What Does It Mean To Support Breastfeeding? Your Answers - Part 1
Monday, January 21, 2013 
Last week, I asked fellow Canadians on twitter if they support breastfeeding. A lot of people asked "what do you mean by support?". I think the answer is different for each person, but I was interested to hear from you. If you do consider yourself a breastfeeding supporter, what does that mean? I wanted to know, so I put together a survey, open to both Canadians and non-Canadians, and asked a bunch of questions about factors that are often or sometimes equated with breastfeeding support. I got 1631 responses to the survey.
Wow...that's amazing!
What did you say? In this post, I'm publishing the fascinating results from eight out of the ten questions on the survey. One of the other questions was an open-ended question asking respondents if they wanted to add anything else about what it means to support breastfeeding. More than 500 people had a comment to add, so I'll publish some of those comments in a second post later this week. The final question asked people where they lived, because I wanted to see if the answers were vastly different for Canadians versus Americans versus other countries. In the end, none of the answers had significant differences across geography (58% of respondents were from the US, 33% from Canada and 9% from other countries). If you aren't able to read the results in the graphics below, you can also view the results on surveymonkey.
The first question asked people about the extent to which they support a woman's right to choose how to feed her baby. Almost 90% agreed or strongly agreed that women should be able to choose whether to breastfeed or not. Of the remaining respondents, who either disagreed or were neutral, it would be interesting to know why. Is it because they believe babies have the right to be breastfed and that this trumps the woman's choice? Do they believe it should be a joint choice between both parents?
The second question asked people about the extent to which they support some of the Baby Friendly Hospital initiative's steps to successful breastfeeding (with some variation in language) and other factors that are often linked to breastfeeding success in a hospital or birth centre. The first few hours and days of breastfeeding are critical in establishing breastfeeding and breastfeeding problems are often attributed to poor hospital breastfeeding practices. Respondents were overwhelmingly in favour of practices that help establish a strong start to breastfeeding, but were quite split on whether a formula should be made available to a mom who wants to breastfeed without the sign-off of a doctor (I also considered saying "without sign-off of a lactation consultant" in this question, which I think would have conferred greater breastfeeding expertise, but possibly also be seen as more biased toward breastfeeding than a doctor).
Next, I asked how you, as a breastfeeding supporter, would support someone else who is struggling to breastfeed. I was pleased to see that most people suggested having the mom see a lactation consultant, with a breastfeeding support group coming in second. Most doctors do not have sufficient training in breastfeeding and I was glad to see that most people wouldn't suggest the doctor as the first stop. That said, within a Canadian context, the problem with these answers is that visits to the doctor are covered by the public health care system, while visits to the lactation consultant (except in hospital after giving birth) are not covered. That said, ome provinces and some cities do offer weekly drop-ins with lactation consultants (I know I benefited from one to have my low weight gain baby weighed on a weekly basis).
So if a woman does end up in her doctor's office, what should the doctor do? Despite a "celebrity" doctor (well, as celebrity as you get in Canada!) saying that doctors should just tell moms to try formula, most of you didn't think that is what should happen. The number of people who thought the doctor should give breastfeeding advice was a bit scary, given how . Personally, I support the last option. The doctor should start by listening to the mother and understanding her goals. If she wants to breastfeed and is having trouble, the lactation consultant would be the natural next step. But the doctor shouldn't assume that any mom who is struggling with breastfeeding wants to keep breastfeeding (she may not).
Next up was formula marketing. Unfortunately, for the first 200 or so respondents, the second and third items were merged together and I only noticed my typo after an hour or so of collecting answers. However, I got enough responses after fixing it that I feel confident in the results. There was strong support for various restrictions on how formula is marketed and less support for others. Interestingly, there was more support for restricting unsolicited samples (something that is currently not restricted) than there was for the "breastfeeding is best for your baby" statement that is universally used but is also the kind of language that formula feeding moms say contributes to their guilt. Personally, I think that limiting formula companies access to breastfeeding moms (i.e. no unsolicited samples, ending predatory marketing) should be a top priority.
Next, I wanted to know how people feel about human milk. Most people think "breast is best" and "formula is second". However, the World Health Organization puts formula fourth, after the mom's own pumped milk or another mom's pumped milk. Our society pushes breastfeeding, but does very little to support moms who have trouble breastfeeding but still want to give their baby human milk. Almost 90% of you disagreed with the first statement, demonstrating significant support for making human milk banks and human milk sharing a priority. There was mixed reaction to informal milk sharing or moms selling their milk, but quite a bit of support for governments making human milk banks a priority.
