Thursday, May 1, 2014

Income and Breastfeeding

This is a post that I feel needs to be written, but I’m honestly nervous about how it will be received because it is such a sensitive issue, rife with opportunities to offend. Please understand that I have no desire to condescend, only to prompt thought and discussion. I welcome feedback and differing opinions, as well as more sources, information, and personal stories that will help to form a well-rounded picture of this societal concern.
Problem: Breastfeeding has significant health and cognitive benefits for baby, and health and psychological benefits for mothers, but those who might gain the most from these benefits - low-income families - are statistically least likely to breastfeed.

What is needed to successfully breastfeed?

Information: Mothers need to know benefits, how to latch, how to troubleshoot a bad latch, diet and nutrition, breastfeeding economics (supply and demand), newborn behaviors and hunger cues, etc.
Time: A breastfed baby feeds around the clock for at least the first month and often much longer. Establishing a strong nursing relationship and adequate supply may take trial and error. The mother also needs rest to recover from the birth and produce milk. Any other demands on mom's time can impede the relationship.
Support: Studies show that early and ongoing support (especially from other women and/or the mother's partner) is crucial to successful and continued breastfeeding. This can come from family, friends, hospital staff, support groups and organizations, etc. If the woman's social network lacks any supportive or knowledgeable figures with regards to breastfeeding, she is much less likely to attempt or continue with it.

How does income affect these factors?

Living conditions: A low-income mother is likely to live in an area with fewer resources available, like birth/newborn care classes that cover breastfeeding. Even if they are available, she may lack the time or means of transportation to attend.
Photo from this excellent blog post
Hospital: She is likely to give birth at a poorly-funded hospital with fewer resources to promote breastfeeding, such as Lactation Consultants, breast pumps, nipple shields, etc. The hospital may provide formula samples because its lack of funding will incentivize the acceptance of promotional deals with formula companies. While she is of course not obligated to use these samples, in the absence of proper breastfeeding education, she may feel it is easier (and more comfortable) to do so.
Job: A low-income mother may have a part-time job or work at a company with less than 50 employees, neither of which are legally obligated to allow maternity leave. This means she would need to return to work almost immediately to keep her job. Even if she is employed full-time at a large company, the standard 6-week maternity leave often ends before the mother's milk supply has been firmly established, especially if baby has spent any time in the NICU. Likewise, the mother’s employer may not fall under breastfeeding laws which require them to provide the space and time for her to pump, not to mention a place to store the milk.
Marital Status: She may be single or have an absent partner, meaning he would be unable or unwilling to provide her any support. Since the trend appears across several generations, the women in her family are less likely to have breastfed themselves, so they may lack knowledge and experience with breastfeeding, making her likewise unlikely to receive much support for nursing from them.
Equipment: Breast pumps can be expensive, and also require specific care, replacement parts, additional gear like bags and bottles, etc. Their use also tends to have its own learning curve.

What can you do about it?

Personal Support: Support the new, expecting, and experienced mothers in your life, no matter their income level. With sympathy and positivity, offer them your knowledge, encouragement, and friendship. Participate in organizations like La Leche League and Nursing Mothers Counsel, or join an online support group to share your experience with other mothers who may not have access to a local support network. Bake some lactation cookies for your sister, give your friend some soothing gels, and tell your online buddy how getting a lip-tie resolved saved your nursing relationship. And give a big smile to every mother you see nursing in public!
Activism (“Lactivism”): The current legal code discourages mothers, especially low-income mothers, from making the choice and attempt to breastfeed. I will not propose specific political solutions to this problem since we will all undoubtedly have differing views as to what is appropriate, but I will say: get involved.
Learn about maternity leave laws, breastfeeding laws, the effect of the WIC program on breastfeeding rates, lack of lactation management education for doctors, and FDA regulations for infant formulas. Share this information with others, find out where your representative stands on these issues (or if they’re even aware of them), and call or email them to share your opinion. Network with other breastfeeding mothers and advocates, attend events, and always be respectfully open and communicative about your choice and struggle to breastfeed.
Giving and Volunteering: Finished pumping but still have a pump in good working condition? Donate it! Consider giving to programs that support low-income families. If you’re feeling truly generous and are able to give of your time, think about volunteering for shelters and organizations that support new moms who are in tough financial and social circumstances. Breastfeeding is just one aspect of the overall quality of life for a new mother and baby, and changing the culture takes time, but this kind of mother-to-mother care will be invaluable for everyone involved.

The choice to breastfeed should be one that is available to all mothers, regardless of income or social status. For too many women today, not only is it NOT a choice, but it is a near-impossibility. What are your ideas to change this? How have you offered support to others? Are you a “lactivist?” Share your response and experience in the comments, and thanks for reading!

More sources:
If you read only one, it should be this paper
Occupational links to breastfeeding
Risks of Breastfeeding Cessation among Low-Income Families
Effects of WIC Participation on Breastfeeding practices
Nurse Practitioner perspective
Length of Maternity Leave as an obstacle
Formula marketing and legislation

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