well-paid professionals, breastfeeding and the pumping it requires is a matter of choice. For women on the factory assembly line or in the military, pumping is almost impossible.
Robyn Roche Paull* of California knows. An aircraft mechanic in the U.S. Navy, she returned to work after six weeks of maternity leave, full of mothering hormones and breastfeeding zeal. Her job was dirty, greasy and in a male-dominated environment with long hours.
“As the only female in my work area, I found no support for my need to pump and was often the brunt of jokes about expressed milk in the refrigerator,” she says. “While my co-workers took 10-minute smoke breaks every hour, I had to fight to take two 15-minute breaks twice a day for pumping.”
Breast is best
Until about 60 years ago, breastfeeding in the U.S. was a benign topic, the de facto choice for all new mothers. As more and more women entered the workplace, however, and with the introduction of infant formula, the popularity of breastfeeding began to decline in the mid-1940s to 1950s. By 1976, only 25 percent of newborns were being breastfed by the time they were discharged from hospitals.
In recent decades, however, breastfeeding has made a comeback, but not without controversy. The right to breastfeed in public and in the workplace, infant formula marketing, global declarations, national laws and “nurse-ins” have turned an otherwise natural, normal function into a “cause celebre.”
Although a few studies contend that breastfeeding doesn’t always contribute to better health of the child, the majority of experts and health organizations overwhelmingly believe that breast is best. The American Academy of Pediatrics in Illinois recommends exclusive breastfeeding of a child for the first six months for the protection it provides against acute infectious diseases—including meningitis, upper and lower respiratory infections, pneumonia, bowel infections, diarrhea and ear infections. Studies and the data show that breast-fed babies have 50 to 98 percent fewer infections than other babies. The health benefits extend to the nursing mother as well, including reduction in the risk of adult-onset diabetes, breast and ovarian cancers, and osteoporosis.
In developing countries, a child who is breastfed is almost three times more likely to survive infancy than a child who is not breastfed, according to the United Nations Children’s Fund (UNICEF). The World Health Organization (WHO) also recommends that mothers give babies only breast milk for the first six months, and then a combination of breast milk with other foods until age 2. The WHO estimates that 1.4 million babies die each year in poor countries because of low-breastfeeding rates.
“Breastfeeding is the first immunization for the child because human milk contains all these antibodies,” says Dr. Ruth Lawrence, professor of pediatrics and ob-gyn at the University of Rochester School of Medicine, New York <urmc.rochester.edu>. “Those antibodies protect an infant for the period the infant is not making its own antibodies … and there is very good data showing babies who are breastfed have a much lower risk of obesity because we tend to overfeed babies.”
Marsha Walker, R.N., international board certified lactation consultant (IBCLC), of Massachusetts, calls breastfeeding a “very elegant system” especially when the symbiotic relationship between the milk the mother makes and her baby is understood.
“Mother’s milk is specially made for that baby in that situation,” says Walker, the executive director of the National Alliance for Breastfeeding Advocacy (NABA), Research Education and Legal Branch <naba-breastfeeding.org>. “That mother is able to put antibodies into that milk that will protect her baby from most disease. You can’t buy immunization like that.”
Breastfeeding and beyond
If breastfeeding is so beneficial, why aren’t the numbers higher, not only in the U.S., but in other countries? Research shows that only a minority of new mothers breastfeed their babies for the full six months recommended by the WHO. The Philippines is one example of a trend across Asia, where only 35 percent of mothers breastfeed for the first six months.
In Japan, breastfeeding may continue for a year or longer, but many Japanese women are trapped between traditional values and customs and the “modern” concepts of working outside the home and formula bottle feeding. Women from Latin America and Mexico grow up in cultures where 80 percent of women breastfeed for four to six months. But when they immigrate to the United States, breastfeeding rates fall to about 48 percent.
The drop in U.S. breastfeeding rates was confirmed by a 2007 report from the Centers for Disease Control and Prevention in Atlanta. Although most women choose to initiate breastfeeding, only 30 percent of new mothers are feeding their babies breast milk exclusively three months after birth. At six months, only 11 percent are breastfeeding exclusively (no other liquids or solids except for drops, vitamins or medicines).
