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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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The rubber band effect: building and maintaining resilience

When resilience is low, it can feel like life is an uphill battle

When resilience is low, it can feel like life is an uphill battle

Resiliency is one of those qualities that when we’re fully equipped and our resilience cup is overflowing, we don’t notice how strong we are- life just feels good. We tend to be either unfazed in the main by the curve-balls that constantly seem to come the way for many of us as adults or in a state of mind where we can readily find coping strategies to work through the issues we register. When our rubber band gets stretched out however, at some point we suddenly realise that there are cracks forming.

Hopefully, we reach that point with enough insight into our own inner workings and limits to know that our resilience systems are in need of repair. Psychological resilience is our ability to cope with stress and adversity. When we reach this state it’s time to regroup and find that inner strength to alter our situation (frequently that centres on changing our thoughts) in order to bring the rubber band back to its strong relaxed state. If we’re unaware that our rubber band is starting to fragment by being stretched so thinly then it’s difficult to see a way out of the tunnel that’s starting to enclose us and that can lead to the beginning of the blues or other negative feelings and for some people, symptoms of depression.

Stretching the rubber band

This last week and the last of my summer holiday, I reached the sudden realisation that my resilience indicator was reading low. In fact, it felt like I was hitting a record low alongside a feeling of being the most exhausted I have ever been. The power of the mind to erase previous negative experiences or at least lessen their magnitude means I don’t really think this was my least resilient point or my most tired- surely those severe reflux, no sleep newborn months were worse, or the times immediately post-earthquakes or other far more stressful events I have experienced? To me, it just felt earlier this week that like the polar vortex in the US that I was heading to zero or below.

It seems strange that at the end of a decent length holiday anyone should feel least resilient or most tired. However, anyone with children will know that holidays with children are not particularly restful (not even!), as pleasurable as they may be. In my case, after our family time away, it was two weeks at home for me and my daughter whilst my partner was back at work six days a week.

There are many interrelated reasons why my resiliency took a hammering at this point. Parenting a full-on boundary-pushing four year-old is one way to achieve a new level of exhaustion I have discovered (upcoming post). After another long arduous year with effectively no holiday time, it’s probably unsurprising that as the holiday went on, my mind and body realised how much resilience rebuilding I need. That and the trepidation of what the working year ahead entails as I am aware it is going to involve significant restructuring, including job losses, with one of the first (and uncharacteristic) emails issued this year about how we could maintain wellbeing this year (alarm bells screaming). For all the residents of Christchurch still, there are now the longstanding, multi-factorial and accumulated effects of being now three years and counting post earthquakes. The predictions of health professionals (e.g. here and here) were that the 3rd-4th year post quakes would be the hardest and they weren’t wrong and it’s worse for women.

Frequently, there’s a trigger(s) or factor(s) that is a resilience eroding tipping point and I would take a guess that all parents reach a point or many time points where their resiliency is far from optimal. In my case, the camel’s back-breaking stone was actually technology. We live in an age where we have embraced all the advances of technology and what it offers us, but there’s actually significant stress associated with use of technology- it’s real and it’s called tech stress. For me it was combined effects: a faulty motherboard in my work laptop which I have been waiting a replacement for for seven long months plus our home internet failing and promised support call-backs from our provider not eventuating. The ultimate tug on the rubber band has been, for the last month, needing to use my old, faulty and mega infuriating android because my iPhone was being fixed and has just been declared terminal following an unfortunate road/car vs. iPhone incident.

I’m acutely aware that this is a crazy first-world issue and seems pathetic as I write it, but the actual frustrations and time wasted trying to use this largely non-functional phone have felt epic. When technology use actually impedes life and impacts heavily on time in a negative way, it’s not the magical thing it’s touted to be.

How to rebound

I could have spent ages self-analysing and trying to pinpoint exactly what factors were impacting me and to what degree but having spent enough time working out the general list my aim was to get that rubber band back to as close as its strongest phase as soon as possible using decisive action. To take myself back to a state of wellbeing using whatever psychological, social, cultural, and physical resources seemed appropriate. These are called cumulative protective factors.

Get out and get active- surefire ways to boost wellbeing and enhance resilience.

Get out and get active- surefire ways to boost wellbeing and enhance resilience.

