Breastfeeding: An Issue for Everyone

Author(s): Heather Hughes and Jane Maasdorp

Reviewed work(s):
Source: Agenda, No. 9 (1991), pp. 24-28
Published by: Agenda Feminist Media
Stable URL: http://www.jstor.org/stable/4547947 .
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INTERVIEW
An edited
version
of
an
interview
conducted
by
Heather
Hughes
with
fane
Maasdorp,
a
breastfeeding
consultant
and a Durban
leader
of
the
La Leche
League,
an
international
organisation
established to
promote
breastfeeding.
Breastfeeding:
an
issue for
everyone
Breastfeeding:
Public Or
Private?
Heather
Hughes:
There are
those who believe that
breastfeeding
is a
private matter,
of concern
only
to
mothers with
young
babies and
per-
haps
also healthcare
professionals.
Is
this how
you
see it?
Jane
Maasdorp:
Notatali. Al-
though
the mother and her
young
child are at the centre of the relation-
ship,
there are a host of individuals
and
groups
whose actions can either
support
or undermine
breastfeeding:
healthcare
advisers, employers, large
multinational
corporations,
and so on.
HH: Do
you
have
any
idea how
widespread breastfeeding
is in South
Africa or is that
very
difficult to deter-
mine?
JM: I think we
probably
know it
is on the decrease. I have
recently
had a look at a World Bank Technical
Report
on
breastfeeding
and there's
an
assumption
that it is not
necessary
to
promote breastfeeding
in areas
where it is assumed to be the norm. I
imagine
that here in South
Africa,
it's
assumed to have been the norm for a
long time,
whereas in fact it has been
threatened all
along.
IBFAN
(the
Inter-
national
Babyfood
Action
Network)
have said that there's a
great
need
throughout
Africa to do research into
the
type
of
breastfeeding
that's
going
on
-
to what extent it's
supplemented
-
and there'll be
degrees
of
supplemen-
tation
-
and to what extent it
really
is
now
just
token
breastfeeding.
The
more I look at the
way people
are
doing it,
it's
probably
often
heavily sup-
plemented
or token
breastfeeding,
so
that
you may
ask women whether
they're breastfeeding
or not and
they'll
say 'yes',
but the babies are
getting
very
little benefit from
it,
and the
mothers' milk
supply
is low.
Who Causes The Problems?
HH: But what about the
way
breastfeeding
is
supposedly promoted
in this
country?
If I think of
my
own
very
limited
experience,
I came
away
from
hospital experiencing
all sorts of
problems,
even
though they
had en-
couraged
us all to
try
?
JM: I think that
very
word
try'
says
a lot. Research in Natal/KwaZulu
has shown that
many
of the
problems
are
iatrogenic
-
that
is, they
are actual-
ly
caused
by
the medical
profession
and the
hospital set-up.
Because
there is that
attitude,
'are
you going
to
try
this or not?'
Implicit
in that is that
some women
can't, you may
not be
so
good
at
it,
not all of us can do it.
Some mothers come home
extremely
confused about whether
they
should
be
feeding
six minutes a
side,
or twen-
ty
minutes a
side,
instead of
just doing
what
they
feel is most comfortable
-
and
comforting
-
for themselves and
their babies.
HH:
Apart
from the
way
problems
are created in a medical en-
vironment,
how else would
you say
breastfeeding
is
being
undermined?
JM:
Well,
there are
ways
in
which the
big
multinational
companies
involved in the manufacture of
breastmilk substitutes
try
to sell their
products
-
of course at the
expense
of
breastfeeding!
There is an Internation-
al Code of Ethics drawn
up by
the
World Health
Organisation,
but it is
completely voluntary,
and it is
up
to
each
country
to institute its
own,
and
also to decide on the extent to which it
24
Agenda
Breastfeeding
INTERVIEW
would be
legally
enforced. We have a
code of ethics in South Africa and
companies making babyfood products
are
signatories
to
it,
but it is not
legally
enforced.
(Also,
retailers of these
products
are not
signatories.)
