Simeca Alexander Williamson | Provide breastfeeding support for all

There is a clear gap that exists when the recommended exclusive breastfeeding period is six months, yet, according to the International Labour Office (ILO), the recommended minimum maternity leave is 12 weeks.

The gap is the one between the mother and baby as a dyad and the society. The Breastfeeding Week in August highlighted the need for a multisectoral approach towards making breastfeeding support easily accessible for all.

In 2022, there was an infant formula shortage affecting the health of babies worldwide, bringing into question the number of mothers that were given the relevant support to initiate and continue breastfeeding in comparison to those that thought it necessary to resort to infant formula.

In a recent Gleaner article ‘New moms share struggles, triumphs on breastfeeding journey’, two new mothers shared their experience of having a low milk supply. Quite often, low milk supply in the case of a breastfeeding mother is merely a perception. In the majority of cases, actual low milk supply is associated with the premature introduction of supplementation. In the same article, one mom commented that she wasn’t producing as much milk as anticipated. Here is some perspective: During the first few hours postpartum, a mother produces colostrum - a thick, sticky substance that to the layman, may not be recognised as milk. This is one of the major misunderstandings leading a mother to think she is not producing enough, especially when unnecessary supplementation is encouraged, starting the downward spiral of low milk supply. In those initial 24-48 hours, a mere five to seven millilitres of breastmilk per feed is sufficient volume for most babies. However, we believe that babies -with their cherry-sized tummy - are born needing two or more ounces.

MANY MYTHS

There are many myths associated with breastfeeding that prey on the conscience of mothers. One such notion is that breastfeeding is painful, most times leading them to unnecessarily substituting with formula. While discomfort is common, it is NOT normal. Quite often, the default comment from healthcare practitioners is that “it will get better”, discounting a mother’s discomfort. There is no solace for when this will get better, causing demotivation.

When objectively assessed, formula can be posited as the first ultra-processed food introduced to the human body and formula marketing should be deemed as marketing to children, recognising infants as the secondary audience. When the frequency of supplementation is increased, the less a mother will breastfeed or attempt to remove milk from her breasts (using a breast pump or hand expressing, for example), ultimately sabotaging her supply, increasing her dependence on supplementation. Research has shown that pervasive marketing from the $55 billion formula industry uses messages that are often misleading, scientifically unsubstantiated, and violate the International Code of Marketing of Breast-milk Substitutes (the Code) to influence parents’ infant-feeding decisions.

In the midst of an unsupportive society, through myths, cultural practices, and archaic recommendations from varying healthcare practitioners and the expectations of a mother to do everything else in addition to taking care of herself and her newborn, impossible demands give clout to the formula industry. Too often, mothers are told that they should be breastfeeding their babies every two hours, which isn’t a requirement. However, it is important to follow your baby’s hunger cues and feed on demand. One of the barriers to exclusive breastfeeding is the unrealistic expectations placed on mothers to do it all. In reality, mothers should have support to take care of all the other things while she and her newborn get used to each other’s rhythm, bond, and heal.

FUEL ADDED

Fuel is often added in favour of the formula industry. Formula presents an ‘easy’ solution to providing food for infants when a mother is unable to provide nourishment because of external factors. When we remove the misnomer that breastfeeding is simply the act of providing food for a baby, then we will realise that the only support or solution that we provide cannot, or rather, should not, be formula. In a broader context, according to a study assessing the cost of not breastfeeding “formula feeding is neither beneficial for improving child health and cognitive development nor affordable for the vast majority of families living in lower middle-income countries (LMICs) and poor households globally.

According to the Code, “children who are breastfed are less likely to become overweight or obese and less prone to develop diabetes later in life.” The Code advocates that babies be breastfed. If babies are not breastfed, for whatever reason, the Code also advocates that they be fed safely on the best available nutritional alternative. Breastmilk substitutes should be available when needed but not be promoted. Inappropriate marketing of food products that compete with breastfeeding is an important factor that often negatively affects the choice of a mother to breastfeed her infant optimally. With the pervasive marketing of breastmilk substitutes as an equal alternative, many mothers give up even before giving themselves a chance to be successful.

Introducing bottles and pacifiers interrupts the way a baby latches on the breast, complicating the breastfeeding experience. When we associate images such as bottles and pacifiers to the existence of a baby, we are promoting these as the primary modes of feeding over breastfeeding. When we discourage moms from attempting to breastfeed for fear that her baby will not be able to take a bottle before returning to work, we increase the likelihood that she will either supplement or completely replace breastfeeding with formula feeding. Enforcing the Code is just one way that countries can unite in supporting breastfeeding. When we instil doubt in a mother’s mind about her ability to successfully breastfeed and cast embarrassment on a mother’s efforts to breastfeed rather than provide support in all the ways to make it possible such as favourable paternal leave, workplace pumping policies, and public facilities to comfortably breastfeed our infants, then we are part of the problem.

The benefits of breastmilk are irrefutable, however, it is crucial to transition into a narrative that informed feeding is best as the “breast is best” slogan is very traumatic for many mothers, causing guilt when their breastfeeding journey doesn’t go as planned. Neither is this a diversion of support to “the fed is best” phrase as there are many dangers in feeding an infant inappropriately.

Simeca Alexander Williamson is an International Board certified lactation consultant and nutritionist. Send feedback to support@cradleoflifeltd.com and columns@gleanerjm.com.