Tag Archives: breastfeeding

Making mammary use mandatory: why legislative or incentivisation approaches to increase breastfeeding rates are unlikely to succeed & why these measures are an erosion of a mother’s rights

Could being found not to comply with the mandatory breastfeeding law in the UAE see mothers on the wrong side of the law?

Could being found not to comply with the mandatory breastfeeding law in the UAE see mothers on the wrong side of the law?

Breastfeeding has once again been hitting the headlines in the last week, stirring up milk debate around the world with the announcement that the Federal National Council (FNC) of the United Arab Emirates (UAE) has passed a clause making breastfeeding mandatory for the first two years of a child’s life. Breastfeeding at least within the UAE is now ‘a duty and not an option’.

This is indeed an interesting move and one that warrants a little more examination and consideration than any initial response as it raises interesting ethical ideas.

I’m a strong advocate for promoting breastfeeding as the normal scenario for mothers and babies, in line with the official line from UNICEF, WHO and other organisations, whose policies are based on the outcomes of numerous scientific studies.

Note I won’t refer to ‘breast is best’ or state that  breastfeeding gives benefits throughout my posts as breastfeeding is the physiological norm and NOT breastfeeding carries with it numerous potential negative immediate and long term health outcomes for mother and child. I’m also in firm favour of wherever possible breastfeeding to two years and beyond. Thus, you might logically suppose that advocates like myself would be supportive of anything that is intended to encourage breastfeeding and improve breastfeeding rates, including this new law. However, as I’ll explain below I’m not in favour of approaches that do little to educate and empower both mother and child as a whole.

Punishing non breast-feeders

The FNC has been debating the addition of this clause to the new Child Rights Law for some time. There were fierce opponents within the FNC who did not favour its inclusion. The intent of the clause is to foster strong mother-child relationships by maintaining that breastfeeding is a right for all children. This idea (and the suggested duration of two years) is taken from the Quran, although the Quran itself does not suggest that breastfeeding must be mandatory- the derivitisation within the clause stipulates the mandatory nature.

I would say that access to breast-milk (rather than breastfeeding per se) should indeed in these enlightened times be a right for all children. This might on the surface put me at odds with many women, who would argue that it is a mother’s right to choose how she feeds her baby. I’m not arguing against this as I also agree. I don’t perceive a child’s right to breast-milk and a mother’s decision on how to feed her baby as mutually exclusive.

For a variety of reasons, not all mothers are able to actually breastfeed and certainly not all are able to breastfeed for a full two years (I’ll discuss more in later posts how reduced milk supply can arise from breastfeeding patterns particularly within the first 2-3 weeks post-partum). Luckily in Western countries donor milk is now becoming more routinely available, either through formal arrangements such as milk banks or through informal arrangements between friends, now providing a viable alternative for those that cannot feed their babies themselves. In contrast, the alternative arrangement within the UAE seems to be the paid provision of wet nurses for those that genuinely are unable to feed. This may then not be the same (i.e. less empowering) as a mother obtaining donor milk and feeding her child herself, although a much preferred and as paid for by the state, cheaper alternative to formula. There are pros and cons to either donor milk/wet nurse scenario.

Part of the rationale of the addition of this clause is to ensure consistency with existing labour laws that allow working women time for breastfeeding. A clause to ensure all workplaces have a nursery did not pass into legislation although a nursery law proposal not specific to working women will be tabled soon. Thus, it is clear that the UAE is trying to put in other supportive (although still legislative-based) measures to improve the mother-child relationship.

However, the passing of the legislation does allow for husbands to sue wives if they did not breastfeed throughout the first two years of their child’s life. How enforcement would work is unclear at this stage but punitive outcomes could be put in place. I wonder what will happen for mothers who may find their milk supply dwindling between six months to a year and unable to meet their two year quota?

20Mar2011_2220_fence my hand

Opponents argue that such a negative consequences approach will actually lower breastfeeding rates or morale around breastfeeding as women experiencing issues will feel pressure that may adversely rather than positively impact breastfeeding. Parents may hide what they are doing or not doing for fear of losing a child, rather than seeking out support.