The
only parts
of it that are enforced are
those that relate to
advertising
stand-
ards,
so that
they
aren't allowed to
say,
This is as close to mother's milk
as
you'll get',
because the
advertising
standards
authority
would
jump
on
them for that. But there all sorts of sub-
tle
ways
that
they
still
manage
to
operate.
HH: Such as?
JM:
Companies
are not
sup-
posed
to advertise
directly
to the
general public
at all.
They
can adver-
tise to health
professionals,
because
health
professionals
are
supposed
to
know what is in these
things,
and
what
they
should then recommend if
approached.
But if
they sponsor
a con-
ference,
as
they
did outside Pieter-
maritzburg recently,
on child abuse
(Wyeth sponsored
the
conference)
of
course there would not
only
be health
professionals there,
so
indirectly
there
are lots of
ways.
Or
they'll
have a
poster
of a mother
breastfeeding
saying
'Of course breast is
best,
but if
you
have to
give
a
bottle,
this is the
product
to
use',
and
they'll
show the
mother in a
nightie,
as if to breastfeed
you've got
to be at home in bed! And
the
baby
in a
very
bad
position,
across her
lap,
head turned
sideways,
and that'll cause
problems
which are
likely
to make the mother have to
buy
the
product. They
have to be
clever,
because of the international code. It's
a
huge industry
and
they're
not
going
to back down so
easily. They
make
altruistic noises but I don't think we
can trust them at the moment.
They
also have different
practices
in
Europe
and America to
Africa.
They
abided
by
the
code,
and in fact
the
boycott
of
Nestle was
suspended.
And
then it was found
that in Africa
they
were
doing just
whatever
they
wanted,
and for-
tunately
there
were
people
monitoring,
so the
boycott
was
reinstituted. And it's stiil on Nestle.
There are a few cases where
govern-
ments have taken the multinationals
on,
such as in New Guinea:
there, you
cannot
get
milk formula or bottles un-
less
you
have a
prescription
from a
health worker. These
things
are
just
not available on
supermarket
shelves.
I think
maybe
we need
something
like
that here!
Babies In Cotton Wool?
HH: Just
turning
to those who
feel committed to successful
breastfeeding:
do
you
think that
you
need
supports
around
you,
for ex-
ample people
in
your
household
-
your
partner,
or whatever other adults are
around
-
giving you
the
opportunity,
and
releasing you
from the other
pres-
sures
you
would
normally
face?
JM: There are some
amazing
cases of women who succeed in
spite
of all kinds of
pressures.
It
certainly
helps
to have a
supportive
environ-
ment,
but I'm a bit scared of that
being
a
very western,
upper
middle class at-
titude to
breastfeeding,
which
puts
the
mother and
baby
in cotton
wool,
as it
were. We've reached a
point
where
we've
got
to
reintegrate breastfeeding
Breastfeeding
Agenda
25
INTERVIEW
in the wider
world, and if the mother is
working,
we've
got
to make it
possible
for her to
breastfeed,
and not
preclude
a whole lot of other activities. Certain-
ly
the
people
around
you
must believe
that it's the
right thing
to be
doing,
than
just believing
in it will be more
worthwhile than other kinds of
help.
For
instance,
it would
help
for a
mother-in-law or mother not to
keep
saying,
'Isn't the
baby hungry?
Wouldn't it be better on a bottle?' or
the father of the child
agreed
that this
is the
way
he'd like his child to be
fed,
and didn't
put pressure
on
you
to
go
away
on
your
own for the weekend.
Then the rest will follow. For this at-
titude to
develop
we have
got
to over-
turn a
couple
of
generations
of bottle
feeding
culture.
H H : But if it is the belief which is
important,
are we then not
talking
about restrictive
possibilities
for
breastfeeding?
For
example, among
many working
class
families,
hus-
bands are
very antagonistic
to women
spending
the amount of time needed
with the
baby.
There
might
be all sorts
of
expectations
about the woman's
body,
marital relations and so
on,
all
those attitudes that rather
patriarchal
men will have of women.