Although I am largely opposed to listicles, it seems appropriate to insert a list here. None of it is rocket science. For me, some of those key wellbeing steps are:

  • Get out. Getting out of the house to experience new things or favourite things is a key way to bounce back. Sunshine improves mood. Taking children on our journey teaches them too the steps they can take to improve their own mood.
  • Get physical outside. There’s nothing better than pushing oneself hard in the sunshine. In my case that means carrying my petite four year old (but still 13 kg) up a steep hill to the top on a sweltering day for a stunning view or mountains, hills, harbour, sea and (broken) city and then engaging in activities that are fun for both of us.
  • Get physical inside. Whether it’s just at home doing squats and abs or a super hard gym workout.
  • Be kind to self. Kind thoughts. Kind actions. Treat oneself- a hot chocolate out (without over-indulging which will lower self-worth)
  • Dancing. In the privacy of my living room in front of and with my child to the latest hits.
  • Engage in daily mindful breathing. Breathe in and breathe out.
  • Recognising that external situations I cannot change, but my thoughts and attitude I can control, not falling into the victim trap- it’s totally unconstructive.
  • Yoga and pilates. One of my two gym sessions a week where I escape the house sans child.
  • Honesty with my child about how I’m feeling- the most touching thing that happened last week was my empathetic and thoughtful daughter putting together a whole bag of her things while I was in the shower so she could cheer me up, when my phone stress got too much. That and lots of hugs, when the tech stress rose to the surface! This honesty also teaches them that no one is perfect- adults struggle at times too. Letting them be a part of the support of the journey back to wellbeing is invaluable in teaching empathy and also allows them to witness how to find their own coping strategies.
  • Honesty with others (partner, friends, family) about what’s going on. Doesn’t need to be long and involved- a problem shared is a problem halved and all that.
  • Creativity. Doing something for me like craft is such a great way to rebound and feel self-confident and fulfilled.
  • Gardening. Looking at what is growing in the garden, the insects and butterflies and new life is such a restorative activity as is eating produce we have grown.
  •  Doing fun activities in or out of the house with my daughter (and my partner, friends, family)- getting joy from her development, catching up and connecting with others. A day with my parents picnicking and walking on the beach was fabulous.
  • Reading. As a parent and an academic, reading a work of fiction or literary non-fiction is such a decadent relaxing treat.
  •  Watching a movie. There’s no way anyone could watch Frozen and not feel more buoyant afterwards, even my musical hating husband.
  • Organising and goal setting. This can be as simple as getting the house in a semblance of order each day after MissBB is asleep, or making progress on some chores, writing lists and plans or even unpacking some more boxes following earthquake repairs temporary relocation (from a year ago…).
  • Thoughtfulness. Doing something thoughtful for someone else.
  • Abandon technology. Ok, so the technology is not working- may as well pretend I am still away out of range and attempt not to use it.
  • Sleep. Reset the mind. Recover strength.

Most of these are recognised as key factors that promote resilience. In the wake of the earthquakes here, much has been written about individual and personal wellbeing and I will write more on it in later posts. One of the best initiatives nationwide is The Wellbeing Game, which runs for a month each year and individuals from teams have to record their wellbeing activities across a range of categories during that time.  Aside from great data collection for governmental departments, at a personal level this game showed me daily just how many activities I engaged in last October that promoted my wellbeing and it also pushed me to fit in even more. I was pleasantly surprised just how much I did to address my health and it has since made me conscious of what I do in a day to foster personal wellbeing and register when I am not doing enough.

The other great social media campaign running in Christchurch (but applicable to anyone anywhere) is All Right? which is led by the Mental Health Foundation and the Canterbury District Health Board. Like The Wellbeing Game it aims to make us think about our mental health and wellbeing, here as part of the earthquake recovery process. With great billboards, postcards, lots of online resources and crazy spontaneous activities it is bolstering our exhausted residents. Mine and MissBB’s favourites: the posters stuck around the city with ‘free compliments’ to rip off and keep.

Many reality TV programmes are partly built around the concept of testing resilience- the Survivor series and the like. While, I was writing this post in the background I had the new Bear Grylls TV series, “Bear Grylls: Get Out Alive” shot here in New Zealand playing. American teams of two are put in taxing situations in our remote areas and those that don’t have coping strategies are eliminated. It’s both a contrived and extreme example of the assaults on our resilience we face daily, but the methods to improve resilience and be equipped for survival are exactly the same.

Just like the grip of the first polar vortex has eased in the US, my rubber-band is relaxing and rebounding again. Being prepared and equipped means a second cold snap for the US or in my case the return to work should hopefully have little negative effect.

When parents are resilient then they are better able to parent positively. Allowing children though to witness the ebb and flow of resilience is an important part of their own development (more on that in the next post). I just hope I can get our intermittent, suddenly dial-up speed slow internet to behave long enough to put out this post. Breathe in, breathe out.