Yesterday I returned from a family holiday in Canada and came across a piece titled, ‘Time to get a grasp on reality and stop making colossal boobs of ourselves over breast politics’, by Mia Freedman, published in the Sunday Telegraph. I wrote an email to Mia about the article. She was good enough to post it in the comments section of her blog and I have cut and pasted it below because I feel the issues we are discussing are of some importance. I hope you will add your thoughts in the comments below. This is an emotive issue. Many women have tough breastfeeding stories to tell, and many have beautiful stories, also. All are welcome here.

It is important to note that BFHI accredited hospitals (accreditation is governed by the Australian College of Midwives) provide much needed support for all mothers and babies, regardless of their circumstances, desire or ability to breastfeed. It is a global initiative and BFHI policy is the same in every one of the more than 150 countries where it is implemented. The ABA, on the other hand, is a grassroots volunteer organisation that has no involvement with BFHI hospital policy, as implied in Mia’s article.

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Feb 27, 2012

Dear Mia Freedman,

Firstly, congratulations on your ongoing role as one of the leading voices of women in Australia, and on your ability to bring important women’s issues into the public eye. I have read many of your articles published at Mamamia.com.au and in the weekend newspapers, and of course we have met and communicated numerous times over the years. Yesterday I came across your piece titled ‘Time to get a grasp on reality and stop making colossal boobs of ourselves over breast politics’ and I felt I should contact you to address some important issues.

I am unaware of any ‘Breast Feeding Association’ that gives accreditation to hospitals, as mentioned in your article. There is a volunteer group called the Australian Breastfeeding Assoc that provides breastfeeding classes and a 24 hour hotline (1800 mum 2 mum) to help women with breastfeeding problems, with the phone lines manned – ‘womaned’ actually – by volunteers who have earned qualifications to help women struggling with breastfeeding related issues, milk supply, attachment problems, etc. They generously provide a free and helpful service but do not provide accreditation to hospitals. The Baby Friendly Health Initiative, or BFHI (previously named the Baby Friendly Hospital Initiative), developed by the World Health Organisation and UNICEF in 1991 and implemented in over 150 countries worldwide, does provide accreditation for hospitals globally, and is governed locally by the Australian College of Midwives (not the ABA). I think this may be the program you are referring to in your article, and as I am patron for BFHI in Australia I thought I should address some of the issues you raised.

The Baby Friendly Health Initiative, and their ‘10 Steps To Successful Breastfeeding’ have been very successful in raising breastfeeding rates in countries with Baby Friendly accredited hospitals. To give one example, after only two years of BFHI implementation in China exclusive breastfeeding rates in that country doubled in rural areas and increased from 10 per cent to 47 per cent in urban areas. Currently, Australia’s exclusive breastfeeding rate at the medically recommended six month mark is 14% – less than half the world average. Governments around the world, medical professionals and organisations like WHO and UNICEF are actively trying to raise breastfeeding rates and in particular exclusive breastfeeding rates during the crucial first six months because of significant health implications for mothers and babies. The focus on exclusive feeding is due to a wealth of evidence showing health risks associated with formula feeding and mixed feeding. Beyond the long-term outcomes like higher rates of infection, disease and obesity associated with formula feeding, unlike breast milk suckled directly from the breast, formula is not sterile. Equally, bottles and teats are not sterile, and making these items medically sterile can be costly in hospitals, using specialised equipment, and parents can only ever have limited success in making them sterile at home. As human beings we are all imperfect, and as a result, the preparation of formula can be flawed and babies can and do get very sick. The latest research shows that an estimated 53 per cent of diarrhoea hospitalisations could be prevented each month by exclusive breastfeeding, breastfed babies have 15 per cent fewer doctor visits in the first six months, and in developing countries where sterilisation techniques are arguably poorest, use of bottles and formula cause an estimated 1.4 million deaths in children under five. These are some of the reasons why BFHI accredited hospitals aim only to introduce bottles to babies (including expressed breast milk in bottles) when medically necessary.