JM:
Again,
that
might
be a
very
western,
American
way
of
looking
at
the data. There are lots of studies
worldwide now
relating breastfeeding
to socioeconomic
factors,
and certain-
ly
the American ones have shown that
breastfeeding
mothers tend to be
slightly
better
educated,
have
gone
to
antenatal
classes,
may
have had
some career before
having children,
are
slightly
older, and tend to be mid-
dle class. But that is the American
context. In other
contexts,
such as
the
Phillipines,
it was women of the un-
derclasses who led the return to
breastfeeding, contrary
to the idea
that
upper
class women must set the
role model. That's
why
I find it so ex-
citing working
with the women at the
Valley
Trust,
where there has been a
strong breastfeeding
culture,
to
try
to
rescue and reinforce it before it
gets
too threatened
by
materialistic
pres-
sures,
pressures
of nuclear families
-
also of women
worrying
about the
shape
of their breasts!
Breastfeeding
is in fact most threatened in societies
facing rapid
social
change
and tension.
HH: What are the
implications,
then,
for our own
society,
in which
huge
numbers of households face un-
employment, rapid urbanisation,
rural
poverty
and so on?
JM: Our
breastfeeding
rates are
probably going
to
get
worse before
they get
better. One of the
problems
is
(this
was shown in a
survey
in
Botswana)
that
poorer
women tend to
believe that
they
have to breastfeed
because
they
are
poor,
whereas in
fact
they're being jolly
clever! Certain-
ly,
in
places
I've seen in
townships
around
Durban,
it's the mother who
has
just
borne a
child,
who will be the
one to
go
back to work and leave the
baby
with the older
generation.
This
may
mean that the mother lives
and/or works at
great
distances from
her child. In Finland and
Norway,
there are more
working,
than non-
working
mothers,
who breastfeed:
partly
due to childcare facilities at the
workplace,
but also because of
rapid
urban
transport
-
you
are never far
from
anywhere.
Just
being
a mother in
the
greater
Durban area is
very
dif-
ficult.
Could
Working
Mothers Do It?
HH:
How,
in that
context,
would
you go
about
promoting
breastfeed-
ing?
26
Agenda
Breastfeeding
INTERVIEW
JM:
Basically,
what
you're
as-
king
is how a
working
mother
copes.
For one
thing,
mothers have
got
to be
encouraged
to
express
their
milk,
if
they
can. We have
got
to work from
all
angles
-
there is
just
no
easy
answer.
Employers
have
got
to be
educated about the
importance
of
it,
that it is not
just
a frivolous issue at
all.
Employers
tend to be so
flippant
about it. Telecom in
Australia,
which
has 20 000 women on its
staff,
has
a
company
nutrition
policy,
in which
one of the clauses relates to
breastfeeding.
The women know
where
they
stand when
they're
employed
there. I don't know how
many companies
have a nutrition
policy,
let alone
something
on
breastfeeding,
and there are
plenty
of
big companies
in South Africa that
could
easily
institute
something
like
that.
Maternity
leave is crucial.
Again,
studies have shown that if women
return to full-time
employment
before
their babies are four months
old,
it is
highly likely
that the duration of
breastfeeding
will be short.
H H : How
long
would
you
like to
see
maternity
leave?
JM: Let's
say
six months? It's
hard to
give
a
time,
but I believe little
people
deserve to have their mothers.
I think if
you just
look at it in cold
terms of costs:
you go
to
Stanger
hospital
and hear
people asking,
Why
are our wards so full of babies
with kwashiorkor?' Paediatric wards
in other
hospitals
are full of babies
with malnutrition.
Why?
It is a
huge
cost to the state. There could be tax
exemption
to
companies
whose
policy
is to
promote breastfeeding
and
good
maternity
leave,
and hence lower the
morbidity
rates of children. Another
way
to do this would be to have
childcare facilities at the
place
of
work,
and have
flexitime for
breastfeeding
mothers. The In-
ternational Labour
Organisation
in
1919 had a con-
vention about
maternity protec-
tion,
and called
for two half hour
nursing
breaks a
day
without loss
of
pay,
as
long
ago
as that.