Next, I wanted to know how you feel about breastfeeding in public. If moms are forced to hide at home (or in the bathroom) to breastfeed their baby, it will feel like an inconvenience. They will feel like they are being isolated from society, even more than new moms are already isolated. Being able to nurse anywhere and everywhere is critical to a mom's confidence and comfort with feeding. Luckily, most of you seemed to agree with that, with less than 2% disagreeing with the statement that women should be able to breastfeed in public whether they are covered or not. Almost everyone agreed that we need more women breastfeeding in public in order to normalize breastfeeding.
Finally, I wanted to know what you thought the public health care system should support. I thought there would be a huge difference between Canadians and Americans here, but surprisingly there wasn't. Currently, a lot of new moms who struggle with breastfeeding find that it ends up being not only emotionally difficult, but also financially difficult. They end up buying pumps, and nipple shields, and paying for lactation consultants, and laser tongue tie clippings, and more. Sure, formula will end up being more expensive over time if the breastfeeding problems are resolved. However, many moms are on an incredibly tight budget during their maternity leave and these expenses are just too much. The good news is that most of you support having the public health care system pay for some of those expenses. Now how do we make that happen?
On my facebook page, one person noted that I didn't ask about maternity leave and workplace support for breastfeeding. That is true. I initially wrote the survey from a Canadian perspective where we have one year of maternity leave, so it is less of an issue. But they are still important issues. Women should be able to take some time to be at home with their babies and establish a strong breastfeeding relationship. Women should also be able to go back to work and have a workplace that is supportive of breastfeeding when they do.
I've said before, and I'll say again, that there is too much pressure to breastfeed and not enough support for breastfeeding. Moms are told that they must breastfeed. More than 90% of moms in Canada initiate breastfeeding (either because they wanted to or because they felt forced into it). But most of them do not meet their own breastfeeding goals. We need a lot less judgment of formula feeding moms and a lot more support of breastfeeding moms. Without both of those, this will continue to be a huge struggle for many new moms.
What do you think? Were these results what you expected?
...more to come when I share the results of the open-ended question.
Image credit: Kelly Sue on flickr
Reader Comments (24)
I think it is misrepresenting things (and dare I say privileged?) to say that parental leave is one year in Canada. full stop. Well, in a manner of speaking, maternity leave is one year, but it is only realistic for middle-to-upper class families. Because:
1) you have to qualify for E.I., which those who are un/underemployed or have close-in-age-children won't necessarily do and
2) even if you do qualify, then you only get a percentage (55% to a max of $500/week) of your regular pay (and only a few employers top up any material amount) and if you're barely making ends meet on your full pay cheque, then cutting it down to any percentage of it won't do.
So MANY parents opt out of parental leave because of financial reasons, not to mention job security (though, yes, it is technically not allowed to dismiss someone for taking pregnancy/parental leave but it happens all the time, especially to the most vulnerable) and advancement.
Plus, generally speaking, those who need to opt out or don't qualify for parental leave are also in employment situations where breastfeeding support is minimal/difficult, i.e., they are not professionals with access to private offices, self-directed break time, etc... for pumping.
Do you know (or know how to find out) the percentage of families are eligible for and the percentage who do use the full 35 week parental and 17 weeks of maternity/pregnancy leave, where available?
Oh hey, I just read about the "EI Family Supplement," which top ups EI for low-income families (up to 80% of insurable earnings if earnings are less than $25K/year), but still limited to $500/week.
I'm not saying our maternity/parental leave system is perfect (I've written posts before on its shortcomings). I just meant that it wasn't top of mind for me in terms of a breastfeeding support need in Canada.
With regards to workplaces, human rights legislation requires workplace accomodation of breastfeeding needs. That may not be applied universally (which could be an issue that needs work), but the law supports it.
I took the full year off this time around and needless to say it was a hairy situation. I am not middle class to say the least but the amount of money I received was barely liveable. My partner is not exactly rolling in money either so we barely scraped by. Not only that but the repercussions dealt from taking the year off were pretty terrible. When I left my job I worked 10-6 pm shifts and upon returning I was made to work 2 evenings a week to be 'fair' to the new girl they hired while I was off making a human. I think that not only does the EI Maternity leave system need to change but the way employers treat their employees does as well. I am not saying everyone should have children but those that do decide to take that step should not be punished because of it. Having kids is a part of life. I have been back to work for 5 months now and I can honestly say it took about 3 before people started treating me like myself again.
I know this was supposed to be about breastfeeding but I think all facets of Motherhood/Fatherhood are important. The only reason I wanted to take the full year off was so I could ensure my son had at least one full year of exclusive nursing under his belt. I am still nursing him so I am very proud of what my partner and I decided was the right decision for our family.
