A few weeks ago, after a hard-fought campaign by public health professionals and women’s rights advocates across the state of Michgan, Governor Snyder signed into law the Breastfeeding Antidiscrimination Act (SB 674), essentially giving nursing mothers in our state the right to breastfeed publicly without fear of arrest. In celebration of this fact, I reached out to Washtenaw County WIC Breastfeeding Coordinator Gayathri Akella, and Breastfeeding Peer Counselor Pauline Lesser, to discuss the current state of suckling in SE Michigan.
[If you don't already now that breastfeeding is the most super awesome thing that babies and moms can do, just click here for the facts.]
MARK: Let’s start with the statistics… How many women breastfeed in Washtenaw County?
GAYATHRI: The best data we have comes from WIC.
Healthy People 2020 breastfeeding goals:
Exclusively at 6 months: 25.5%
Michigan WIC Rates:
Exclusively at 6 months: 16.32%
Washtenaw County WIC Rates:
Exclusively at 6 months: 21.2%
MARK: I assume that “ever” means that they tried it at least once, whereas “exclusively” means that they aren’t using formula at all, and they’re just relying on breast milk. Is that correct? And do we have historical data, to show if we’re trending up or down?
GAYATHRI: You’re right in your assumptions. As for trend data, the following also comes from WIC.
Washtenaw County WIC Breastfeeding Initiation Rates (at birth):
Breastfeeding Duration Rates at 6 months of baby’s age in Washtenaw County:
2000: 21.90% (16.60% statewide)
2001: 23.82% (17.17% statewide)
2002: 25.60% (17.02% statewide)
2003: 28.10% (18.58% statewide)
2004: 24.56% (18.26% statewide)
2005: 28.33% (18.48% statewide)
2006: 24.52% (19.05% statewide)
2007: 24.88% (18.02% statewide)
2008: 25.44% (17.96% statewide)
2011: 26.81% (19.29% statewide)
2012: 25.84% (20.39% statewide)
2013: 20.98% (15.57% statewide)
2014: 21.20% (16.32% statewide)
MARK: If I’m reading these numbers correctly, every year more and more women are claiming to have attempted breastfeeding. In 2013, according to this local WIC data, 77% of women reported that they at least tried to breastfeed. That same year, though, only 20.98% report as having breastfed for six months. Assuming that they’re being truthful about attempting, and not just responding that way because they feel as though they should be trying, why is it that over 50% of new mothers stop? And how do we change that dynamic? Do we need more lactation coaches to help get new mothers over that initial hurdle, where breastfeeding can be painful, awkward, etc? Do we need to stop hospitals from sending new mothers home with formula?
GAYATHRI: You’re right. A lot of women initiate breastfeeding, however very few women are still doing it at six months. Unfortunately, there are numerous reasons for this drop. Here are just a few.
1. Inconsistent Messages: Unfortunately our local hospitals are not designated “Baby-Friendly”. Baby-Friendly, which is a program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), recognizes hospitals that provide a high level of care and education for breastfeeding mothers and their babies. Baby-Friendly hospitals follow “The Ten Steps to Successful Breastfeeding for Hospitals,” as outlined by UNICEF and WHO. The steps include: following a policy that is routinely communicated, educating expecting mothers about breastfeeding, helping initiate breastfeeding within one hour of birth, and teaching women how to maintain lactation. The Ten Steps encourage breastfeeding on demand and “rooming in” – to allow mothers and babies to remain together, as well as referring mothers to breastfeeding support upon discharge. Unless medically indicated, no food, drink (other than breast milk) or artificial nipples are to be given to breastfeeding infants. There is ONLY ONE hospital in Michigan that is Baby-Friendly designated. It’s the William Beaumont Hospital in Grosse Pointe, which attained its designation in 2012. Michigan, it’s worth adding, is one among a very few states that did not meet the Healthy People 2010 goals for breastfeeding.
2. Socio-Economic Challenges Faced by Single Mothers: Various studies have found that socially disadvantaged mothers start breastfeeding less often and also breastfeed for a shorter period. A lot of moms have to return to work within six weeks post-partum, risking the continuation of breastfeeding.
3. Teen Mothers and Higher Incidence of Smoking: The literature on the determinants of breastfeeding has consistently identified maternal smoking and lower maternal age as predictors of lower breastfeeding rates.