Thus, we have a situation where the rights of the child are being acknowledged, which is fabulous, but not at this stage the rights of mothers. Like other advocates, it’s my belief that such an approach will not work. Some mothers within the UAE are also speaking out.

In the UAE, both a woman and her breasts actually belong to her husband. The Child’s Rights Law now makes the breasts the property in essence of the child for the first two years of its life. So at no stage does a woman actually ‘own’ her own breasts. For us living in different countries this is a staggering thought.

And what of mothers who wish to breastfeed longer than two years? I Am Not The Babysitter sums it up here in her post when she says that it will just add to the stigma of breastfeeding. Husbands regain ‘breast control’ at two years of age and may either potentially say Stop or Continue.

If we want to improve outcomes for parents and their children, and specifically here improve breastfeeding rates and duration of breastfeeding, then the key is both appropriate education programmes and strong support systems from hospital bed to home. Women need to feel empowered about the choices they make for themselves and their children.  It’s going to take a community approach to improve breastfeeding rates, not a predominantly law-based one.

Legislative measures do have a place, however, alongside education and mentoring systems. Longer (six months or more) paid maternity leave, nursing and childcare facilities within/adjacent to workplaces are key infrastructural support components that are known to work. In most countries though, including here in New Zealand, we are a long way from the ideal at present.

Rewarding breastfeeding with cold hard cash

Could mandatory breastfeeding become the standard in other countries too? I think that this is highly unlikely in most Westernised countries at least but an opposite and potentially as disastrous approach is being employed in some places.

Last year it was announced by University of Sheffield researchers that a trial was being conducted in some areas of Britain to tackle the very low rates of breastfeeding in Yorkshire and Derbyshire by incentivising through cash payments. If the trial is successful, the intention is to trial the scheme out nationally, before making it a nationwide policy. The trial will record breastfeeding levels and look at the attitude of the mothers to the monetary vouchers given.

Mothers who opt to breastfeed (and regardless of whether they were going to anyway) will receive £120 ($245NZD) in vouchers for chain stores/supermarkets. All they have to do is sign a form saying they have breastfed their child for six weeks. At six months they go through the same form signing to receive another £80 (160NZD). Although the intention is that they buy quality food etc, there is nothing to stop participants spending the money on cigarettes or alcohol. If the scheme is adopted, cash would be given for mothers to spend as they see fit. There is also no way of knowing whether participants are telling the truth.

The idea of the incentivisation scheme is that it will supposedly raise the perceived value of breastfeeding through paying mothers for the service. Although it’s the ‘flip side of the coin’, this scheme in essence is disempowering women in much the same way as the UAE scheme is and it has received a lot of flak. UNICEF released a statement saying that incentivisation may have a role and that “any new research can only be assessed once it has been completed and its various successes and limitations are clear”- in other words- a reasonable ‘let’s wait for the outcomes’. UNICEF emphasise that support is fundamental to breastfeeding success.

To me though, it is frightening to think that these are the solutions that being offered. How can those in charge so easily misjudge people and inaccurately identify appropriate solutions? It doesn’t look like the scheme is associated with any form of education, support and mentoring system.

The researchers involved have defended their scheme and the money invested in it by saying that similar schemes exist elsewhere (Quebec, monthly payments for breastfeeding; India, free food for breastfeeding mums). Just because a scheme operates elsewhere, it doesn’t make it the right choice. The researchers also claim that they surveyed mothers in the target areas who were largely in favour of the scheme- this might be the case, but again it doesn’t mean the scheme will be successful or appropriate. Schemes like this in my mind actually probably cheapen mother’s perceptions of themselves and their behaviours and disempower with the “You do this and I’ll give you this” mentality- there’s a level of handing over control of your body to someone else and I’m not talking about the baby.

