It is so simple! Breastfeeding can improve the health of infants dramatically. Well, yes, that is true but the whole thing about it being simple is a bit of a problem. Karen Grepin shares a personal anecdote as to why:
Honestly, if I hear another public health official (frequently male) allude to the fact that breastfeeding is among the simplest interventions available I think I am going to lose it. I can tell you from first hand experience, breastfeeding was among the most physically and emotionally challenging aspects of raising my own son.
My son was born a week early by cesarean section due to the fact that he was breeched. This delivery likely delayed my own milk production and I spent four very distressed and agonizing days watching my son shrivel up because I was so hell bent on making breastfeeding work. The simple solution would have beee to supplement his feeding. The advice and support I received from the breastfeeding experts usually took the form of one counsellor telling me to only do Y and whatever I do don’t do X only to be followed up by another counsellor telling me to only to X and never to do Y. Oh, and I did I mention how painful it was? Picture cracked, bleeding and infected nipples and a whirlwind of hormones. Yeah.
Most public health experts recommend mothers to “exclusively” breastfeed their children for 6 months. But that means that the mother can never very far from their baby this entire time. The fact that this might negatively impact a mother’s labor force participation or productivity seems completely ignored in these cost-effectiveness calculations. Simple in this case is leaving a bottle so that fathers, grandparents, and other care givers can share in the feeding of children.
Her larger argument, which is excellent, is that behavior change is really hard. There are plenty of simple solutions (don't smoke, drink less, eat fewer calories) that have health benefits but are not so easily executed. So, while the solution itself is seemingly simple the execution is not.
In learning about clean water last week, it became obvious how the most simple solution (aka chlorine) fails because it alters the flavor to the point that people do not want to drink the water and it requires the right amount to be used. You can address without much trouble, but adding additional steps can mean the difference between people treating and not treating their water.
Photo Credit: White African
Photo Credit: White African
3 comments:
I'm sorry to hear that Ms. Grepin had a difficult birth and breastfeeding experience, and in no way should she feel personally diminished by her ordeal. But the truth is that breastfeeding is quite simple for most, or the human race wouldn't have made it this far. In low-income rural areas where mothers, aunts, and grandmothers are there for advice and support, and where instincts aren't broken by decades or centuries of cultural disruption and bad (male) medical advice, the feeding of babies is pretty straightforward for most people, and it's not a good idea to export our society's conflicted feelings about it. A minority of people will have difficulties with anything, and they deserve compassion and assistance in solving their problems, but their experience shouldn't form the basis for broad attitudes and policies.
I think the point is not to say that breastfeeding should be abandoned or ignored. Rather, the point is that what is seemingly simple can in fact be challenging due to a host of reasons. There are many factors that can contribute to women not breastfeeding despite knowing it is best for the health of the child. Grepin's anecdote is to illustrate this point. I should have included her final paragraph that says, "
This of course is just one of these interventions, and this is just my own personal reflections on the process – many women love and adore breastfeeding – I even started to enjoy it after a month or two and before my son decided he had enough and decided to communicate this to me by biting during feeding sessions – but it points to what I believe is a very important and overlooked issue in global health, that of why some healthy behaviors and technologies are adopted while others are not. That is not so simple and we have only begun to scratch the surface being able to influence these behaviors through policy."
Of course, your point is very well taken, particularly with things like smoking, drug and alcohol abuse, or poor food habits, all of which can be extremely resistant to change in the majority of people who have health problems in these areas. I’m simply suggesting that breastfeeding is in a different category because only a minority of people have difficulties in this area, and their problems thus don’t form a good basis for broad policy. In other words, losing weight or quitting smoking is difficult for almost everybody; breastfeeding is not. But there are two other factors which feed into this discussion:
1) It’s extremely difficult to persuade people to adopt or maintain practices which are perceived as low-status in their societies. Low-income women in many areas around the world now have the impression that breastfeeding is a low-status practice for poor, ignorant women, and as long as affluent women from developed areas prefer bottle-feeding, many will continue to emulate them even at significant health and economic cost to their families and children. And of course, as with smoking, even when behavior begins to change among the top economic and educational tiers, it’s like turning an ocean liner, and the unhealthy practice will continue among low-income people long after it has been abandoned by the privileged classes.
2) Because breastfeeding is still not well-understood in developed societies (most people have no idea that the World Health Organization advises “continued breastfeeding along with appropriate complementary foods up to two years of age or beyond”), and because it frequently continues to be discouraged in public as though it were some sort of obscene or sexual act, many modern women have significant emotional conflict or discomfort which contributes to higher rates of failure to breastfeed. There is an unhealthy dynamic that has developed in the literature between (sometimes strident) breastfeeding advocates and (sometimes strident) career women who can’t or don’t want to breastfeed, with emotionally charged assertions and challenges being exchanged on both sides. I think the feelings and conflicts between the parties in this debate, while genuine, are not culturally universal, and it’s important not to allow this dynamic to unduly influence international development policy in regions where most women don’t have these issues.
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