When I was younger and naive I believed what society told me about economic groups (Wealthy, Middle Class, Working Class, and the Poor). I believed that my decision to breastfeed my children was as much based in financial need as it was in my desire to do what was BEST for my children. I have since learned that my decision to breastfeed was made possible by my financial and social privilege.
August is World Breastfeeding Month. An entire month devoted to improving Breastfeeding outcomes. There is plenty of evidence that human milk is BEST for human babies. Human milk is AMAZING! Human Milk Production interacts with the baby's saliva to provide nutrients and antibodies that the baby needs in that particular feeding session. Human milk is FREE. Human milk is convenient (no need to keep bottles cold, then heat them) it is on demand nutrition. So why in the WORLD would any family choose NOT to nourish their child with human milk?
There are many reasons people (and societies) around the world choose to nourish with human milk and many reasons they are forced to nourish with formula. This blog post is specific to the United States of America. Not just first world nations, but the United States of America specifically.
Families may choose to bottle feed (with human milk or formula) for any number of reasons, here are just a few:
Previous physical trauma
Cancer
Mastectomy, Gynocomasty or other surgeries that have traumatized the mammary tissues (Yes IT IS POSSIBLE to nurse after breast/chest reduction, if that is your situation please find an IBCLC with experience in this area)
Poverty
Lack of Support
Lack of Information
Un-supportive boss/co-workers
time
pain
fear
This post will focus on the financial factors that effect a families ability to nurse their child, and touch just briefly on a few of the social factors.
First, financially, many families cannot afford to nurse their child. Some of you might be thinking that human milk is free, convenient and accessible and therefore poverty should not negatively effect the ability of a family to nurse their child. Sure, you don't have to hand over cash for human milk. But that is not the whole story.
Birthing persons are guaranteed 6 weeks of maternity leave. Your employer cannot fire or demote you for taking maternity leave. Maternity leave is NOT PAID LEAVE. SOME people are eligible for partial reimbursement of lost wages under "disability pay" and others full pay under "the paid family leave act." I am not a legal expert, nor do I fully understand the Paid Family Leave Act (I left the workplace before this existed), but neither program is universal.
Let's assume that the Birthing Person qualifies for disability reimbursement for their 6 weeks of leave. This is partial reimbursement of wages. Why am I so focused on the word reimbursement? Because when you live paycheck to paycheck making just enough (and in many cases NOT ENOUGH) to cover your bills, having to wait 4-6 weeks after you leave work to receive less than half of what you make simply isn't feasible. Many birthing persons go back to week at 3 weeks, not 6 weeks. Not because they want to, but because they HAVE to.
The human milk supply (on average) takes 12 weeks (3 months) to establish. Whereas we are only guaranteed 6 weeks of leave. A nursing parent who goes back to work in the 3-11 week period may have added challenged in establishing a sufficient milk supply to nourish their child.
There are legal protections in place that allow nursing persons the right to pump at work. However, uncooperative companies, bosses and co-workers may make this impossible to assert. If there is no clean/quiet space to pump, pumping may not happen. IF a supervisor or boss is upset with a nursing person using their right to pump they may find "other" causes to write that person up and threaten them with being fired. Sending the unspoken message that it is the job or pumping. Of course that person would have legal repercussions against any employer who fired them for exercising their rights, but this is ONLY ACCESSIBLE to those individuals with the social and financial means to fight for their rights.
Let's assume that your employer is friendly and supportive to pumping at work. Pumping is not the same as physical nursing. The skin to skin contact is a crucial factor, as is baby's saliva, and a number of other factors that are missing when pumping. Many people find pumping MORE difficult and even painful (reporting MORE mastitis/clogged ducts with pumping than exclusive breast feeding). For those who lack the social and professional support this can be a tipping point. Formula is sufficient, it is designed to be.
For those with social/financial privilege there is access to PRIVATE CLCs (Certified Lactation Consultants - an unregulated field) and IBCLCs (Independent Board Certified Lactation Consultants - an independently regulated field) if there is a lack of immediate social circle support, they have access to PAY someone with information and knowledge to support them on continuing their nursing journey.
Groups like Beautiful Birth Choices offer wonderful paid supports as well as FREE resources like their Breastfeeding Cafe. Additionally, area hospitals like Highland and Rochester Regional Health also offer free Breastfeeding Support Groups. That these are FREE is wonderful, but they are still not accessible for MANY poverty families. They happen during the week, during the day when MANY have to work. (Beautiful Birth Choices has a weekend meeting.)
We've talked about pumping at work, but what if you don't have access to a QUALITY pump? It is my understanding that ALL insurances have to provide new parents with a breast pump, but the how is a little grey. For example, almost ALL NYS plans require that baby be born BEFORE a breast pump can be ordered under insurance. Each insurance company has it's own guidelines for what pump it will cover and how to acquire said pump. In some cases a family must pay a co-pay or pay out of pocket and then be reimbursed. This prevents some families from ever ordering their breast pumps.
Milk storage bags are not free. Milk storage bags cannot be reused. They are a one time use. Milk can be stored in bottles, but if one is primarily pumping it would require a larger investment in bottles to have enough stored milk to get through 1-2 days while pumping to keep the stash supplied.
Now that we have touched the tip of the iceberg with financial constraints to nursing, let's explore some of the social constraints (a/k/a racial bias).
What happens when the medical community is racially biased and assumes that people of color either won't nurse at ALL or won't stick with it, so they don't provide support in the hospital? Or the support they provide is mean and gruff, making the initial experience unpleasant? What if parents of color are set up to fail?
What happens when there is a historical social stigma attached to nursing? (Wet Nursing)? What happens when everyone around you constantly says "Why don't you just give the baby a bottle? You look tired. It is nutritionally the same."
What happens when a new parent is told that WIC provides formula, but isn't told that nursing parents are entitled to additional WIC benefits in place of formula, to support milk production?
What happens when racism enters the picture? When a parent of color nurses their baby in public, and a white male is offended? What happens if that white male raises a stink? Calls the cops? Is the parent of color afraid of being arrested? Having their child(ren) taken from them?
The fear of having one's child(ren) increases in the extended breastfeeding argument. When white people begin to make comments like "Isn't your child to old to still be nursing?" the fear (and reality) that a report for child neglect or endangerment will be made increases.
There is so MUCH more to the racial bias that impacts a parents ability to nurse their child, but it would be better explained from someone who has experienced this. So I suggest if you want to know more, you Google "racial bias and breastfeeding" and read articles written by people of color on the topic.
So please consider before you like/share/post a Meme or Picture that touts BREAST as BEST that some people are not ABLE to Breast Feed and these posts and Memes make them feel inadequate or a failure. Please consider that a NOURISHED BABY IS BEST.
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