Enforcing Caesareans- cutting out a mother’s rights

Where are we heading to if we are intent on fostering change by disempowering rather than empowering mothers? Again in the UK last year there was an alarming case of an alleged forcible Caesarean carried out following the mother supposedly seeking help for a panic attack. The outcome of this was being sectioned under the Mental Health Act, five weeks of hospitalisation followed by sedation and a C-section without her knowledge and consent in order to remove the baby purely for child protection purposes. How far will we go to push parental control out of the hands of the mother?

06Aug2011_3329_fence blue sky

Both a mother’s right and a child’s right must be considered

It is a step forward in many ways that the rights of children are being considered and given weight to. We acknowledge the right of the child even as a fetus from a close to midway point in gestation. Knowing the health outcomes of breastfed babies versus formula and advocating for the right of the child to have a chance at the best life possible through a right to breast milk is a further forwards step but in no way should this also be at the exclusion of rights to the mother as this may inevitably lead to negative impacts on the maternal relationship. If we want good parenting then we must put considerable effort into support and mentoring of parents- neither a carrot-based approach nor a cane-based approach fit this manifest.

The researchers and enforcers should learn from positive parenting what really works

Financial incentives and/or legislative change may be one small puzzle piece in improving breastfeeding rates, although it’s personally not one I favour. After all, we use negative financial incentives (taxes) on harmful substances such as alcohol and cigarettes. The University of Sheffield researchers state that “the advantage of financial incentives is their ability to attract and engage their target audience”. It seems to me that this is buying in (excuse the pun) to the idea of entertainment as a solution. I think we parents deserve a little more respect than that.

The approaches discussed above appear to come from the perspective of treating the symptoms (let’s improve breastfeeding rates) and not the cause (why are breastfeeding rates in the UAE and UK (and other places) so low?). Such a solution is the easy way out, that might result in a short spike of improvement as a quick fix but is unlikely to be sustainable in the long term.

Legislators and researchers might be wise instead to look to those of us who use positive, gentle parenting approaches to understand that communication, superb educational and peer mentoring together with widely available nurturing support are likely to have more substantial positive effects on breastfeeding rates. Alongside these approaches as well as increased paid maternity leave, better or cheaper childcare access and breastfeeding rooms in workplaces, consideration should be given to taxing formula in the same way as alcohol or cigarettes, making formula prescription only, investing in milk banks to ensure all children have access to breast milk and even perhaps some incentivising of breast milk donation (like sperm donation, where the money is given outside of the target family and therefore does not impact on that family relationship). In knowledge, not money, lies our future.

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An article based on this post appeared on The Conversation UK site on February 20 2014. You can view the article and comments at https://theconversation.com/forcing-mothers-to-breastfeed-is-no-way-to-help-children-23377#comment_317931

Links

http://www.thenational.ae/uae/government/fnc-passes-mandatory-breastfeeding-clause-for-child-rights-law

http://www.unicef.org/eapro/breastfeeding_on_worldwide_agenda.pdf

http://www.who.int/topics/breastfeeding/en/

http://au.lifestyle.yahoo.com/practical-parenting/baby/feeding/article/-/21171893/uae-passes-breastfeeding-law/

http://muslimvillage.com/2014/01/31/49427/uae-mothers-must-breastfeed-for-two-years/

http://www.iamnotthebabysitter.com/three-reasons-uae-mandatory-breastfeeding-law-sucks/

http://www.telegraph.co.uk/health/healthnews/10442290/New-mothers-bribed-to-breastfeed-by-NHS-with-200-shopping-vouchers.html

http://nz.lifestyle.yahoo.com/practical-parenting/baby/feeding/article/-/19803323/financial-incentives-to-breastfeed-a-waste-of-money/

http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/Statement-on-new-study-on-financial-incentives-to-breastfeed/

http://www.theguardian.com/commentisfree/2013/nov/20/not-ashamed-giving-mothers-incentives-breastfeed

http://www.theguardian.com/commentisfree/2013/dec/02/caesarian-choice-allegations-forced-intervention-pregnancy-childbirth

