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The Big Picture

Barbara Sturmfels
Director, La Leche League New Zealand
From: LEAVEN, Vol. 44, No. 2, 2008, pp. 14-15

At this moment, millions of mothers and babies all over the world are engaged in the fundamentally human activity of breastfeeding. Some of these mothers and babies are living in peace and security, others in conflict or uncertainty. Some are affluent, most are poor. Some are living in densely populated cities, others in remote rural areas. Some mothers are healthy and well-nourished, others are hungry or ill. Some mothers and babies are alone, others are with family or friends or workmates or strangers. Some are in the company of other breastfeeding mothers and babies. In all likelihood, some are at this moment at La Leche League meetings somewhere in the world.

Also at this moment, thousands of babies and young children around the world are feeding at their mothers' breasts for the very last time. Some of these are children aged three or four or more; some are babies born only hours or days or weeks ago. In many countries of the world, including New Zealand, most of the babies and children who are being weaned from the breast at this very moment are not ready. Their weaning is premature. I believe that for most of their mothers, the weaning is premature, too. If they had the right mix of approval, encouragement, protection, support and information, most of these mothers would willingly breastfeed their babies for longer.

Breastfeeding beyond babyhood, even beyond toddlerhood, used to be the norm in every human society. It was taken for granted, and its enormous value for health and life was possibly not even explicitly understood. It was just the way things were. It still is in some parts of the world where traditional cultures, including traditional breastfeeding practices, survive. For the rest of the world, the massive technological, economic, commercial, social, and medical changes of the last two centuries have resulted in fundamental changes in the way that mothers and babies interact.

If powerful forces had set out to conspire to separate mothers and babies from each other, even in their own homes, they couldn't have hoped to do much better than what has happened in recent human history. The separation of home and work heralded by the industrial revolution; the ascendancy of prescriptive advice about infant care from "experts"; the availability and marketing of artificial baby milks and prepared baby foods; ambivalent attitudes about breasts, babies, and women as mothers; the growth in institutional care of babies and young children. These forces, and many more, have resulted in breastfeeding as an underlying cultural practice being lost or severely threatened worldwide.

Meanwhile, evidence about the value and importance of breastfeeding, and the risks of artificial feeding and undue maternal-infant separation, has grown. In addition, mothers—individually and in groups—have held out against the tide of undermining influences to keep the remnants of a breastfeeding culture alive. Enlightened health care providers—sometimes going against the tenets of their professions—have lent support. Determined individuals and non-governmental organizations have taken up the cause. And slowly but surely, nationally and internationally, breastfeeding has risen up the political agenda.

In 1981 the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes, and has passed several resolutions since to clarify and strengthen it. In 1989, WHO and UNICEF jointly published the Ten Steps to Successful Breastfeeding, which formed the basis of the Baby Friendly Hospital Initiative. In 1990 the Innocenti Declaration set out an international agenda that re-emphasized the importance of the Code and the Ten Steps, called for legal protection of the breastfeeding rights of working women, and called on governments worldwide to establish national breastfeeding committees and coordinators. The United Nations Convention on the Rights of the Child, adopted by the UN General Assembly in 1989, asserted children's "right to the highest attainable standards of health." In 2000, the International Labour Organisation adopted a new Convention on Maternity Protection, setting out standards for the protection of women in their dual roles as mothers and workers. In 2002, the World Health Organization and UNICEF endorsed the Global Strategy on Infant and Young Child Feeding, recommending that babies be exclusively breastfed for six months and that breastfeeding continue for up to two years and beyond. In 2005, on the 15th anniversary its original signing, the Innocenti Declaration 2005 was adopted and set out five additional operational targets. In 2006, the World Health Organization published new Child Growth Standards, based on healthy optimally fed (i.e., breastfed) babies and children.

Around the world, governments are enacting laws, formulating policies, and implementing or supporting programs that protect and support breastfeeding in line with this international agenda. In New Zealand, while progress is inevitably slower than breastfeeding advocates would like, there is still considerable progress. Every maternity facility is now required to meet the standards required for accreditation as a Baby Friendly Hospital. Most have already been accredited and all others are actively working toward accreditation. The Baby Friendly Community Initiative, currently being piloted, will set similar standards for primary health practitioners in the community. Some paid maternity leave provisions have been introduced, and legislation currently being considered by parliament will provide for breaks and facilities for breastfeeding mothers in the paid workplace. Some progress has been made toward implementing the International Code. A National Breastfeeding Advisory Committee was appointed in 2006 and has just published its advice in the form of the National Strategic Plan of Action for Breastfeeding. The Ministry of Health now requires all local health authorities to produce and implement a Breastfeeding Action Plan consistent with the principles of the National Strategic Plan, and the Ministry is about to launch a social marketing campaign in support of breastfeeding. LLLNZ's breastfeeding peer counselor program is getting an increasing number of customers as more funding becomes available to implement breastfeeding support projects and the value of informed mother-to-mother support is increasingly recognized.

There is a long way to go before New Zealand meets the standards set out in the international documents. Considerable attitudinal, structural and cultural change is needed throughout society before breastfeeding becomes the cultural norm once more. But the trends are in the right direction. I am optimistic that, some time in the future, almost all New Zealand mothers will be able to breastfeed their babies for as long as they and their babies desire, and be able to do it without the extraordinary determination that so many have to have to succeed today.

Adapted and updated from a column published in LLLNZ's magazine, Aroha, June 2006.

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