The discourse around breastfeeding, both public and private tends to flit between two summations: “Mothers should breastfeed” and “Mothers shouldn’t feel guilty”. I’m guessing that regular Hoydenistas have spotted the framing problem already: “Mothers should”. (If you’re a mother, are your teeth grinding as much as mine are?) So how about everyone stop with the “mothers should” statements, and start in on everyone else?
So what do we, as a country, need to do in order to see more babies breastfed for longer? Off the top of my head: stop bombarding everyone with blanket advertising that shows artificial feeding to be both routine and ideal, reduce gratuitous birthing violence that compromises breastfeeding initiation, give women and babies enough time together to establish and sustain breastfeeding without penalising mothers in social, financial or career-progress terms, stop harassing and bullying women for feeding their babies, and stop charging them money for the privilege. Sounds simple? You’d think, wouldn’t you?
Well, apparently not.
The Australian Parliament House Standing Committee on Health and Ageing today released its “Inquiry into Breastfeeding” (dun-dun-dunnnnn!). I have the feeling there’s going to be a fair bit of “Yay, breastfeeding!” responses to this Report in the media and the blogosphere. Well, I’ll be your curmudgeon for this evening. We shouldn’t be contented with whatever crumbs are thrown our way, we should be implementing policies that protect and support real women in real ways, instead of feel-good motherhood statements and inane platitudes.
“The Best Start”, they called it, which was a bad start. One of the problems that has constantly dogged efforts to support breastfeeding has been the idea that breastfeeding is “best”, “ideal”, “optimum”. When you’re a parent, “best”, “ideal” and “optimum” equate to “impractical”, “unachievable”, and “not really necessary”. Most of us are shooting for “good enough”, aren’t we? The inquiry talks about the “health benefits of breastfeeding”, as though there are any. Yes, you heard me – breastfeeding doesn’t have any health benefits. Breastfeeding has health benefits only in the same way that eating food and breathing air have health benefits. Breastfeeding is normal. Breastfeeding is what mammals do.
The more we go on about how breastfeeding has “benefits”: the more we construct artificial feeding as the default, the norm to which other forms of feeding are compared. And the more we do that, the more we as a society can’t really be bothered supporting women and babies to breastfeed. Breastfeeding is something that those perfect mothers choose, and they can do it on their own time and on their own dime. When breastfeeding is “ideal”, that means that genuine breastfeeding support is going over and above the call of duty. An optional extra. A bonus.
Before you feel that you need to add “I really couldn’t breastfeed” stories – I get it. I really do. That bit up there – the bit about how we shouldn’t say “Mothers should” ever again – I really believe that. I’m not telling you that you should have done anything different, that you should have done anything different; I’m saying everyone else needs to. And I get that it hurts, it hurts a lot, which is something the artificial feeding industry will never admit to. And I get that a few women and babies really can’t breastfeed, in exactly the same way that some people can’t walk or can’t lift their arms above their head or have kidneys that don’t function. Fact is, it’s not me that doesn’t give a shit about you if you’re in this situation, it’s the rest of society. When your kidneys fail, it’s a medical drama. You get hundreds of thousands of dollars of medical care, there are Kidney Associations, there are research foundations and telethons, you get time off work and specialist appointments and medications and dialysis. When your breasts aren’t working quite as they should? “Here, have formula. Never mind dear, it’s just as good, you shouldn’t feel guilty. Yes, of course you have to pay for it. Specialist help? *snort* Why would you want that? Gosh, that sounds like too much trouble. Well, there is something called a lactation consultant. Oh no, you’ll have to pay out of pocket for lactation consultants, if you can find any in your area. Need a pump? Here, that’ll be five hundred dollars, plus GST. Pump subsidy or rebate? No, we don’t have those, it’s an optional extra, you could always use formula you know. Donor milk? Oh gosh no, that’s just for babies who actually need it. You need a few more weeks off work to get difficult breastfeeding working? That’ll be unpaid, thanks. It’s your choice, it’s not medically necessary. You feel sad that you can’t breastfeed? Why on earth would you? Formula’s great! And so convenient! Why are you crying? What are you, crazy?”