http://www.naturalchild.org/guest/leslie_burby.html

http://www.shef.ac.uk/scharr/sections/ph/research/breastmilk/fi

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Life is precious

P1000747_BB baby

This wasn’t the first blog entry I had planned to write. The topic I had in mind was entirely different- philosophical and thought-provoking, yet in keeping with the festive season. It should appear next week all going to plan just in time for Christmas. However, this weekend, life had other plans for me, or more specifically some rather nasty gastroenteritis-causing virus that so typically since becoming a mother danced around the edges of my existence, causing discomfort but not disabling, before it so nicely waged war on MissBB (my only child, aged 4) and my other half. Naturally, this leaves me, the maternal force in this household taking charge, keeping on going, whilst the afflicted victims crank up far too much screen-time in a pallid, limp state.

I am grateful that in the last four years that this is only the second stomach bug my daughter has faced, due I am sure to the extended breastfeeding relationship we have had (expect more on that in later posts). However, it had a violent onslaught at 1am Saturday night and the rest of the night thereafter. The multiple bed changes and all the necessary nurturing, I am sure all parents have to go through at times when their children are similarly attacked by such nasty viral visitors, is exhausting. I should say here that this is but another layer of exhaustion on top of the general working mum fatigue and the fatigue of someone living in Christchurch three years post the quakes that have ravaged my city.

I work an incredibly full-on job as a part-time academic (0.8FTE paid….) but typically far from part-time in hours (more to come in future posts on this). Many part-time parents can relate to this familiar tale of the realities of part-time employment, full time parenting. Some of the flow-on effects can be found here and here (tip of the iceberg- I’ll delve into this intermittently in my future posts). My work comes home with me every night and once the parenting is done, the household chores are sorted, the late shift of work begins. This weekend I had (heck, have, as yet to start) some pressing work to finish, deadlines to meet.

When MissBB first called out at 1am I was trying to get my head around what exactly those work tasks were and decide how I could prioritise to do them the next day. Amongst my instant and instinctive response to attend to my child’s needs, but mainly in the aftermath lying beside her trying in vain to sleep in between holding the bowl for her vomiting episodes, my mind was the pressure of the work tasks ahead of me and the impossibility of the situation. How could I get it all done? Eventually I let go and still much later sleep finally  but briefly slipped over me after 4 am.

Yet nestled within the unpleasantness of dealing with someone being so violently ill, there was a strange but recognisable beauty. Holding my daughter’s hair gently back from her face, whilst she without a whisper of complaint held her head over a bowl for the first time and then again and again reminded me of all the times my mother and partners over the years have done that for me and it felt so soft and gentle to be doing this. Wiping her face with a cool cloth after each episode and holding a cup whilst she ever so delicately sipped water to take away the acid burn was such a symbol of nurturing also, that I couldn’t quite help but be touched by the intimacy of the moments my daughter and I shared.

In the morning that followed with my mind telling my brain to be still about the tasks as yet to be started, I found a pressing need for calm. My daughter needed me and my full attention whilst she lay on the couch, limp, pale and feverish and so uncharacteristically still and quiet. And whilst I may have momentarily glimpsed a sense of panic within me when she curled up on top of me to doze mid-morning for well over an hour (that to-do list just itched to burst into a loud song) , I chose instead to savour that time. My arms curled around her whilst she lay on me in the fetal position like she was a newborn let four years flash before my eyes. It felt so special and so incredibly precious to be holding my daughter and to have this moment that it needed to be cherished, saved up, remembered.

Perhaps I was more sensitive to the need to hold, be still and calm, and reflect this particular weekend. The tragic death of my boss’s wife when their car hit a rogue horse on the road on Thursday reminds me that life is indeed too precious and sometimes far too short. Our greatest gift to the world and to ourselves is our children. No matter how unpleasant the job of parenting may seem at times there is always beauty and tenderness that can be found. Forget the to-do list – it will still be there. Take the time instead to savour the gift you created.