Until such practices were widely banned, many hospitals gave out free packs of formula to new mothers, and had formula tins and formula advertisements displayed within maternity wards, where new mothers are most vulnerable. Unsurprisingly, this resulted in significantly lower breastfeeding rates and higher rates of formula use. (To give an example of how much sway advertising can have on a culture, formula is reportedly one of the top 3 consumer commodities and one of the top imports in the Philippines, where there is currently no ban on the advertising of formula for babies, and sales amount to nearly half a billion US dollars annually despite much of the country living in poverty.) It is for these reasons that formula is not displayed in BFHI accredited hospitals, however it can be readily accessed for medical reasons or if the mother wishes. The introduction of bottles is not taken lightly because of the increased health risks for babies and the potential hurdles it can create for mothers who wish to breastfeed, including ‘nipple confusion’ and attachment problems in newborns, and lowered milk supply in mothers. Breastfeeding is not always easy in the early days or weeks and the last thing we need is any hospital policy that makes it yet harder to breastfeed. For many of the same reasons, nipple substitutes, such as pacifiers, are not encouraged in BFHI accredited hospitals either. It is important to mention that although BFHI accredited hospitals have policies in place to support breastfeeding, they also have policies in place to support women who chose not to breastfeed or can’t breastfeed for medical reasons. That does not extend to actively promoting or displaying artificial nipples or breast milk substitutes. As you wrote in your article ‘formula was never displayed anywhere – it was hidden – and neither were bottles of ANY KIND EVER’. Indeed. Why should formula be displayed in maternity wards? We see aisles of it in supermarkets.

You mentioned in your article that you have breastfed three children and you wrote your piece from the perspective of someone who has loved and hated breastfeeding. Amen. I am writing this as a mother of one who introduced my daughter to formula at only two days of age, on doctor’s recommendations, and fed her formula ‘top-ups’ for six weeks before breastfeeding exclusively. (After some hurdles at the start, we are still going strong with breastfeeding). I do not view my formula use as a personal failure or a source of guilt, and nor should anyone else.

But more importantly, I am writing this not just as a mum, an individual, but as patron of the BFHI program, and in this volunteer role it is my job to pass on evidence-based information on this topic, quite beyond my very small sample size or personal anecdotes. It is because of decades of exhaustive research conducted around the world by scientists and health professionals that I can confidently say that the perceived injustice of an objectionable facial expression from a midwife, or the need for midwives to sign off on formula to feed a newborn, in the case of your friend’s experience, is a small inconvenience for a policy that provides significant improvement in health outcomes for babies and mums, eases the burden on our health system and in some cases even saves lives.

BFHI hospital accreditation exists only to support the health and wellbeing of women and children, to reduce infections and to save lives. Guilt-trips and ‘breast politics’ have nothing to do with it. I encourage any expecting mother to chose a BFHI accredited hospital. I know I will.

You may find these links of interest:

BFHI Australia

World Health Organisation

Please feel free to contact me any time to discuss any of this.

Best wishes,

Tara Moss

UNICEF Patron for Breastfeeding for BFHI

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An addendum: I’ve had it pointed out to me that not everyone who wants to birth in a BFHI accredited hospital can find one. This is an excellent point. There is a comprehensive list of BFHI accredited hospitals here, listed by state:

http://www.babyfriendly.org.au/health-professionals/find-a-bfhi-hospital/

If there are no BFHI accredited hospitals in your area, I recommend writing down and communicating your desire to have ‘skin to skin’ time directly after birth. This has a variety of medically proven health benefits, can assist with breastfeeding and is also a wonderful bonding experience for everyone, including those who will not be breastfeeding for any reason. A version of skin-to-skin can also be achieved with caesarean births, so ask your hospital about it. Also, write down and communicate your desire to breastfeed exclusively and not be offered artificial teats or artificial milk unless medically necessary. (Do not worry, if it is medically necessary for any reason the hospital will organise what your baby needs.) All this can be part of what is commonly called a ‘birth plan’, and communicating these desires to the health professionals in the hospital where you intend to give birth will give you a better chance of the ‘baby friendly’ environment you desire. Most hospitals are very receptive to these requests and everything will be done to support you.

Any questions or comments about BFHI or complaints about problems in BFHI hospitals can be directed here:

http://www.babyfriendly.org.au/contact-us/

Thank you for all your feedback and for sharing your stories.