Tag Archives: incentive

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?

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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?

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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