Breastfeeding is a Public Health Issue?

As a non-vaxer, the term “public health issue” makes my ears perk up.  I do not believe that “public health” ever trumps “personal liberty”.  Recently though the American Academy of Pediatrics issued a new statement on breastfeeding that has some lactivists rejoicing while other moms (breastfeeding or formula feeding) are insulted at the infringement of their personal choice.

Here is the gist of the AAP recommendation read the full text here:

infant nutrition should be considered a public health issue and not only a lifestyle choice.

The wording of “lifestyle choice” seems to imply that this statement is aimed at individuals.  I can completely see why mothers would get their hackles up at another attack on how they choose to mother.  However, I do think that the statement is a positive thing and here is why:

Audience

The audience for this statement is pediatricians.  The statement goes on to say,

Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad.

To me this is the most important point.  How many of us have had our breastfeeding undermined by pediatricians that say we need to supplement or that our supply is insufficient without ever referring us to a Lactation Consultant.  Many (not all) pediatricians are very blasé about breastfeeding and even worse some hand out formula samples to exhausted, worried new mothers and just they time they need someone to encourage their breastfeeding plans.

The AAP’s statement is a strong call for pediatricians to fill their roll on the front-lines of breastfeeding support.  Hospitals already have a strong incentive to change their policies to breastfeeding-friendly ones with the Baby Friendly Initiative.  Often, a baby born in a baby-friendly hospital next meets resistance from a non-breastfeeding friendly pediatrician.  I think this recommendation will greatly improve breastfeeding support by normalizing not just breastfeeding but breastfeeding support (read: not sabotage) by doctors.

Effect of Lifestyle Choice

The AAP also has very strong statements about vaccination.  So much so that not only are 99% of pediatricians recommending vaccinations but many are rejecting families who make a different choice.  This is wrong and exactly what should NOT happen with breastfeeding v formula feeding.  The role of an AAP recommendation should be to unify the pediatric practice with the AAP’s opinion on best practices.  Currently that is vaccinating and now breastfeeding.  That does not mean nor give license to pediatricians to discriminate against families that make an alternate choice.  If you choose to not vaccinate or not breastfeed at most a pediatrician should share his opinion with you respectfully and then go about providing care to your children.

Effect of Public Health Status

The reason I am in favor of this new statement is that defining something as a public health issue brings great attention to it as well as follow-up funds!  For example, the strong stance on vaccination by the APP (and FDA and CDC) is one of the reasons that vaccines are covered by nearly all insurance plans.  The medical community deems it important ergo it is covered.

The same effect can help breastfeeding.  If it is framed as a public health issue then perhaps insurance companies will cover breastpumps (some do), lactation consultants, and galactogogues.  The exposure of the issue will improve breastfeeding support for working mothers and perhaps one day contribute to what I feel is the biggest impediment to breastfeeding – a complete lack of paid maternity leave.

Can this recommendation be abused to shame women?  Of course.  Isn’t everything?  However, WE are in charge of that.  We can decide that this is not about individual women’s choices but about the system that can and often does limit our choices (after all “choosing” to formula feed because as a waitress you know your boss won’t let you pump is NOT a choice).  We can always defend a woman’s right to choose what is best for her family.

At the same time perhaps society will put some power behind their empty words that they “care about breastfeeding”.  This is patently untrue when a woman has no access to basic support for breastfeeding.

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