Two things to consider. First, it would have been helpful in interpreting the results if you had asked people if they self-identify as a breastfeeding supporter. Because you made the survey open to anyone and issued a public invite via social media, it doesn't really tell us if these are the answers of BF supporters. I'm pretty confident they are, given your audience! But I'm also curious about the outliers and wonder if those are people who don't identify as BF supporters who ended up taking the survey. Second, some of the spread in response ito question 6 may be down to the questions you asked. For example, moms "should establish" informal milk sharing networks is a confusing statement if you know that they already exist.
All in all, an interesting exercise. Thanks!
I agree with all the results in terms of support, but I also think that the ways the questions are formulated puts too much on the mother herself, even if all those things mentioned are there to support her decisions and help her meet her goals. It's always about the woman and her choices. When really, at the end of the day, I believe strongly that at least 50% of the problem (at least here in the U.S.) comes from physicians and hospitals/nurses. Some of the hospital practices mentioned will help - encouraging rooming in, etc. - but until everyone in the medical community is retrained to stop giving false information and using scare tactics to get mothers to stop breastfeeding we aren't going to see those numbers go up at all. The pressure from doctors makes me so angry. A friend recently switched to formula in the first month because the baby "wasn't gaining enough" weight (I don't know what that meant exactly, but I know the baby wasn't FTT) and the doctor thought she must have "low supply." I couldn't say anything but it made me so frustrated. It's very hard to advocate for yourself against that kind of advice unless you are super super committed to breastfeeding.
The survey was promoted as being for people who self-identify as breastfeeding supporters. Also, when I promoted it, I always linked to my blog post which provided the context (and not directly to the survey).
I did review the results and there wasn't a trend in the outliers of people disagreeing with everything that is positive and supportive. It was mostly people who would agree in one area, but disagree in another. That could come from a lack of understanding about what is useful/helpful in establishing breastfeeding (i.e. one person objected to all of the baby friendly hospital practices) or from person opinions on how public funds should be spent (i.e. everything is great as long as it doesn't come from my tax dollars).
Thanks for publishing the results so quickly. It was good to see that those who support breastfeeding are big supporters of a women's right to choose. I think the Canadian influence in terms of the maternity leave is a big deal. I know that living in the US and seeing women returning to work after 6 or (a generous) 12 weeks has softened some of my more rigid thinking around breastfeeding.
Oh goodness, this makes me sad. I know it's real but it's hard to see it laid out on paper(or a tablet I should say).
I am very glad you did this though, and I plan on sharing.
Support is key. I had a ton. Between my mom, who nursed me and my sister, my sister who nursed 3 babies, my MIL who wished she had nursed my husband longer, and other friends who nursed their babies, I knew I had a slew of women I could turn to for support. And my husband was great too. He knew it was best for baby and since it's free, he was all for it!
Support without pressure is a find line and I've found myself walking it at times. I think I could do a better job of supporting mothers who are struggling, and the next time I talk to someone who is struggling, I'll try to find that line and come down on the right side of it.
Wow, this is a fantastic post! Thanks so much for putting so much effort into doing this survey. I'm a HUGE advocate for breastfeeding and could my lucky stars every day that I gave birth in Canada at a hospital that provided amazing BFing support and that I have a year to be home with baby, I wish I had longer but despite working FT when baby is 11 mos I plan to nurse at least twice a day as long as she wants.
I am happy to see the results so quickly. Thank you for posting them!
While I think it would be nice if some of the questions had even more of the majority in agreement, at least the good intentions are there. I still cannot understand how on earth anyone who calls themselves a breastfeeding supporter can think breastfeeding in public is not acceptable. Who are those people? Why do they think they support breastfeeding but think the mother should pump a bottle or just stay home?
But for the other questions about donor milk availability and formula's availability, support after birth, the results speak the truth about what I feel. Breastfeeding supporters are not trying to take away a mother's right to choose and are not trying to ban formula, even though we want donor milk to be more available. We know that is certainly not the way to help moms and babies. I agree that both breastfeeding and bottle feeding moms need support and compassion. As a tandem nursing mother of two, i wouldn't want to be a bottle feeding mom for all the money in the world. My constant mom guilt is already tough for me to handle. Mentally dealing with failing to breastfeed for my entire life, the extra judgement coming from internal and external forces, and the worry about not giving my child the best, the biological norm, not being able to provide my own milk through their infancy into early childhood like a full-term nursing mother can provide, and worrying about long term health effects that I see correlated with formula would be more than I would want to bear. I want to give big hugs to the formula feeding moms I know that tried so hard to breastfeed but couldn't.
That turned into a ramble! Anyway, thank you.
Well said! I actually came here to say exactly this.