And before you ask, if you really feel you needed to ask on a feminist blog, I support women’s choices to breastfeed or not too. As with any other aspect of reproductive choice, these decisions are NOT made in a vacuum – I support _justice_, not just a nebulous ideal of uninfluenced, liberal “choice” politics. And much as I can support the choice to abort a pregnancy and still vehemently advocate for excellent prenatal, birthing and postnatal care for all women who want it, I can support the choice not to breastfeed while vehemently advocating for excellent, universal breastfeeding support.
I hope you can see where I’m coming from now. And maybe sometime I’ll share my personal story here, though that sometime isn’t right now.
So, the Report on the Inquiry into Breastfeeding. Overall? I found it disappointing. It’s weak, it’s flimsy, and it has giant gaping holes. There are statements of general support for the concept of breastfeeding, but very little in the way of recommendations for action. And the recommendations that are there are, on the whole, things that should have been implemented many years ago. Statements of the Bleeding Obvious (SotBO). I’ve picked out just a few. Bear in mind that these are just recommendations; given the aftermath of the Little Children are Sacred report, in which exactly zero of the recommendations have been implemented, I don’t even hold out much hope for the SotBO recommendations to be implemented.
* Abolition of the Goods and Services Tax on breast pumps and other equipment needed to manage breastfeeding complications:
Lactation aids such as manual and electric breast pumps, nipple shields and supply lines are input taxed under the Goods and Services Tax (GST). These products are used to assist infants who are not able to obtain milk directly from the breast. Some babies are unable to suckle, through separation, illness or disability, or even inexperience. However, breast milk substitutes such as infant formula are GST-free. This means that infant formula is effectively subsidised, rather than levied by the tax system, while breast milk production is taxed.
* Medicare provider numbers for IBCLCs (Internationally Board-Certified Lactation Consultants). There’s no detail on this recommendation, but it’s a welcome recognition for the role these providers play in assisting women with particular difficulty establishing breastfeeding, difficulty that goes beyond the scope of a midwife or ABA (Australian Breastfeeding Association) counsellor.
* Funding for the expansion of the Baby Friendly Hospital Initiative (BFHI) to all maternity hospitals nationwide. The BFHI is an international project promoting a high standards of maternity care in hospitals. Maternity hospital must meet ten steps in order to be accredited, which include such basics as a written breastfeeding policy, appropriately trained staff, early initiation of breastfeeding, information on the maintenance of lactation in separated mother-baby pairs, and no artificial teats for breastfed babies. Again, SotBOs, yet many hospitals don’t meet these most basic of criteria.
* Food labelling. Right now, despite the World Health Organisation Code on the Marketing of Breastmilk Substitutes, to which Australia is a signatory, baby food companies are permitted to label infant foods as suitable from four months of age. This report recommends that standards be aligned to the Guidelines, with complementary infant foods only labelled as suitable from six months and above. Baby food marketed as suitable for “4-6 months” is a breastmilk substitute, and this marketing is a clear breach of the WHO Code. These violations are occurring every day, by companies who claim to be supporting the Code. They are lying.
* Funding for pilot programmes and a feasibility study for a nationwide milk banking network. Donor breastmilk is essential for babies who cannot have access to mother’s milk, particularly very premature or ill babies in intensive care units. Since 1980, the WHO and UNICEF have supported donor breastmilk as the third choice for infant feeding, after mother’s milk direct from the breast, and expressed mother’s milk. Formula is the fourth choice. Yet milk banking programmes were only established in Australia in the past year or two, scattershot and without a nationwide framework of support.
* No publicly funded or private health insurance cover, subsidies, or rebates for breastfeeding and pumping equipment where required.
* No mandatory workplace accommodations of any kind. The inquiry merely supports, in hand-wavy tones, voluntary accreditation with the vaguest of minimum requirements. Oh, and “awards” for exemplary breastfeeding accommodation, which we all know is a bonus, not a basic part of civil society.
* Nothing whatsoever on reversing the unnecessary overmedicalisation of birth, only the BFHI which attempts to mop up the aftermath.
* Nothing on educating non-IBCLC healthcare workers (GPs, child health nurses) on supporting normal breastfeeding, on managing common breastfeeding problems, or on relactation. Relacation, you say? Yes, the majority of mothers who have weaned could be supported to relactate. When babies are admitted to hospital with severe respiratory or gastrointestinal infections, which are strongly associated with artificial feeding, all mothers should be offered relactation information and support. But this is the big taboo, this one. I’ll wager most doctors and nurses have never heard of such a thing.