That's in addition
to tea time and
lunch time! If the
child isn't
going
to
be at home in a
one-to-one
nanny
relationship,
then
the next best
thing
is to be at a
childcare centre
close to the
mother's
workplace
so that
she can have ac-
cess. Some of
the childcare
facilities where
babies
get
left on
the
way
to work
are like batteries
-
little humans were
never meant to be
raised like that.
And
they
can be
very expensive
for
the
working
mother too.
HH: Do
you
think that
breastfeeding
is
compatible
with
women's
rights?
Breast Or Bottle? Sume J
?
Babies
breastfed for
less
than 6 months or not at
all are 6 to 14 times
more
likely
to die in the
second 6 months
of life
than babies
breastfed for
6 months or more
?
Bottlefed
babies are
more
likely
to be
hospitalised
than
breastfed
babies
?
The cost
of hospital
treatment
of bottlefed
babies is 15 times
higher
than the cost
for
breastfed
babies
?
The
infant food industry
in South
Africa
is worth
R 1 billion a
year
?
Many governments
have
found
it
necessary
to
take direct action
against baby food
com**
pa??es, Algena
has
put
the sale
of baby foods
under state
control,
New
Guinea has made
baby foods
available
only
on
prescription,
and
Sweden and Guinea-Bis-
sau have banned all
direct
advertising of
baby food products
Breastfeeding Agenda
27
INTERVIEW
JM:
Absolutely.
One
gets
a
tremendous sense of
self-sufficiency
from
it,
and a sense of self-esteem
that comes from
seeing your
child
grow
on what
you
are able to
produce.
There was
apparently
an article on
breastfeeding
in a British
leftwing
magazine
some while
ago,
and the
flood of letters that came in
complain-
ing
about it shows that
people
across
the
spectrum
are still dismissive about
it. There hasn't been true under-
standing
of what it
really
means.
HH:
Why
have
people
been dis-
missive?
JM: Part of it is that we have a
faith in
science,
that man has made a
formula that is
just
as
good.
And let's
face
it,
children seem to
grow
on bot-
tle
feeding...
HH: How would
you
answer that
argument?
JM: In late
1989,
an entire issue
of the
journal
of the American Institute
of Nutrition was devoted to articles
debating
the
upper
limits of the in-
gredients
of formulae: for
example,
how much sodium is safe? We don't
know the answers
yet
to
many
of
these
questions.
Formula
feeding
has
been called the
greatest
uncontrolled
experiment
the world has ever known.
They put
all kinds of
things
in formula.
In the same
way
that we do not know
what is safe in
formula,
we do not
yet
know
exactly
what is in breast milk.
But the more
they
find
out,
the more
fantastic it is. There are
ingredients
that interact with one
another,
in a
way
that
they
can never do in a 'dead'
powder.
There are
ingredients
that in-
teract with the
baby's system
at the
time that it is born...we
just
don't know
about all these
things.
And there's no
reason
why breastfeeding
should be
right only
for the first few
days
-
again,
more and more studies show that it is
beneficial
right up until,
and even well
beyond,
the second
year
of life. It
gives
the child such
good protection.
Something
came out last
year
which
shows that
breastfeeding protects
children
against
childhood
cancer,
a
significant enough
statistic for it to be
published.
There are others too: acute
respiratory
tract
infection, diabetes,
all
these
things.
There's this little crea-
ture that is
born,
and it needs a
species-specific
milk. It makes sense
we wouldn't have survived all this time
without it! ?
Action to take in
industry
?
Employers
should have a
nutrition
policyf including
a
breastfeeding policy
?
There should be
proper
maternity
leave
for
work-
ing
motlters
?
There shouId be
adequate
childcare
facilities
at the
place of
work,
and
mothers should be al-
lowed two
half
hour nurs-
ing
breaks a
day
without
loss
of pay.
?
All
staff,
men and
women,
should be educated about
the
benefits of breastfeed-
ing.
28
Agenda Breastfeeding