The breast-feeding debate sparked off by a World Wildlife Federation report, which claimed pollutants in breast milk, highlights concern at why Irish breast-feeding rates are so low. Two out of every three mothers do not breast-feed, giving us one of the lowest rates worldwide. British rates are double our own.
So a new report, Knowledge of and Attitudes to Breast-feeding in the Eastern Health Board with Special Reference to Community Care Area 1, is particularly timely. Its findings show that middle-class mothers are more likely to breast-feed than their working-class counterparts, and that family patterns have a significant effect on individual behaviour. The report highlights an ambivalent role for health professionals. Most significantly, the battle for breast-feeding seems to be lost or won ante-natally, with attitudes formed, perhaps unconsciously, many years before a woman has a child.
The survey, carried out on behalf of the EHB's Health Promotion Department, covered a representative sample of adults from south Co Dublin and used focus group interviews with mothers in the same area.
It found:
Over 80 per cent of respondents believed breast was best.
More people in class 1-3 believed this.
Only 35 per cent of parents reported having breast-fed.
Barriers to breast-feeding included: perceived attitudes of other people, lack of public facilities, pain, inconvenience, more tiring for mother.
Significantly fewer young people and those from social class 4-6 believed breast-feeding was convenient.
This group regarded breast-feeding as embarrassing for the mother.
When asked what would increase breast-feeding rates, men tended to opt for better education, while women asked for better facilities.
The focus groups offered valuable anecdotal evidence of women's experience of breast-feeding and pointed to where work needed to be done. "We were lucky because we got the private room. The midwife said we were only there because we were breast-feeding," said one woman. "In hospital, I had one night when she [a nurse] said, `Well you're not capable of breast-feeding. If that child hasn't gained weight in the morning you're putting him on the bottle'," said another. Stories of people being asked to stop breast-feeding in public or to move to a more private area were common. "Someone said, `Would you not do it the proper way and use a bottle?' "
Community nutritionist Freda Horan was the project manager. "Regarding the gap between what people believe - that breast is best - and what they practise, I think part of the reason is cultural. We don't see people breast-feeding, we haven't grown up with it, mothers, sisters aunts haven't done it. We don't have the role models," she says.
"Also while people say breast is best, they don't know why. The survey showed that health issues were not a predominant motivation to breast-feed. I think that's a reflection on health professionals not standing up to say that artificial milk is second best, and explaining why."
Just for the record, breast milk provides protection against allergies, gastroenteritis, colds and infections, reduces the risk of high blood pressure, and helps create a special loving bond between mother and child. Putting the toxins in breast milk controversy in context, the World Wildlife Federation report stressed that it is still better for babies to be breast-fed than not.
The EHB report showed that if a woman has decided to breast-feed, her maternity hospital experience can support and encourage this decision, but if she has decided against it, hospital staff have less clout. "But there are some women who haven't made a decision, who aren't sure, and with the right approach will begin and persevere," says Nicola Clarke, breast-feeding support midwife at the National Maternity Hospital, which has a multidisciplinary breast-feeding team.
However, generally the report reveals a patchy approach to breast-feeding by the health services. Some women felt discouraged from breast-feeding; others felt pressured to do it. Tipperary GP Dr Lucia Gannon believes that for breast-feeding to be promoted in Ireland, we must begin with the chiefs, not the Indians. Writing to her peers last week in Medicine Weekly, she says: "This involves educating ourselves on the benefits of breast-feeding, convincing ourselves of these benefits and not being afraid to communicate this knowledge to the general public." One of the report's four recommendations is to "provide concerted, in-depth education on attitudes and practice for all health professionals dealing on a regular basis with pregnant women".
Another recommendation was to educate second-level students on the value of breast-feeding. It was significant that more young women were liable to find breast-feeding embarrassing, some going so far as to describe is as "disgusting". It would have been instructive to ask the same group how they felt about page-three girls and female nudity generally. If breasts are used increasingly as products for sexual titillation, it seems as if they can be distanced in the female consciousness from their nurturing and sensual qualities. Changing these kinds of attitudes will obviously not happen overnight, but beginning at school sounds right, with the Social, Personal and Health Education programme an obvious vehicle.
ALMOST three-quarters of the respondents felt that breast-feeding was less easy than bottle-feeding for women at work. Most felt that lack of facilities, irregular hours and length of maternity leave all made breast-feeding being less easy than mixing a formula when the mother returned to work. In Norway, which enjoys initiation breast-feeding rates of 98 per cent, there is extended maternity leave of 10 months with full pay, and paid lactation breaks of up to one hour a day when a woman returns to work. Freda Horan says that many breast-feeding women here manage by expressing breast-milk which is fed to their baby in their absence. But while breast-feeding baby for four months is recommended - a month longer than current maternity leave - even giving the baby a three-month start is preferable to nothing.
The survey was undertaken as part of an ongoing project to increase breast-feeding rates within the EHB, and much good work has already begun. Most community care areas now have a breast-feeding support group for new mothers meeting weekly at the local clinic facilitated by a specially trained public health nurse. A plan to enlist the help of GPs in promoting breast-feeding is already under way. The Health Promotion Department also works closely with La Leche League and Ciudu, (the Irish Childbirth Trust), two voluntary support groups for mothers, offering practical help by regular meetings and telephone helplines.
"There can be a significant fall-off rate when people come out of hospital, and we tend to hear from mothers who run into problems," says Eithne Carey, La Leche spokesperson. "Many of these can be sorted with proper information and support. Breast-feeding can have its difficulties, women can feel very isolated, but we find that if they manage to get to a minimum of two meetings they normally go on to breast-feed successfully." She concedes that La Leche has been perceived as fanatical and is also fairly middle class. "But all we want to do is to encourage mothers. We're not a pressure group, nor a campaigning one; we offer help and support," she says, "but we can't tell lies and if we feel breast is best, we have to say so."
Finally, to the report's first recommendation: to target women in the less affluent groups and younger women for priority intervention. Doing this will involve an examination of perhaps deeper reasons why economically deprived women don't choose the cheaper option of breast-feeding. These reasons may have to do with their wider expectations of life generally. If they don't feel they get the best in other areas, why bother giving their children the best in this one?
Freda Horan says she sees the point. "But I believe that all mothers want their children to be healthy, and I believe if they really understood the value of breast-feeding, they would be more inclined to do it." Eithne Carey agrees: "I think we just need to make breast-feeding normal and anything else inferior. We need to change the culture. The sign on many changing rooms is a bottle. It should a mother with a baby, or even a baby. We need to work to a situation where you can expect to see breast-feeding, which can be absolutely discreet, wherever it is acceptable for a baby to be."