Second opinion: Breast is best; but not for Irish babies

Irish women are committed bottle- feeders. Despite overwhelming evidence that breastmilk is best for babies until they are at least six months old, few Irish women breastfeed. The abysmal rates are the lowest in the EU.

The OECD figures show that almost all babies – between 95 and 97 per cent – are breastfed in Norway, Sweden and Denmark. Only 56 per cent of Irish mothers attempt breastfeeding, and within 48 hours of birth the rate drops to 42 per cent. After three to four months, only 16 per cent of women are breastfeeding exclusively.

All 19 maternity units in the country now support the World Health Organisation's (WHO) Baby Friendly Hospital initiative designed to facilitate breastfeeding, yet the 2013 Perinatal Statistics Report shows that rates are the same as 2012. Why?

Feeding our young

Nothing humans do is ever straightforward. We are the only mammals that have made a meal, excuse the pun, out of feeding our young. History shows that the practice of breastfeeding, or not, is inextricably linked to patriarchy (a woman’s job is to look after men’s needs, not spend months feeding children); misogyny (a deep distrust of all things female, mother’s milk transmits more than nourishment); medical practice (interventionist models of childbirth); power (the ability to give birth and feed children is too powerful and must be controlled); religion and prudishness (women must not expose their breasts in public); and social class.

Irish women had, and have, to deal with more patriarchy and misogyny than women in other EU countries leading to lower breastfeeding rates.

For millenniums, women’s status determined whether they breastfed. Before bottles and formula foods were invented, poor women fed their own infants on pap of various kinds, including bread soaked in goat or donkey milk, and hired themselves out to rich women as wet nurses. In 1800BC Hammurabi’s Code regulated their behaviour. Contracts for wet nurses have been found on ancient Egyptian scrolls. An English countess in the 17th century hired wet nurses for her 18 children. Only one son survived. It could be argued that society’s negative attitudes to women and their breasts was a form of man-made global suicide. Infant mortality rates for children not breastfed by their own mothers were sky high.

Little is known about the practice of breastfeeding in Ireland prior to the 1950s. There was a sharp decline in rates from 64 per cent in the mid-1950s to 16 per cent by 1975. This coincided with the introduction of the Mother and Infant Care Scheme (Mics) in 1956, which was supposed to improve the health of women and infants but had the opposite effect.

Mics meant women had no choice but to give birth in interventionist maternity units overseen by obstetricians. The birthing experience has a profound effect on breastfeeding outcomes. Becoming pregnant, giving birth and breastfeeding are on a continuum and it is not reasonable to provide a wholly unnatural birthing service and expect women to feed naturally. Giving birth surrounded by technology makes it more likely that women will choose bottles and formula food.

Formula food

Obstetricians contributed to the decline in breastfeeding throughout the western world. They were favourably disposed to formula food from the beginning.

In 1904 a Chicago paediatrician claimed that the nursing function of woman’s breasts would eventually disappear. By the 1930s formula manufacturers began to advertise directly to doctors. In the US, formula food companies had to seek approval for their products from the American Medical Association leading to a positive relationship between physicians and formula companies. By the 1950s physicians/obstetricians promoted formula as being as safe, if not safer, than breastmilk.

Formula manufacturers began to target pregnant women directly using aggressive and coercive advertising.

When Sigmund Freud (1856-1939) declared that suckling infants experienced sexual pleasure, more women switched to the bottle. (See A history of infant feeding by Emily E Stevens, Thelma E Patrick and Rita Pickler in the Journal of Perinatal Education, Volume 18, Number 2, Spring 2009: iti.ms/1LgMPoi

HSE plan

The HSE is committed to improving breastfeeding rates. Its new plan, Healthy Ireland in the Health Services: National Implementation Plan 2015-2017, aims to "promote breastfeeding among all pregnant women with a focus on groups where rates of breastfeeding are low".

At least 60 years (since Mics) of negative attitudes to women need to be dismantled. The new maternity strategy, due later this year, must normalise childbirth by ensuring the 19 maternity units are midwife-led.

Advertising of follow-on and growing- up milks must be banned or it is only a matter of time before women wonder if they shouldn’t use formula from birth to get babies used to the taste. Children do not need these artificial substances. Breast is best, always was best, always will be best.

See breastfeeding.ie

drjackyjones@gmail.com

Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.