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Mixed messages

"Best for Baby. Best for Mom." Can't we do better?

By Johnna Thompson

As an older first-time mother, I was determined to do everything right when my daughter was born. After a lot of thought, and more than a little bit of reading, I decided that meant I should breastfeed and supplement one bottle per day for my husband to give her. It worked pretty well for about three months -- no "nipple confusion" or feeding problems here. Nope! My baby was (and is) too hungry for that. But one day, when she was three months old, she decided, "no more bottles, ever!" Funny, all the reading and internet surfing I did prior to her birth made it sound like babies will pick the bottle every time if given a choice. Silly of me to believe all those "experts," right? At eight months old, my daughter is still breastfeeding -- no formula at all, though she's recently started eating the occasional green bean or bite of sweet potato.

If you had asked me the benefits before my daughter was born, I could have recited a list of health advantages for both the baby and myself. I would have told you that breastfeeding:

  • helps mom regain her shape sooner
  • prevents postpartum depression
  • saves time and money
  • can postpone another pregnancy
  • promotes bonding
  • makes baby's poop and spit-up less smelly
  • doesn't affect baby's teeth
  • doesn't cause ear infections
  • makes baby have less upset stomach and prevents constipation
  • forces mom to take time out and relax
  • is "natural," but not easy

If you ask me now, I'll tell you that there's only one advantage that has really mattered to me when the chips were down. When I was exhausted after months of little sleep and no leisure time, my muddled brain didn't have to think about feeding my daughter; I just opened my shirt and voila. It's pretty much impossible to screw up, since it takes zero prep or cleanup. Although some of the other things are true, this was the only benefit I could name when my daughter decided not to sleep for days at a time.

As to the advantages in my list, my actual observations have been a little different. Here's a sampling of my experiences:

  • I did not lose a lot of weight
  • Poop stinks, period -- even the poop of a breastfed baby
  • Breastfed spit-up doesn't stain like formula spit-up
  • My baby still gets a stomachache sometimes, even constipation or diarrhea
  • My menstrual cycle did not resume until my daughter was seven months old 

In my efforts to continue breastfeeding my daughter until she's at least one, I've done a lot more reading about baby feeding since her birth. I've seen several references to a government campaign for breastfeeding, and I recently looked up the website. The campaign started in 2000 when the Department of Health and Human Services issued its Blueprint for Action on Breastfeeding. The HHS Blueprint was developed in coordination with several other government agencies, the American Academy of Pediatrics, the National Alliance for Breastfeeding Advocacy, and other medical and advocacy groups. The media campaign, "Best for Baby. Best for Mom." was launched in June 2004. The TV and radio ads are long since done, but other materials, like posters and slide shows are still available.

Before my daughter's birth, my only exposure to the government campaign was one of the TV ads from 2005. In that ad, a pregnant woman rides a mechanical bull while a voice-over announces, "You wouldn't take risks before your baby's born, why start after?" My only other "official" source of knowledge about breastfeeding came from materials my doctor gave me, including several brochures on how to breastfeed and why it is best. Despite the fact that the brochures said "breastmilk is best for your baby" in tiny print, they presented formula as nearly as good. They were written by a major U.S. formula company.

Once I made the decision to breastfeed, I realized I knew very little about it. Only one person that I knew at the time had breastfed any of her children, and she lives across the country from me.  I didn't grow up around it, and I was worried that I would mess it up. As a result, I depended heavily on those brochures from my doctor. I did do some other reading on my own, though I still trusted the doctor's information the most. Friends and family gave me books on pregnancy, most of which included a short section on breastfeeding. I visited a couple of websites that I had heard of, including the La Leche League International website.

If the government truly wants women to breastfeed, it needs a more visible, authoritative campaign. Advocacy groups and formula companies are each conducting somewhat disorganized but highly visible campaigns about breastfeeding that have nearly drowned out any messages from the government's campaign. The overt message, even from the formula companies, is always that "breast is best," but the details of why it's best and how much better it is are seemingly dependent on the source of the information.

