Tuesday, 9 July 2013

Public, positive messages to support a woman's right to breastfeed

I've been delighted to observe and be part of a movement for improvements in birth and maternity services that is gaining momentum (see this article by Toni Harman in the Huffington Post.) In the UK the Positive Birth Movement, with its network of positive discussion groups, and the establishment of Birthrights, has done much to foster genuine, productive debate about women's experiences of birth in today's society. Writer Milli Hill has been commissioned to write a positive birth column after her piece Is Kate being bullied about her birth? was a runaway success for bestdaily; home birth advocate and journalist Beverley Turner, of Radio 5s Bump Club, has also had a number of positive articles published in recent weeks. There's a real buzz about positive birth at the moment and it's great to see.

Conversely, National Breastfeeding Week 2013 has left me feeling a little flat. Not because there weren't some great things going on - both on and off-line - but because, as the figures revealed in the papers during the week showed breastfeeding rates taking a small dip for the first time in years (and Rebecca Schiller so clearly articulated in her piece in the Guardian), without government-level strategic support for breastfeeding, all the efforts of everyone who is passionate about supporting women to breastfeed are just scratching the surface. As Schiller summed it up: 'if policymakers aren't funding enough midwives or a centralised system of breastfeeding support we simply set women up to fail.' (In my own area, with no funding for National Breastfeeding Week, the NHS, through which we work as peer supporters, couldn't support the events we ran in any way.) She also pointed out that the constant breast v bottle debates in the media (which I've critiqued in other posts, like this one) are falsely polarised and damaging to both sides, with women suffering guilt, fear of judgement and lack of support, regardless of feeding method.

I can't help wondering whether the key to improving our dialogue about breastfeeding lies in learning some lessons from the movement for improving birth. If we alter the fundamental question at the heart of all the arguments, what happens? In the introduction to his forthcoming book A Gift for Life (Pinter and Martin, pub date Sept 2013) Dr Carlos Gonzalez, author of My Child Won't Eat and Kiss Me! How to raise your children with love, Spain's answer to Dr Jack Newman, writes:
"...lactation isn’t a tool for achieving health, but rather an integral part of health itself. Not a means, but an end. Telling people to ‘avoid artificial lactation because it causes diarrhoea’ now seems to me as absurd as exhorting them to ‘avoid blindness because blind people are more likely to get run over’. Lactation is no more a way of avoiding infection than being able to see is a way of avoiding accidents. They are both normal parts of a healthy life. I know now that lactation is not an effort, much less a sacrifice, that a woman makes for the good of her child, but rather that it is part of her life, of her own sexual and reproductive cycle. It is a right that no one can take away from her.
I am aware that some women don’t want to breastfeed. This is fine. A right isn’t the same as a duty. Many people don’t go on marches or vote in elections, but they still have that right." (my emphasis)
There's a parallel here with the idea (enshrined in law thanks to Ternovsky vs Hungary) that it is a woman's right to choose the circumstances of her birth. If we see breastfeeding as a woman's right then that frames the whole question of our duty, as a society, to ensure that her rights are respected and supported, in a completely different way. Viewed in these terms, breastfeeding is no longer a 'public health issue', or a 'women's issue'; the right to breastfeed, if she wants to, becomes a completely integral part of the care a woman can expect from maternity and child health services - it cannot be seen as an optional extra, or a 'nice to have', the cherry on the cake once mum and baby have navigated the birth itself. It demands commitment to breastfeeding, and supporting breastfeeding, at a strategic level.

(For the few women who cannot breastfeed, the logical extension of the idea that breastfeeding is a woman's right would be to have robust systems in place to provide those women with acceptable alternatives; provision of donor milk and supplementary feeding systems, wet-nursing or milk-sharing, for example.)

So seeing breastfeeding as a woman's basic right, which she is free to exercise or not, is one way of reframing discussion of it. We move on then from divisive breast v bottle polemics, and instead focus on how our society and culture is, or is not, doing what it needs to do to ensure that a woman's right to breastfeed is not infringed. We're part of the way there with laws that protect breastfeeding in public, but we must also look at our failure, in the UK, to fully implement the WHO Code on the marketing of breastmilk substitutes, and confront what the recent figures showed so clearly - that breastfeeding in Britain is effectively a postcode lottery (despite what we know about its potential to reduce health inequalities). As Rebecca Schiller, in her role as co-chair of Birthrights, says:
"Women have a fundamental right to autonomy when deciding how and where to give birth and how to feed their babies. Birth choices are often made with feeding goals in mind. However, women in the UK do not universally have equal provision of these birth settings and often tell us that they are refused entry to them. Birthrights is working hard to raise awareness of this issue and work with women and health professionals to ensure that the choices women make around birth  - for whatever reason - are respected, supported and made realistic.

