The
Real Breastfeeding Issue Goes Far Beyond Mere Guilt
by
Cynthia Good Mojab, MS
Thursday,
July 25, 2002
The
Oregonian
The
less a woman breastfeeds, the greater her risk of breast cancer. So concluded
a landmark meta-analysis in The Lancet medical journal, as reported on
the front page of The Oregonian ("Study finds key factors to lower risk
of breast cancer," July 19).
News
like this is often met with concern about inducing guilt in women who don't
breastfeed. But in no other area of health are people seen as needing emotional
protection from the knowledge of risk. In fact, concealing risk is unethical
and violates the principles of informed consent.
Women
are told of the risks of alcohol and cigarettes to their unborn children.
Smokers are told of tobacco's hazards to them and to those who breathe
their second-hand smoke. Yet the known dangers of formula feeding are rarely
disclosed to parents in a straightforward manner.
Instead,
parents hear about the "benefits" of breastfeeding, as though they are
perks above and beyond what mothers could want for themselves and their
children. These "benefits" are measured against the poorer health outcomes
of formula feeding–-outcomes so common in the United States that they are
seen as the "norm" by which we measure health.
These
outcomes are culturally but not biologically normal. Breastfeeding is biologically
normal. Breastfeeding for longer than a few months is biologically normal,
even if it is not culturally normal in developed countries today. The increased
incidence of breast cancer among women who do not breastfeed or who minimally
breastfeed is just one in a long list of risks that formula feeding poses
to mothers and children.
Because
of these hazards the American Academy of Pediatrics recommends at least
one year of breastfeeding per child and the World Health Organization recommends
at least two years.
Mothers
cannot make informed decisions without full information. Still, women can
know all the risks of formula feeding, have the desire to breastfeed, and
not breastfeed. When this happens-–and it often happens-–it is very likely
because of insufficient information and support.
Breastfeeding,
though biologically normal, is a learned skill. Many of us grew up with
no breastfeeding role models. We commonly have no reliable breastfeeding
advisers in our own families. Most physicians have little training and
experience with breastfeeding. Hospital routines regularly pose unnecessary
barriers to breastfeeding. Most U.S. workplaces fail to support breastfeeding.
Many states have actually had to enact legislation clarifying that women
have the right to breastfeed in public!
In
such a challenging environment, breastfeeding initiation rates are low,
breastfeeding duration is short, formula feeding is the cultural norm and
breast cancer rates are increased.
This
issue isn't about guilt. It's about respecting the right of women to make
informed decisions about their and their children's health. It's about
stopping the unethical marketing of human milk substitutes by formula companies
who profit from our declining health. It's about hospitals engaging in
evidence-based practices that support breastfeeding, and medical schools
including sufficient training on the importance and management of breastfeeding,
and employers enacting policies that keep women from having to choose between
making a living and breastfeeding their children.
A
woman's decision not to breastfeed must be respected. But women are routinely
deprived of the chance to decide based on all of the facts. And when they
decide that they want to breastfeed, they routinely face social and institutional
barriers that undermine breastfeeding and increase the risk of illness,
disease and death for children and women. A higher risk of breast cancer
is just one of those risks.
Cynthia
Good Mojab is a breastfeeding researcher and co-author of Breastfeeding
at a Glance: Facts, Figures and Trivia about Lactation. Further information
is available through her Web site (http://home.comcast.net/~ammawell) and
from La Leche League International at 800-LA-LECHE or www.lalecheleague.org.
©
Cynthia Good Mojab, 2002. All rights reserved.