I have a four-week old baby that is exclusively breastfed. I'm also self-employed and have a part-time work contract that stretches to the end of March. I will be working from home with baby until that time, then getting self-employed EI (which you are only eligible for if you signed up an ENTIRE YEAR in advance of when you want to make a claim... not reasonable for many Moms who are dealing with unplanned pregnancies or who didn't expect to be self-employed when they had babies (like me) because that is the only work that was available when they were looking for work and we need to eat, whether or not we like the work arrangement).
When I do qualify, I will only be eligible for benefits until my child is a year old, meaning I will miss out on many weeks of leave that other mothers with 'traditional' employment arrangements can receive. And, when getting the maximum $485 per week (after two unpaid weeks of waiting), making ends meet won't be easy. Many of my friends, for example, have only taken 4-6 months of maternity/parental leave because they simply can't afford to live on EI benefits for any significant length of time, especially if they already have one or more children.
As to Karen's question about EI uptake, the statistics likely exist inside HRSDC (the gov't department administering the program), but I don't know if/how they are released... it may be worthwhile for someone to do a freedom of information request to get these data if they are not publicly available, because I know that many, many, many are like my friends and me - unable to take 35 or 52 weeks of EI for various reasons, yet we don't have the clout or collective voice of the middle and upper middle classes who receive employer top-ups, who have well-paying jobs, and who have job security.
Was question 8 the last question? I don't remember. If so , I think the survey needed more questions about workplace support.
I would like to see more conversation about supporting breastfeeding mothers at work. As mentioned up-thread, there's virtually no support for lower-wage earners or women in certain fields. (How does a bus driver pump at work?) My biggest struggles with breastfeeding my two girls came when I returned to work. Even with laws and employer policies on my side, there were some things that I needed to fight for and advocate for, and it wasn't easy. I gained a lot of knowledge with my first, and used that to demand support with my second. Many women might easily have given up when faced with barriers, their own lack of knowledge or the lack of knowledge on the part of co-workers and bosses.
The last three points on question number five ... stupidest thing I've seen on the Internt to date. Formula should be banned? So the mom with the double mastectomy get's to what??
You didn't read it very closely.
Martina:
First of all, none of the questions here references formula being banned.
Second, even if it did, this is a survey, not a sermon. So I could have put that question out there (and I would assume most people would have strongly disagreed with the idea of formula being banned).
Third, the mom with the double mastectomy should (a) be able to get formula and (b) in my opinion, also be able to access donor human milk. When people need blood, we turn to blood donors, not to artificial blood. Theoretically, the same is possible for breast milk.
Since there seems to be a lot of interested in discussing maternity leave, I thought I would post a link to one of my blog posts on the topic, where I discuss some of the problems (as I see it) and proposed some solutions. I'd be interested in your thoughts on that post too.
http://www.phdinparenting.com/2009/08/08/flexible-maternity-leave-parental-leave/
Some of that is different for Quebec, where I live. They've had self employed benefits for longer (I used them 6 years ago), the amounts paid are higher, and there is more flexibility (take shorter leave at a higher rate vs. longer leave at a lower rate). It still isn't perfect, but for me it allowed me to stay home for 6 months with my daughter (versus the 3 months I took with my son, when I was on the EI leave as an employee under the federal system).
1. Sorry ... meant to say the advertising of formula.
2. The majority did strongly agree with ads for formula being banned or rather prohibited
3. My mistake ... thought you wanted formula banned ;)
I personally LOVED getting free stuff such as diaper bags from Similac as did my Sister who solely breast fed. I like to think that I support breastfeeding to a certain extent anyway. As for the blood, we're actually moving towards artificial.
There is a significant difference between banning a product and banning ads of that product. I see formula as being similar to a c-section in a lot of ways. It is an alternative that carries some risks, but some people need it and others choose it. That's fine. But you don't see hospitals putting up billboards advertising "20% off scheduled c-sections this month" or talking about how "our c-section is the closest to vaginal birth". No one needs c-section advertising to know that they are available or to ensure their access to them. It is understood that they are available as an intervention when needed or desired.
I was curious about the artificial blood thing, and found this... wow!
http://articles.timesofindia.indiatimes.com/2013-01-12/india/36295882_1_blood-cells-artificial-blood-cord-blood
Looks like it's made from cord cells.
I think there will be more possibilities for milk banking in the future, but I don't see formula disappearing any time. Most women loathe pumping and lack much time to do pumping in the days when their babies are small, and human women are not dairy cows bred for maximum milk production. I wouldn't mind donating milk these days since my child is older and I have more time, but nobody's interested in mature toddler-adapted milk, so no go!
These results are interesting!
I wonder how they would compare to what we would see in society at large.
[...] phdinparenting on January 26, 2013 The last question of my survey on what it means to support breastfeeding was an open-ended one. I asked if there was anything else you wanted to say about what it means [...]