Читать книгу No Child Left Alone - Abby W. Schachter - Страница 12
ОглавлениеAdvocating for breastfeeding isn’t enough—it has to be the law
“YOU ARE TALKING about my body as if it is state property,” Captain Mommy Suzanne Barston complained when we spoke by phone. Which part of the body is the activist blogger and author talking about? Barston was referring to all the government regulations, policies, and requirements when it comes to women’s breasts, or more specifically how a woman’s choice whether or not to breastfeed is a matter of national interest.
Barston is an advocate for what she calls “feeding freedom,” and in her book Bottled Up1 and blog Fearless Formula Feeder,2 she chronicles the personal experiences of those who feel pressured to breastfeed and the coverage of scientific studies that promote breastfeeding as the best—really, only morally good—way to feed a baby. She writes that breastfeeding should be “an empowering personal choice rather than a government-mandated, fear-induced act.” Surely she must exaggerate when she says the government sees her boobs as state property? As we shall see, however, she’s not exaggerating. Instead, Barston has her work cut out for her, in part because cities, states, and most of all the federal government are pulling multiple levers to promote this particular behavior.
MICHAEL BLOOMBERG may be the former mayor of New York City, but he’ll always be emperor of Nannyville, USA. And he’s certainly among those who Barston argues see a mother’s breasts as national treasures requiring government protection. During his time as mayor, Bloomberg enacted bans on smoking in public places and trans-fats, and he tried to ban large-sized sodas. But his biggest triumph has got to be the breastfeeding mandate of 2012, which—similar to Iranian law3—essentially makes infant formula a controlled substance.
According to recommendations of the Latch On NYC initiative, city hospitals must not only remove the free formula goodie bag that used to be available to mothers in the hospital, but they must also keep formula under lock and key. If a mother requests it, hospital staff administers formula as if it were prescription medication or a narcotic. Moreover, before the mother can get a bottle to feed her kid, she’s got to sign a waiver stating that she understands she’s making the “less healthy” choice for her baby.4
When New York says it wants to “support” breastfeeding, the underlying argument is that only human breast milk is safe for babies. After all, in announcing the program, Thomas Farley, then-commissioner of public health for New York City, claimed that “formula feeding markedly increases serious health risks for infants” and that lower breastfeeding rates “result in excess health care costs and preventable infant illness and death.” The millions of mothers who have chosen not to breastfeed would not recognize the characterization of formula as virtually a poison.
Peggy O’Mara, founder of Mothering magazine, has certainly internalized the formula-is-poison message. “It is naïve to believe that the formula industry’s distribution of formula to you is an innocent gift,” she wrote in her magazine about the free diaper swag for new mothers.5 “A ‘gift’ of formula is like a ‘gift’ of a pack of cigarettes when you’re trying to quit smoking; it will undermine your resolve,” O’Mara wrote.
When the New York City program was announced, it was proudly deemed necessary for public health reasons. “Human breast milk is best for babies and mothers,” Latch On claims.6 The program has four basic elements.
1. Enforce the [New York State] hospital regulation to not supplement breastfeeding infants with formula feeding unless medically indicated and documented on the infant’s medical chart;
2. Restrict access to infant formula by hospital staff, tracking infant formula distribution and sharing data on formula distribution with the Health Department;
3. Discontinue the distribution of promotional or free infant formula; and
4. Prohibit the display and distribution of infant formula promotional materials in any hospital location.7
“When babies receive supplementary formula in the hospital or mothers receive promotional baby formula on hospital discharge it can impede the establishment of an adequate milk supply and can undermine women’s confidence in breastfeeding,” Latch On promotional materials declare.
This extreme sort of language about the “need” to breastfeed and the “risk” of formula didn’t come as too much of a shock to my sister-in-law, who described how pervasive the lactation dogma was even before the new mandate took effect. When my niece was born in 2010 in New York City, she was delivered early by C-section, and in the 24 hours after her birth, her weight and other measurements had landed her in the NICU. My sister-in-law was understandably eager to do anything she could to help her child, but it took 24 hours before one nurse quietly suggested that my niece’s weight and other “numbers” would go up if my sister-in-law would agree to give the child a bottle of formula. “They’d let her out of here if she gains a little,” the commonsense staffer advised.
When my sister-in-law described this scene more than two years later, it was obvious she was still angry, and justifiably so. “Why didn’t they just tell me in the first place that formula would help,” she fumed. “I was pumping anyways, so what did it matter if I just stored all that milk and they gave the baby a bottle?”
The Latch On mandate did surprise some others, however. Gayle Tzemach Lemmon reacted in The Atlantic. “Women who have . . . decided—for whatever personal reason—to feed their newborns formula, will now have to justify their reasoning before they are given access to it. When, exactly, exercising a personal right about what to do for your child (and with your own body) became a public statement, open to the city’s files and others’ judgment, is unclear.”8 As Barston argues, the state seems to be asserting a right over women’s bodies that some like Lemmon identify as breathtakingly broad and audacious.
New York City isn’t the only metropolitan area taking up this cause, though. Portland, Oregon, banned free formula samples in 2007,9 and, as of August 2014, all of Philadelphia’s birthing hospitals agreed10 to “ban the bags”11—the name for the national campaign to stop mothers’ receiving free infant formula at the hospital.
