Let's begin with my American perspective from the 1980's to 2000's...
My first memory of breastfeeding was not until I was 15 years old. I was bottled fed...my brother was bottle fed...all of my cousins and every baby I ever saw were bottle fed. It was not until my youngest cousin was born that I knew anything about breastfeeding. My mother's youngest sister was quite a maverick and decided to nurse her second child. I don't remember how old he was when she weaned him, but I am almost certain it was somewhere between six months and his first birthday. In all that time, I saw her nurse him just once and then only fleetingly.
When he began to fuss, she would simply disappear into a bedroom to do some unimaginable ritual. That one time, I absolutely had to use the bathroom and to get to it I had to trespass upon this scared ground. I am not certain which of us was more embarrassed by the brief glance I had of the inch of exposed boob above his little blond head. But it was hardly an auspicious introduction to this womanly art form. I wonder sometimes how from that simple beginning I became such a committed nursing mother.
When I breastfed my oldest son in the USA over two decades ago, I remember feeling just as uncomfortable as the new mother who wrote to me. I spent a great deal of money having specially made tops so that I could breastfed discretely. Even then people would stare rudely or make comments under their breaths. But one of the strongest memories was of the missionary from Nicaragua who visited our church. She broke down in tears when she saw me nursing my son. Our pastor translated that her tears were of regret that she had not breastfed her child because in their culture formula was considered more beneficial...due largely to advertising dollars spent in this poor 3rd world country.
In the early 1990s, I was privileged to be part of a new programme through the Women, Infants & Children (WIC) project. WIC offered food stables and formula to low and middle income (working poor) families. To provide formula cost them over $100 per month, while providing food supplements to nursing mothers cost them just $32. This programme was nothing short of state sanctioned peer pressure.
They identified women who had participate din the programme that had breastfed. These volunteers were trained jointly by WIC and La Leche League. Before pregnant women received their supply of food coupons they must attend an educational session with a peer counsellor where the benefits of breastfeeding were presented. Then we took contact details of all the expectant mothers including due dates.
We called them several times during their pregnancies to discuss it further. Then when they had their baby we visited them either in their homes or the hospital to offer assistance getting off to the right start. This project and many others like it across the US have made dramatic impacts upon the number of new mothers from low and middle incomes that choose to breastfeed their babies. Dramatically, 63% of African-American mothers now breastfeed while just twenty years ago less than 15% did.
Fifteen years after my first son's birth and almost a decade after this project, I had another child. I was living in California at the time. I must say that those years and perhaps the more open culture of southern California meant that breastfeeding even in public was not an issue. I returned to work when my son was 8 weeks old and my employer was happy to accommodate breastfeeding and pumping. Our paediatrician was a grandfatherly type who if possible was even more pro-breastfeeding than me. While the American Academy of Pediatrics and the World Health Organisation recommend exclusive breastfeeding to six months, Dr Jones recommended not adding solids until nine months to a year. He felt that introducing them sooner increased the chances of children developing allergies. Even my militant breastfeeding could not quite meet this laudable goal when my eight month old son stared longingly at each bite of food I took.
In stark contrast though was the visit we took to my partner's family home in Mexico when my son was a few months old. It was like stepping back in time...or even worse. I remembered once again the tears of that Nicaraguan missionary. No one...and I mean no one breastfed despite the poverty. Families would come into his uncle's store and purchase expensive formula and two or three eggs and bread for the rest of the family. Of course by this point I had become what might be considered a militant about breastfeeding and considered it my personal mission to expose as many people in that small Mexican town as I could to the sight of my son nursing at my breast.
When I moved to the UK with my youngest daughter in 2006, one of the biggest adjustments was the differing views upon breastfeeding. When we first registered with our doctors I was delighted at the novel prospect of Health Visitors...until my first visit with one. My daughter was eight months old and still nursing well even though I had added solids a few weeks before. I was shocked and appalled when my HV stated in an authoritarian tone...You need to wean that baby. After my shock wore off, I politely educated her that I had always followed the World Health Organisations recommendation to breastfeed until at least two. Our visit quickly deteriorated into an argument as she asserted that was for Third World countries only. From that moment, I simply avoided Health Visitors.
A few months later I was pleasantly surprised when they were handing out fliers in the same clinic for a new breastfeeding peer counsellor programme. I once again signed up and was pleased to be one of the first again to complete the training. But over time I became disillusioned. Unlike the WIC programme I had worked on earlier, we were directly under the PCT which meant we were instructed never to countermand anything that mothers were told by Health Visitors...even if we knew it was blatant misinformation.
One thing I do know, I am glad that my daughter was born in the US. She was premature by a month. While she had no difficulty breathing, her digestive system was another matter. She had jaundice, difficulty pooing and for the first two months of her life barely gained any weight. From my personal experience as well as my peer counselling work I know that if we were in the UK, I would have been pressured to top-up (not that I would have listened).
So what about this new mother and the thousands of others like her? Is there any hope that the UK will become like the Los Angeles I left with babies feeding from exposed breasts any time you visit the mall? I have seen glimmers of such hope. One is my daughter's swimming class. Of course we are in the toddler group, but the baby class is right before ours. The teacher encourages the mothers to breastfeed on the steps of the pool after class to make a positive connection in the babies' minds of water...and milk. I was also very encouraged some months ago by the teen black mother, who was so positively interacting with her baby and discretely fed her on the Piccadilly line.
But if the UK is to successfully increase the number of mothers who breastfeed their babies, we must not only provide the expert advice needed to get them off to the right start but we must provide a supportive culture that recognises the unique value of the nursing relationship. It was not an easy or short battle for the US...and the war is far from over there either considering that in the southern states breastfeeding is lower even than the UK...but given the physical and emotional benefits to mother, baby and society, it is one worth undertaking.
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