"Fresh Is Always Best": Evidence-Based Interventions For Supporting And Promoting Breastfeeding

The "Demonization" Of Breastfeeding In Public

For many decades breastfeeding has a played a major role health promotion and is one of many public health interventions that has been strengthened through health education. However, the rates and support of breastfeeding still lag, and much work still needs to be done.

Public health needs and interventions include but are not limited to protecting the public's health, and promoting and encouraging health behaviors, which include support for policies and laws that encourage and accommodate breastfeeding. 

Major Benefits Of Breastfeeding

Breastfeeding promotes and maintain an infant's health, and facilitates and helps to maintain critical skin-to-skin contact that is necessary between a mother and her baby following birth. After birth, a mother's body produces colostrum, containing antibodies to boost the baby's immune system, and aid in  short and long term prevention of disease for both mother and baby. Since the flow of colostrum is slow, a mother can learn nursing skills, and baby learns how to latch, suck its mother's milk, swallow, and breathe while  breastfeeding.

Social, Cultural, Federal, Legal And Political Determinants

With a host of great  benefits, why is breastfeeding so demonized? Our health behaviors, cultural and social perceptions and beliefs are heavily influenced by our surroundings and environment. Although everywhere we turn, there is an abundance of exposed breasts on television, in the media, and magazines, a mother and her baby are demonized if they engage in breastfeeding in public.

Proponents of breastfeeding, regard this as truly infringing, scary and downright hypocritical. Especially in the United States, mothers still cite negative, cruel experiences by the public, and even some health care professionals when they attempt to breastfeed in public. While in many cultures breastfeeding is normal and expected, in other cultures, especially Western cultures, women are vilified. Breastfeeding is seen as a 'forbidden, mysterious, and vile activity.'

Even with state and federal laws allowing mothers to breastfeed in public, such laws are not enforced, and women are only protected if they breastfeed on federal property. Many have been asked to leave certain establishments and places of business and other locations.  Mothers still feel uncomfortable, and fear for their lives and the safety of their babies when they breastfeed in public. As such, they avoid doing so-however necessary. Further exacerbating this situation, is the fact that there are no allowances or accommodations for mothers to breastfeed while traveling or at work, and no policies in place to support, promote and enforce the laws for this necessary and health promoting activity.

In sum, the major determinants for the low rates include but are not limited to cultural and societal norms, health beliefs and behaviors, access to health education and health care, and the lack of health educators and knowledgeable health care professionals, lack of sufficient funding and federal and state support to effectively support breastfeeding.

Public Health Concerns And Strategies To Reduce Disparities

The misconceptions, attitudes, barriers and lag in breastfeeding practices is a major public health concern and dilemma, and disparities in breastfeeding initiation and duration rates are higher in areas where mothers and their families are from lower socio-economic groups. 

Key strategies and interventions can solve the many  problems surrounding the issue. However, they must be appropriately chosen, and should be based on the target population. In other words, since there is no 'one size fits all' in health care, interventions must be tailored to meet the unique and individual needs of mothers. Funding at the federal, and state levels for continued evidence based research and public health community interventions is also critical.

Key strategies to promote breastfeeding, should include public health community interventions that will help to improve behaviors, perception, stereotypes, misconceptions, knowledge, lactation skills, and overall attitudes regarding breastfeeding. Mothers should receive the appropriate prenatal education which includes breastfeeding skills. In addition, since health care providers are at the forefront of healthcare and can significantly influence mothers, provision of intensive courses for health professionals and health education for mothers regarding the social, cultural, legal, and global aspects of breastfeeding will foster the initiative.

Major interventions should include but not limited to:

• Since early attachment and bonding relationship between mother and child through breastfeeding is very time-sensitive, newborns should be introduced to the mother's breast hours after birth. Evidence-based studies suggest that such infants are more likely to continue breastfeeding than their counterparts who are introduced later.

• Laws and regulations and public health policies should be in place prohibiting posters to be displayed by the manufacturers of baby formulas.

• Increased, intensive collaborative efforts with community-based healthcare agencies, hospitals, gynecologists, obstetricians, family doctors, pediatricians and midwives to display and promote multilingual posters and breastfeeding related pamphlets and steer clear of those relating to baby formulas.

• Mothers should be discouraged from using and relying on pacifiers, since pacifiers could lead to fewer breastfeeding experiences.

• Public health and public service advertisements must be increased to increase public acceptance of breastfeeding, and should include legislation that protects mothers and ensures a mother's right to breastfeed when and where it is necessary.
   
• Unless enforced, laws are moot and redundant. Although every state in America makes it legal for mothers to breastfeed in public, they can still be harassed and the culprits will not be held legally responsible. This is a 'slap in the face' for many mothers , especially poor, and single mothers who can only afford their healthier breast milk and cannot afford lawyers to fight for them in court.

• Workplaces, and businesses should designate 'nursing lounges' and other care facilities for children and mothers.

• Health education on breastfeeding should start as early as possible and incorporated into the schools' curricula to promote early understanding and acceptance.

• Hospitals should refrain from accepting and handing out manufacturers' formula 'care packages' to mothers, and should make every effort to ensure that mothers can be with their babies in a 'room-in' experience for closer and easier access to their babies so they can practice breastfeeding.

• Every hospital experience should be a positive one, and since most babies are born in a hospital, the period of stay for mother and baby should be used to promote a sound breastfeeding initiation and duration.

• Finally, it is necessary to acknowledge and include breastfeeding in discussions about women's reproductive health issues as much as possible. This will strengthen public health efforts to garner more support for women, babies, and breastfeeding in general. Breastfeeding will hopefully become the norm, rather than a deviation from the standard. This will then generate more tolerance, understanding and public acceptance.

Public Health's Commitment To A "Safer Breastfeeding"

In the meantime, public health organizations globally will continue to stay committed to increasing, promoting and supporting breastfeeding initiation and continuation rates, throughout the world. This health promoting stance will go a long way in contributing towards public health's ultimate goal: That of improving the public's health.