4. Lack of Prenatal Breastfeeding Support: WIC has Breastfeeding Peers, often moms who have been on the WIC program themselves and who provide breastfeeding education and support. But they only work with women who enter WIC prenatally. Prenatal breastfeeding education provides confidence and willpower to initiate and continue breastfeeding.
MARK: So, how do we fix it?
GAYATHRI: Three things; 1. More Baby-Friendly hospitals. 2. Building bridges between WIC and medical providers. (We need to increase the referrals to the WIC program by medical care providers in the early part of pregnancy.) 3. More outreach to expectant moms, leading to increased early prenatal entry into WIC.
MARK: I understand that there are factors at play, like those which you noted above, which result in a significant number of women not breastfeeding. I’m not quite clear, however, as to why, over the past ten years, we’ve fallen from 28% to 21% when it comes to new mothers who are breastfeeding exclusively for at least six months. How do you account for that drop? Why the precipitous drop now?
PAULINE: Mark, a few things can account for that. One is a change in how WIC captures that data. It’s complicated but it has to do with whether a mom was coded correctly in the system in the time period prior to Spring of 2011.
We know, though, that many of our WIC moms face economic realities that force them back to work sometimes as early as two weeks postpartum. And it takes four to six weeks to establish milk supply. Even women who have the proper facilities find it difficult sometimes to maintain their breast milk when the mother-baby rhythm doesn’t have those four to six weeks to be solidified. Women who don’t respond well to breastpumps face an even tougher challenge because they could pump for hours on end and still not be able to leave enough of their milk for their absence, thus leading to supplementation with formula.
MARK: In addition to the health benefits to the baby, if I’m not mistaken, there are also significant financial benefits across society when women breastfeed. Do you have any estimates as to what the health care savings might be in Washtenaw County if, say, we got our six month breastfeeding number up to 50%?
GAYATHRI: According to a 2010 study published by Pediatrics, “If 90% of US families could comply with medical recommendations to breastfeed exclusively for six months, the United States would save $13 billion per year and prevent an excess of 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance)”.
MARK: Until yesterday, I’d never heard of the Washtenaw County Breastfeeding Friendly Business Awards, the annual program that you run. How long have you been at it.
PAULINE: The Washtenaw County Breastfeeding Coalition started giving the awards (or providing feedback as to how companies might improve to get an award) in 2008. Toyota, Zingerman’s, The Little Seedling, Eastern Michigan University and Google have all won in the past. We’d like to broaden our reach this year, though. Even though pumping spaces and breaks are required by law, some folks still don’t seem to get it.
MARK: What are the criteria you’re looking for in a potential winner?
PAULINE: Businesses are required by law to provide time and space for mothers to pump. Our winners in the past, who we refer to as “Gold Level Supporters,” have all gone above and beyond what’s required, providing things like dedicated mothering rooms with appropriate furniture, a sink in the room for washing parts, locking cabinets so each mother can put away her pump and parts, etc.
MARK: In addition to praising companies that go above and beyond for their employees, do you also have an award for companies that don’t do enough is this regard… a boobie prize, if you will?
PAULINE: We don’t call them out by name, but, yes, our co-chairs have been known to give constructive feedback if a woman chooses to nominate her employer in a satirical way. And we’re always available to present the “Business Case for Breastfeeding,” should a business owner want to hear it.
MARK: And what is the business case for breastfeeding? I mean, I know it’s the right thing to do, and it likely leads to greater employee satisfaction, which probably translates to increased productivity, etc, but I’m curious if studies have actually been done which prove that to be the case… Do we, in other words, have quantifiable evidence that it makes good business sense to support nursing mothers in the workplace? Personally, I don’t think that it matters. Right is right, regardless of the bottom line. I’m just wondering if such data exists.
PAULINE: The Business Case For Breastfeeding is actually a federally developed training designed for staff like Gayathri to present to businesses that are reluctant to fully support breastfeeding. More info on this comprehensive program is available here.
MARK: What should people do if they want to nominate a business?
PAULINE: Just fill out a quick nomination form. Nominations will be accepted until July 28, 2014.
MARK: And when will the awards be given out?
PAULINE: The event will be held on August 22 at the Washtenaw County Learning Resource Center, at 9:00 AM.
[Those of you who want to go deeper on the politics of breastfeeding should check out my last post on this topic, titled Let Them Eat Tits.]