Despite women wanting to breastfeed, many can’t and don’t for a variety of reasons. For one, many women just don’t know how to do it, says Kay Lebbing, IBCLC, who has a private practice in the Chicago suburbs, and is a La Leche League International (LLLI) leader <llli.org>.
“It’s a myth that all women know how to breastfeed just like it’s a myth that all men know how to fix cars,” Lebbing says. “It’s not instinctive, but something that has to be taught. We would like women to be prepared before birth and La Leche League does have meetings that women can start attending when they’re pregnant.”
Expressing in the workplace
Economics, however, plays a larger role. Most women today work outside their homes and find gender inequity and a work environment that is usually not nursing friendly.
“The United States is only one of two developed countries in the world with no national maternity leave policy,” Walker says. “We wouldn’t have a lot of these issues, such as breastfeeding, if we were protected like the Scandinavian countries, because their government has made this a priority.”
A 2007 survey by the National Women’s Health Resource Center (NWHRC) and Medela, Inc., reveals that 32 percent of new mothers in the U.S. give up breastfeeding less than seven weeks after returning to work because of obstacles, including: no privacy; inflexible schedules; lack of refrigeration to store breast milk; and insufficient or lack of company policies to allow them to take an adequate number of breaks to pump.
Worldwide, women may face similar challenges, although some countries are doing better than others. In France, women with a baby under 12 months are entitled to two 30-minute breaks a day, while in Argentina and Bolivia, mothers also are given breastfeeding breaks.
Returning to work full time increases the likelihood that mothers will stop breastfeeding, although that didn’t stop Paull, the military aircraft mechanic. She had to face practical issues such as milk leaking on her uniform and eventually found a corner in a locker room with an outlet where she could pump. She continued to breastfeed her son exclusively until he was nine months old.
“I feel I did the best I could under the circumstances,” she says. “The military did not and still does not have a policy on breastfeeding.” Each branch of the military is responsible for its own breastfeeding policy.
A formula for controversy
What’s needed, advocates agree, is education of mothers, not only on how to breastfeed but how to make informed decisions. Some women choose to bottle feed for a variety of reasons, and many of them report they’re made to feel guilty about it. The “guilt” issue is one that lactation advocates know well.
“Guilt has been the excuse for not talking about breastfeeding for years,” Lawrence says. “The obstetrician would say, ‘I don’t want to talk to mothers about breastfeeding because I don’t want them to feel guilty.’ But every woman deserves to make an informed decision and she can’t do that unless she knows the facts. If she should choose formula feeding for whatever reasons she may have, then that is her informed decision.”
Every mother wants what’s best for her baby, says lactation consultant Kay Lebbing. Women giving birth in the 1940s and 1950s were told to switch to formula because no-truth-in-advertising laws existed then, she says. “Women could be told formula is better than your own breast milk because of that type of marketing, being told that’s what the modern woman does.”
To protect all mothers and babies from inappropriate marketing practices, the International Code of Marketing of Breast-Milk Substitutes was adopted by the World Health Assembly in 1981. While not banning the sale of breast milk substitutes, the code does address how they are marketed.
The WHO blames the decline of breastfeeding in many countries not just on advertising, but on other promotional tactics by formula manufacturers, such as giving free samples to health-care professionals. In June, the WHO called such aggressive marketing tactics “an alarming threat to child survival” and said that in many countries in the region, “the combination of weak public health systems, slick and expensive marketing of milk formula, and poor enforcement of marketing regulations have contributed to the decline of breastfeeding.”
“If you look at a country like Japan, unfortunately what we’re seeing is infant formula creeping into that country,” Walker says, “so we’re not seeing good breastfeeding rates there. And if you look at Mexico and South America, breastfeeding rates are high, but mothers are not exclusively breastfeeding but combining both [breast milk with other foods] because a lot of mothers have to work.”
