Message in a bottle undermines breastfeeding

SECOND OPINION:Many Irish babies have never tasted human milk, writes JACKY JONES

DO IRISH WOMEN have dysfunctional breasts? They must have because only 45 per cent of children born in Ireland are exclusively breastfed when they leave the maternity hospital, according to a recent ESRI report.

This means that a large number of Irish babies have never tasted human milk. Contrast this with breastfeeding rates in other countries, for example Norway (99 per cent), Vietnam (98 per cent), and Austria (93 per cent).

In fact, almost all countries in the world have better rates than we do. In spite of our abysmal breastfeeding rates, World Breastfeeding Week, which is celebrated in 170 countries, came and went last week with virtually no media coverage or public interest.

The ESRI report shows that better-educated women are more likely to breastfeed (63 per cent) than less well educated women (27 per cent). The prevalence of breastfeeding varies by geographic location so infants born in Dublin are more likely to be breastfed (56 per cent), whereas the rate in Galway is 36 per cent.

Women most at risk of poverty are the least likely to breastfeed, which means their baby receives a double whammy. They will have worse health because their mothers are poor and, although breastfeeding has a huge potential to redress this health inequality, their babies are denied access to a superior quality food.

Why are the Irish rates so low? The simple fact is that Ireland does not have a breastfeeding culture. There is no breastfeeding culture in maternity hospitals, in families and social networks, or in communities.

The skill of breastfeeding has been lost and the women who choose to breastfeed often do so with great difficulty. These difficulties are not physical but are related to cultural norms and attitudes of health professionals, families and friends.

HSE figures for last year show that by the time a baby is three months old, only 22 per cent of women are still exclusively breastfeeding.

The Irish bottle-feeding culture is not helped by government policy. In 1994, when the rates were about 30 per cent, the Government developed a breastfeeding policy. Even then the message about the benefits of breastfeeding was ambiguous as exemplified by the following quote: “It is recognised that when a mother can produce enough milk and wants to breastfeed . . . she should be encouraged to do so . . . but alternatives to human milk must be available.”

It is no wonder rates did not improve much, rising a mere 2 per cent by 1999. That first policy was inherently anti-woman and implied women’s breasts could not be trusted to do the job they were designed to do. It set the tone for the kind of supports women receive in maternity hospitals around the country. Bottles are widely available, even in so-called baby-friendly hospitals. In most maternity units, an attendant ensures that mothers are well stocked up with artificial milk. Bottles are not offered in countries with the best breastfeeding rates, although some hospitals have vending machines where formula feed can be purchased. Bottle feeding is normalised in Ireland – after all if hospitals are doling out free milk it must be good, right?

The 2005 five-year Government plan to improve Irish breastfeeding rates has been a miserable failure with overall rates increasing by just 2 per cent in the first four years of strategy implementation. One wonders if health professionals really believe that human milk is a superior food and that women are capable of producing it successfully.

Mothers complain about inconsistent advice and mixed messages from health care workers because, although the professionals say breast is best, there is always the get out clause.

None of this is surprising since most people giving advice to mothers were not breastfed. Partners, in-laws, relatives, friends and grandparents were not breastfed. Transition year students who visit maternity units think breastfeeding is disgusting.

To retrieve our breastfeeding culture the HSE should immediately abolish the bottle-distribution system in all maternity units, install vending machines and ensure health professionals provide effective breastfeeding counselling in accordance with World Health Organisation guidelines. But we cannot just blame the HSE or the Government for our abysmal breastfeeding culture. Breastfeeding is primarily supported by family and friends, and rates will not improve until we as a society believe in breastfeeding as the superior way to feed our children and trust women to do it successfully.

Dr Jacky Jones is a former regional manager of health promotion with the Health Service Executive