Why the fuss about freebie formula? “What companies have done is co-opted health-care providers into doing their marketing for them,” explains Marsha Walker,12 who is executive director of the National Alliance for Breastfeeding Advocacy. Removing free formula, therefore, means that moms are supposedly only now able to make an unbiased choice between breast and bottle. “It is still the choice of the mom if she breastfeeds or not,” but now she is making the decision free of marketing influence, said Katja Pigur, who led the Philadelphia ban-the-bag campaign for the Maternity Care Coalition.13
The argument against free formula is that mothers who might otherwise commit to breastfeeding may become “discouraged” or “break down” and give their babies some too-readily-available formula if they are having any complication with nursing, and that in turn will discourage keeping to exclusive breastfeeding going forward. What breastfeeding advocates want to prevent is mothers feeding their kids formula at all, so they want to make getting your hands on it as difficult as possible.
These zealots do have a point about the work required to breastfeed. Mothers’ milk does take time to come in after birth, and getting used to breastfeeding and generating an adequate milk supply does require a level of time, energy, and commitment that isn’t required when mixing formula. Powdered infant formula gets mixed with water and can then immediately be given to baby. Also, breastfeeding advocates worry aloud about “nipple confusion” if infants are given the breast and then a bottle before they’ve become accustomed to the harder work of nursing. In addition, the flow through a bottle nipple is quicker than a woman’s breast, which critics of bottle feeding say is another reason to stick with exclusive breastfeeding, though it is important to note that even the most ardent breastfeeding advocate will urge mothers to supplement with formula when medically required.
The question is how hard hospitals will make the rational decision to feed babies with formula. Will it be an easily accessible choice, or will new moms have to send their husbands, mothers, grandfathers, friends, or a friendly nurse to Costco or the nearest supermarket to get a can of formula while they are still in the hospital recovering? As new mothers may not be directly aware but can no doubt sense, there is a web of organizations at the global and local levels that have made it their agenda to demonize formula and promote breastfeeding as the only acceptable method of nourishing infants.
PUMPING UP BREASTFEEDING: 1. GLOBAL
The World Health Organization (WHO), which is pushing its Baby-Friendly Hospital Initiative (BFHI) in the United States and across the globe, would love for formula to be as difficult to get as possible. “Launched in 1991, [BFHI] is an effort by UNICEF and the World Health Organization to ensure that all maternities, whether free standing or in a hospital, become centers of breastfeeding support,” the UNICEF website declares. And according to their “About Us” statement, breast milk is really the only correct choice.
Human milk fed through the mother’s own breast is the normal way for human infants to be nourished. . . . Breastfeeding is the natural biological conclusion to pregnancy and an important mechanism for the continued normal development of the infant. With the correct information and the right supports in place, under normal circumstances, most women who choose to breastfeed are able to successfully achieve their goal.
There is no qualification here. The “normal” and “correct” choice is mother’s milk, and if every mom would just try hard enough and get enough encouragement from the institution where she gives birth, the goal of exclusive breastfeeding can be realized. Of course, the Baby-Friendly designation comes with strict rules for the institutions that choose to sign up for certification. These rules include the means for getting most everyone to breastfeed and include an anti-formula perspective. For instance, supplementing baby’s food at all is discouraged. “Give infants no food or drink other than breast-milk, unless medically indicated,” WHO says. Also, since they want staff to “encourage breastfeeding on demand,” to be baby-friendly means practicing “rooming in—allow[ing] mothers and infants to remain together 24 hours a day.” This is nice in theory but hard on mom in practice. Having just given birth, most moms are in need of rest; but since the breastfeeding police want you to jump at every opportunity to breastfeed, mom is going to spend most of her time listening for baby rather than sleeping. Finally, WHO doesn’t want anyone to offer baby pacifiers or “artificial nipples to breastfeeding infants,” lest baby develop any attachment other than to mama’s milk supply.14 The fact that babies suck for comfort as well as for food seems to be of no concern to the “experts” at WHO.
Each hospital and maternity ward could and does come up with their own policies about infant feeding, but as one former hospital administrator explained to me, many institutions will take every opportunity to market themselves as the “best” place to give birth. If a globally recognized organization is telling them to institute a few rules to receive a stamp of approval—like baby-friendly—so much the better. Here the standards have been developed and corresponding educational materials created for the sole purpose of getting staff to institute “baby-friendly” procedures. And the whole process is free, almost. There was a study done for the University of Texas’ Health Sciences Center to gauge the price of BFHI, but even though results showed that “first year marginal costs will approximate $110 per delivery (birth)” and that “BF hospitals have around a 2% higher cost structure than non-baby-friendly facilities,” the researchers believe it is worth it.15 As my hospital administrator friend put it, “the hospital is thinking of marketing itself to the whole family, not just the baby.” She added that when a hospital is focused on gaining the business of every family member and not just performing a single service, like a delivery, then anything that gives them a way to signal they are a leader in quality services, like being baby-friendly, will be deemed worthy.
PUMPING UP BREASTFEEDING: 2. STATE
The hospitals working to earn the World Health Organization–defined label “baby friendly” for banning formula giveaways and the entire cities riding the breast-is-best bandwagon aren’t alone in their zeal to promote exclusive breastfeeding.
Five states—California, Illinois, Minnesota, Missouri, and Vermont—and Puerto Rico “have implemented or encouraged the development of a breastfeeding awareness education campaign,” reports the National Conference of State Legislators. Twenty-seven states, the District of Columbia, and Puerto Rico have laws related to breastfeeding in the workplace.16