Women most certainly have the right to adequate levels of postnatal support and the right to make fully informed choices about how they give birth and feed their babies. If our maternity service doesn't offer all women the chance to make and realise those choices through appropriate provision of a range of birthplace settings and experienced, adequately staffed postnatal services, it certainly raises the question as to whether, through lack of resources and lack of evidence-based policy, we are effectively giving an illusion of choice where often none exists." 
Another way of reframing the discussion of breastfeeding takes a different tack - focussing on public, positive messages about breastfeeding (again, following in the footsteps of the Positive Birth Movement and Tellmeagoodbirthstory). My book Breastfeeding: stories to inspire and inform and its accompanying Facebook page attempt to promote positive breastfeeding stories - a recent favourite is this one from a mum who never thought she'd breastfeed, but changed her mind. Other groups and individuals are doing their bit to normalise breastfeeding and breastfeeding in public. Christina Conboys and a group of mums in Harrow have put together a book of fabulous, inspiring photographs called Breastfeeding is Beautiful; spoken-word poet Hollie McNish's heartfelt poem 'Embarrassed' is being shared all over the web - it sums up brilliantly some of the cultural issues affecting how we see breastfeeding in Britain. I also love the work of We Do It In Public, a photographic library of normal mothers breastfeeding in all sorts of everyday situations - for (paid) use by organisations, companies, websites and anyone who needs images of infant feeding to accompany their content. And it's a great resource for mothers to browse too.

The impact of these positive, public messages about breastfeeding cannot be underestimated. They are the antidote to all the little comments that undermine breastfeeding that we all come across every day: about four-hourly feeds, about a bottle before bed to get them to 'go a bit longer', about 'needing your body back', about no nutritional benefit after six months, about formula being 'just as good these days', about how 'he's using you as a dummy'. It works in the same way that positive birth stories counter negative messages about birth. It's well-known that supportive breastfeeding groups (again the parallel with the Positive Birth Movement is obvious), where mothers meet other women with similar experiences to their own, are of immense value in supporting women to meet their breastfeeding goals; that's why the major breastfeeding charities, such as La Leche League and the ABM, put mother-to-mother support at the core of their activities. I recently read this interesting blog about how negative experiences of breastfeeding in public affect mothers and influence their decisions about how long to breastfeed for; if we exchange those negatives for positives we both support breastfeeding and support women.

It seems to me that raising the profile of breastfeeding in the UK requires (at least!) a two-pronged approach. If we started by accepting that it is a woman's right to breastfeed if she wants to, then that would give us a clear way forward: breastfeeding needs to be at the heart of what we do, in government, in law, and in public life. It's not rocket science. It's just something else that HR departments, TV programme commissioners, editors and policy-makers would need to at least consider, in the way that they already consider diversity, gender, accessibility. And if, at the same time, we could increase the visibility of breastfeeding as it's done, everyday, by thousands of women, then it wouldn't be long before everyone stopped paying so much attention to it. It would just be normal.

(I'm reminded, in writing this, of feeding my daughter on a trip to the Westfield centre in Derby, a huge shopping mall with multiple, well thought-out parents' rooms. I often suggest to new mums I support that it's a good place for an early trip out with the baby because of these facilities. However, last time I was there and my daughter needed a feed I was close to benches in a large, airy seating area, with all sorts of people sitting on them - older Asian men, Derbyshire grannies and giggly teens. I consciously chose to join them all and feed my daughter there rather than going to the parents' room. I felt, as a confident third-time mum, that I was doing my bit to normalise breastfeeding. It may have backfired, however, as the Derbyshire grannies that cooed over the baby had leaned right over, stroked her head and tried to talk to her before they even realised she was feeding...)

What do you think of the idea of breastfeeding as a woman's right as a normal part of her sexual and reproductive life? I'd love to hear from you in the comments.