* No funding for the Australian Breastfeeding Association. This amazing non-profit organisation packs in a huge amount of mother-to-mother breastfeeding support and education on the barest whiff of donor funds and a whole pile of volunteer time. As always, women are the ones expected to volunteer and to donate for the good of all. We need to properly fund this association RIGHT NOW.
* No additional funding to train IBCLCs. We could be training nurses, midwives, doctors to become certified lactation consultants. Right now? They’re all women, and they’re all doing it on their own time and on their own dime. This is starting to sound familiar, isn’t it?
* No recommendation to revise the Australia Dietary Guidelines in line with the World Health Organisation recommendations on breastfeeding duration. The WHO recommends that breastfeeding should be exclusive for the first six months of life, and should continue to 24 months and beyond. Australia has decided that toddler breastfeeding is all scary and stuff, and has set the cutoff at 12 months. The Report makes no move to revise that Guideline in line with the WHO. It contains a very weak endorsement of sustained breastfeeding, which it labels “extended” breastfeeding. A “bonus”, again.
* Extremely poor on implementation of the WHO Code on the Marketing of Breastmilk Substitutes. This is possibly my biggest disappointment in the report, though it’s hard to pick just one. We should have implemented the Code long, long ago, with a working complaints process and real penalties, and we’re still wimping out to the demands of the babyfood-pharmaceutical-industrial-complex. The Report recommends that the Department of Health and Ageing implement the Code, presumably limited to healthcare facilities and Department literature. Meanwhile, the flagrant everyday violations go on unchecked. Instead, we have the MAIF (Marketing in Australia of Infant Formulas) Agreement. Because we all know how well diluted, voluntary “industry” codes work. Page 135 of the report outlines the key differences between the Code and the MAIF agreement. There are no penalties for breaches of the MAIF Agreement, so the industry loves it.
* No toddler milk marketing action. “Toddler milk” marketing is a backdoor around the toothless MAIF agreement, so that companies may reap the PR benefits of pretending to adhere to it. The branding is identical to infant milks, and there are no restrictions at all on the content of toddler milk advertisements, despite them being a breastmilk substitute (since children are supposed to be fed to at least 24 months, remember?). “Nature’s Next Step”, they say. Karicare Toddler Gold won the Parents Jury “Smoke and Mirrors” award for their misleading toddler milk advertising last year, which featured a mother calmly freaking out about feeding her precious toddler milk from a cow. “Toddler milk” is largely dried cow’s milk and sugar.
So if jarred baby food labelling is in the scope of this Report, why is toddler milk explicitly excluded? Because of the Dietary Guidelines still not acknowledging that fake formulas marketed for children over 12 months old are breastmilk substitutes.
* No mention whatsoever of legislation to outlaw harassment and bullying of mothers and children breastfeeding in public. Nothing. Nada. Misogyny-rooted public abuse is a huge disincentive to women breastfeeding a baby for more than a few months. Yet we have no coherent legislation on the harassment of breastfeeding women. Unbelievable.
* No paid maternity leave recommendation. A brief mention that maybe voluntary industry-provided maternity leave might be rather nice, sometimes. Sort of.
* Nothing on emergency and disaster breastfeeding support. This is a huge one. Disasters happen in developed countries, too. Katrina, the Newcastle floods. We could have tsunami and hurricane devastation anytime. Breastfeeding is the only safe way to feed a baby in disaster conditions. Breastfeeding support, including donation, cross-nursing, and relactation is absolutely essential in emergency situations. The WHO has acknowledged this, with comprehensive training tools for healthcare and emergency workers, even the American Academy of Pediatrics is on board, but Australia is either frightened or oblivious.
* Formula companies are full of shit. No surprises there, eh? I’ll leave you with some quotes from the report, whose authors seem to agree.
In contrast, infant formula manufacturer NestleÌ does not consider that there is any evidence to support the introduction of new measures with respect to marketing of infant formulas.
Heinz Australia are concerned that the use of formula is being politicised and would like to see “…the use of formula milk be
depoliticised and treated objectively as a routine aspect of baby care, rather than as a moral issue …’ and that while breastfeeding is encouraged, mothers who do not breastfeed are not made to feel inferior.