The world community has taken other steps to ensure child survival through breastfeeding, including adoption by at least 30 governments of the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding in 1990 and the Baby-Friendly Hospital Initiative (BFHI) in 1991, supported by the WHO and UNICEF. One of the first baby-friendly hospitals, the Catholic University of Chili, Santiago, witnessed an increase in the initiation of breastfeeding within the first two hours, with exclusive breastfeeding increasing from 20 percent to more than 60 percent.
“These documents were put forth saying you could not promote formula to mothers newly delivered, because what’s happening is mothers are given free formula in hospitals,” says Lawrence, “and therefore they don’t develop their own milk supply. They go home and formula costs a day’s wages and often they have to mix it with contaminated water. In certain countries of the world, the death rate in the first year of life for babies not breastfed is 50 percent.”
The right to breastfeed
Nursing mothers are not sitting idly by. They are speaking up for their right to breastfeed in the workplace and in public. In the summer of 2007, 120 mothers with their babies converged on the lawn of the Capitol in Washington, DC, for a “nurse-in.” They wore T-shirts and held up signs that read: “I make milk. What’s your superpower?”
More demonstrations were held in September at 60 Applebee’s restaurants in at least 30 U.S. states after a manager asked a mother to cover herself with a blanket while she breastfed her 7-month-old son. The request, according to officials, was in violation of a Kentucky state law allowing women to breastfeed in any public or private location.
Breastfeeding in public can make some people cringe, but many advocates feel it boils down to this: People’s discomfort, at least in the U.S., with the breast. Yet, society seems to flaunt the breast in other ways without question, they counter.
“It is so ingrained in us from very early on that breasts are sexual objects and are only for a man,” Walker says. “Nobody blinks at some of these ads on TV or in women’s magazines … but you put a child at the breast and all of a sudden we’re kicked out of airplanes.”
Lebbing assures that most women do breastfeed discreetly and La Leche League teaches women ways to nurse the baby without drawing attention. As to breastfeeding “militancy,” she attributes it to media hype.
“Some women are just totally and completely fed up with this idea they cannot feed their baby anywhere they want,” she says. “Mothers have the right to breastfeed their babies anywhere. If the baby is hungry, the baby needs to eat.”
Making it a federal issue
Today, nursing mothers are garnering more and more clout. Recently, Sophie Currier, a Harvard student, was turned down by the National Board of Medical Examiners when she requested extra time to take her nine-hour medical licensing exam so she could pump breast milk for her 4-month-old daughter. A Massachusetts appeals court ruled that Currier must be allowed the extra time. In July 2007, Pennsylvania passed its Freedom to Breastfeed Act, exempting breastfeeding from its indecent exposure laws. And while breastfeeding in public is a right in all 50 U.S. states, many laws vary from state to state and are often confusing or inadequately enforced.
This prompted Representative Carolyn Maloney (D-NY) to make breastfeeding a federal issue. Maloney introduced the Breastfeeding Promotion Act of 2007 to encourage breastfeeding by working mothers. The bill also provides tax incentives for businesses that set up private areas where mothers can express their milk.
Such programs ultimately benefit a company’s bottom line, advocates say. Data from CIGNA’s Working Well Moms program revealed a savings of $240,000 annually in health care expenses for breastfeeding mothers and their children compared to their counterparts. An additional savings of $60,000 annually was realized through reduced absenteeism among breastfeeding mothers in the company.
“If women were given maternity leave and support to breastfeed, the employee herself is more productive, takes less time off from work to care for her baby and will have less absenteeism. In addition, the company will have less expenses in terms of substitute employees,” says Walker.
As breastfeeding mothers continue to confront a variety of issues, they also are making personal choices. For Paull, it was to pump breast milk in the workplace and breastfeed despite barriers, and she doesn’t regret a minute of it.
“I cherished every drop of milk that Morgan received,” she says. “He never had an ounce of formula during my time in the military. My son’s face would light up when I arrived after a long day of work and he would reach for my shirt, in a hurry to nurse. In this way, he thanked me, which made it all worthwhile.”
(*Personal stories in this article were adapted from the book, “Hirkani’s Daughters: Women Who Scale Modern Mountains to Combine Breastfeeding and Working,” by Jennifer Hicks, La Leche League International, Publisher.)
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