The "Best for Baby. Best for Mom" campaign was originally planned with an emphasis on the negative impacts of formula. Criticism from various groups, including some doctors, some mothers, and the big formula companies, began even before the campaign launched. The original list of risks included diarrhea, ear infections, respiratory infections, leukemia, and diabetes. In response to the critics, references to leukemia and diabetes were dropped from the campaign because studies didn't link these risks strongly enough. In contrast, the HHS Blueprint includes the following more extensive list of risks: diarrhea, respiratory tract infection, ear infection, pneumonia, urinary infection, intestinal infections, and invasive bacterial infection.  In addition, the Blueprint states that, "breastfed infants, compared with formula-fed infants, produced enhanced immune responses to ...[certain common] immunizations," and had "earlier development of the infant immune system."

The compromise that resulted from the early debates is a strange mixture of negativity and ambiguity. The television ads come off as aggressive (showing clips of pregnant women riding bulls and log-rolling), while the print ads show pictures of dandelions and ice cream. It seems to me that print is the appropriate medium for explaining risks, while video is better for showing positive images. The formula companies know that mothers pay attention to the brochures doctors hand out, that's why they give them to doctors for free -- why can't the government do the same?

The current government campaign lacks focus and clarity. If the campaign is to achieve its goal of a 75 percent initial breastfeeding rate, it needs to do a better job of disseminating a loud and clear message. Though I'm aware that my experiences are not necessarily representative of women across the United States, I'd like to make some suggestions to improve the campaign.
1. Make breastfeeding a legally-protected activity, everywhere. This seems pretty obvious, and I can't believe that it hasn't already been done. The recent flap with Delta Airlines illustrates why this is important. Enough said.

2. Show women breastfeeding on TV and in other popular media. Even though many Americans say they think it's best, those same people often say they never want to see a baby breastfeeding. Keeping women sequestered when they are breastfeeding just encourages them to stop. In a recent article on Mothering Magazine's website, I read a great explanation of why some people don't like breastfeeding in public: "it is... common for human beings to be fascinated with things they have seldom ... seen before, to stare and gawk and appear rude....  Sometimes people who are unfamiliar with breastfeeding interpret their quite normal fascination as prurient or are simply embarrassed by their own responses."  Small but frequent exposures to the sight of breastfeeding women could work on the public the same way that allergy shots work on those with hay fever. A short ad, showing a woman breastfeeding and stating the campaign slogan, "Best for Baby. Best for Mom." could be shown repeatedly on TV; it's simple, easy to remember, and effective.

3. Use truthful advertising. Let women in our society who have breastfed talk about it in the campaign materials. These women need to be as honest as they can. They should be able to talk about the good and the bad. I think a lot of women who start off breastfeeding end up quitting because they didn't realize just how often their baby would need to nurse -- so it's important to help them prepare for that along with making them aware of the other possible benefits of breastfeeding. Clips of these women talking about their experiences would probably be too long to use realistically in TV ads, but they would make great educational videos for high schools and hospitals that give birthing classes.

4. Clearly explain the known risks of formula feeding. I've heard it said over and over how we shouldn't put a guilt trip on mothers who don't breastfeed, but I'm not sure why we think that. The truth is that mothers are not as fragile as that condescending statement suggests. Everyday, nearly every adult in the U.S. makes decisions about risks that they have been informed of through public information campaigns. We eat things that are bad for us, smoke cigarettes, drink lots of caffeine and alcohol; we drive without a seatbelt. We assess the risks based on previous experience and knowledge, then we proceed to do what we will. There is no excuse for not educating mothers about the real risks of formula feeding.

I realize the government doesn't have infinite funds for this campaign, but I think our tax money could be spent much more effectively. When I was drafting this article, I asked my husband if he knew that the U.S. government had a campaign for breastfeeding. I figured he's a new parent, if anyone would have noticed, he would. He said no. For me, that sums up how effective the current campaign is.

mmo : february 2007

Johnna Thompson is a stay-at-home mother of one.  She has a master's degree in statistics and is currently "studying" motherhood. She lives in Texas, where she breastfeeds her daughter and blogs at http://jobeanie.blogspot.com.
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