To the Editor:
Several days ago, Rhode Island became the first state to officially ban formula sample bags from hospitals. This decision was lauded by the state’s First Lady as a way for Rhode Island to “have healthier children, healthier mothers, and a healthier population as a whole.” AP reported that “formula will still be available to new mothers who experience difficulties with breastfeeding”, and a lactation consultant/nurse interviewed for the story assured the public that the “new policy isn’t intended to force women into nursing their children, “ but was rather designed to “(help) mothers decide what’s best for their child.”
As a mother who faced numerous challenges attempting to breastfeed her first child, and an author/blogger who has immersed herself in the breast/bottle debate for the past three years, I’m worried about the impact of this announcement. My problem is not that hospitals are opting to cease giving away commercial goody bags; as Marsha Walker, RN, commented in the AP story on the ban, “hospitals should be marketing health and nothing else”. My problem lies in the gleeful rhetoric used by a government spokesperson to announce this ban, and the growing anti-formula sentiment the ban represents.
While the AAP, WHO, and other major health associations have come out strongly in favor of breastfeeding – and well they should, considering it is a truly amazing gift a mother can give her child – the fact remains that the decision to breastfeed is not made in a vacuum. According to a 2009 article in US News and World Report, only 8% of American companies offer paid maternity leave; the average woman takes 6.6 weeks of unpaid maternity leave. Many breastfeeding experts agree that there is a learning curve for breastfeeding; that breastfeeding is a lost, and learned, art; something that does not come naturally to many women in our society. Some feel that it takes up to 6 weeks for breastfeeding to be established; this is 2-3 weeks longer than some women have off of work, altogether. And when they do return to work, they will have to pump at regular intervals to maintain exclusive breastfeeding – a feat which remains difficult for women in waged labor positions, despite Obama’s recent passage of a new workplace lactation policy. This new policy only applies to women working in companies with more than 50 employees, and disregards the inherent difficulties of expressing/storing milk while working as, say, a barista or factory worker. Not all working women are white-collar workers in female-friendly environments.
Additionally, many women have physical or emotional barriers to breastfeeding that have nothing to do with “predatory” marketing by formula companies. The phrasing used by the lactation consultant quoted in the AP piece, that banning free formula is “helping mothers decide what’s best for their child,” implies that what is best is breastfeeding, full stop. This is not always the case. What about mothers who must choose between contraindicated psychopharmaceuticals and nursing? What is better for that child – a healthy, sane mother, or a mother who is breastfeeding? What about a mother who is a survivor of sexual trauma, for whom feeding an infant from her breast brings back devastating flashbacks of abuse? Or what about a single mother with older children at home, who has a rough start breastfeeding, and who does not have the time, energy or resources to attend breastfeeding support groups or obtain in-home visits from lactation consultants? Or the mother who belongs to the supposed 1-5% of women (I personally believe it is a far greater number) who are physically incapable of producing enough milk?
These are all problems which may not be noticed by those working in maternity wards, or acknowledged as “medical reasons” for “needing” formula in the first few days postpartum. Yet they are real problems that real women face. These women come to my blog in states of despair: some feeling like negligent mothers for their failure to provide “the best”; some having watched their newborn babies lose precious weight while well-meaning lactation professionals have warned them against supplementation. And while taking away their opportunity to bring home free samples of formula may not be a big deal on the surface, taking away their opportunity to make a choice which is right for them, and right for their families, without being made to feel they are acting against medical orders, is a big deal.
Promoting breastfeeding does not have to mean clucking our tongues at the choice to use formula. There are numerous other risk factors which affect a child’s health and well being: having parents over the age of 40; going to daycare; living in the city versus the country; living in poverty versus wealth; being born anything other than white and middle to upper class. Just like with breastfeeding, these factors influence statistics about child health, any yet we don’t have government campaigns suggesting that all good mothers have babies in their prime childbearing years, or move to rural Ohio after giving birth. (Imagine posters announcing “Having a baby at the age of 21 reduces the risk of birth defects! Reproduce before college!” or, “Babies born to mothers living in high traffic areas have increased risk of low birth weight, prematurity, and respiratory problems. Country Living is Best for Babies!”) We all do the best we can with the circumstances we are given. While breastfeeding advocates insist that formula’s prevalence in our society is harming breastfeeding rates, I’d submit that a lack of public health care, paid maternity leave, individual circumstance, maternal health, and personal preference have just as much impact, if not more.
Take away the formula bags, if you must (although I’d still like someone to tell me why we can’t simply have them available upon request, if the formula companies are willing to provide them), but it’s time we started speaking up for the women who cannot, or choose not, to breastfeed. Anyone with an internet connection has gotten the message loud and clear: science has proven that breast is best. Now it’s time to let us take that information for what it is worth, perform our own risk/benefit assessment, and feed our children in the way we deem appropriate. Removing the temptation of formula freebies is not going to stop women from formula feeding, but it certainly will make women think that formula feeding is something to feel ashamed about. If that is the goal, then well done, Rhode Island.