Breastfeeding is a Women's Issue

Testimony Before the Ohio Women's Policy and Research Commission, April 29, 1997, Columbus, Ohio

Linda J. Smith, BSE, FACCE, IBCLC

Women spend approximately half of their lives in their childbearing years. Pregnancy, birth, and breastfeeding - and all the choices and decisions surrounding these issues - have a profound impact on women. While men are no less effected by many children's issues than women, the biological impact of childbearing events on women is simultaneously immense and unique. Integrating women's productive lives with their reproductive lives is a major issue in child survival and overall societal health. This testimony focuses on an aspect of childbearing that many women encounter over several years, even decades, of their lives: breastfeeding. Increasing the percentage of women who choose and implement the decision to breastfeed is a major global and national goal.(1)

Economic implications of infant feeding decisions
1. Increased infant & child illnesses are linked to artificial feeding(2)
  1. Respiratory and other infections(3)
  2. Diarrhea and other GI illnesses, and hospitalizations(4)
  3. Chronic illnesses: diabetes, autism, asthma, etc.(5)
2. Workplace productivity is decreased when babies are not breastfed(6)
3. Environmental impact of artificial feeding(7)
4. Educational implications of infant feeding decisions
  1. Cognitive development is weakened in artificially fed babies(8)
  2. Learning and developmental milestones are different(9)
  3. Vision and speech differences are linked to artificial feeding practices(10)
Health implications of infant feeding to women(11)
1. Breastfeeding improves women's health as well as infants' health
  1. Breast Cancer
    1. Breast cancer risk higher if she does not breastfeed her children(12)
    2. Increased risk of later cancer if not breastfed(13)
  2. Ovarian Cancer is reduced by breastfeeding(14)
  3. Osteoporosis is increased when women do not lactate(15)
  4. Multiple Sclerosis may be affected by infant feeding decisions(16)
  5. Childbearing
    1. Breastfeeding significantly affects & improves Family Planning(17)
    2. Breastfeeding lessens postpartum hemorrhage and obesity(18)
    3. Lactation improves mothers' ability to cope with stress(19)
  6. Domestic violence may be linked to infant feeding decisions(20)
Legal implications of infant feeding - the Texas Model Proposal(21)
1. Breastfeeding is a constitutionally protected right(22)
2. Health laws are inadequate
  1. MCH Block Grant inadequately addresses breastfeeding(23)
    1. Testimony: BF related to MCH Block Grant Goals
3. Family laws are deficient and unclear
  1. Divorce and custody decisions fail to protect breastfeeding(24)
4. Civil remedies are absent or lacking when mothers' rights are infringed(25)
  1. Public opinion surveys verify that most people approve of women breastfeeding in public.(26)
  2. Discrimination in public places
  3. Sexual harassment for breastfeeding
5. Employment law needs to include breastfeeding(27)
6. Criminal statues may be vague and ambiguous(28)
ACTIONS REQUESTED
1. Legislation similar to precedent-setting laws in others states is needed to protect a woman's right to breastfeed her baby in any location where she is otherwise allowed to be.(29)Legislation similar to precedent-setting laws in others states is needed to protect a woman's right to breastfeed her baby in any location where she is otherwise allowed to be.(29)
2. Breastfeeding should be moved to a higher priority, and adequately funded in the MCH Block Grant.
  1. Data on feeding method should be collected at all existing recording points for children less than two years of age.
  2. Research is needed on lactation status correlated to women's health issues.
3. The Ohio Revised Code should be carefully reviewed and amendments proposed to protect breastfeeding in the following areas:
  1. Health law
  2. Family law
  3. Civil law
  4. Employment law
  5. Criminal law

As a lactation consultant and childbirth educator, I work with women in their most vulnerable times: pregnancy, labor and birth, and early motherhood. Women's emotional and psychological health is profoundly impacted by societal pressures and prejudices during these periods. And conversely, the empowerment of women through informed and supported decision-making during these periods has a documented positive effect on all other aspects of their lives.(30) Breastfeeding empowers, protects and enhances women's lives and its uninhibited practice should be widely promoted, adequately supported, and legally protected.

Thank you for the opportunity to address these issues.

Linda J. Smith, BSE, FACCE, IBCLC
Mother of Edwin, Hannah and Carl
Grandmother of Carrie
Owner, Bright Future Lactation Resource Centre
6540 Cedarview Court
Dayton OH 45459-1214

Attached: Notes and references

NOTES and REFERENCES

1. United States National Breastfeeding Promotion Program will launch in August 1997 with a half-million dollar budget and specific legislative support. Ohio is one of 10 pilot states testing a comprehensive media campaign. The Healthy People Year 2000 Goals include "Increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period, and to at least 50% the proportion who continue breastfeeding until their babies are 5-6 months old." (Objectives 2.11 and 14.9)

2. Cunningham AS, Jelliffe DB, Jelliffe EFP. Breastfeeding and health in the 1980s: a global epidemiologic review. Journal of Pediatrics 1991; 118(5), 659-666. Dewey KG, Heinig J, and Nommsen-Rivers L. Differences in morbidity between breastfed and formula-fed infants. Journal of Pediatrics 1995; 126: 696-702.

3. Wright AL, Holberg CJ, Martinez FR, Morgan WJ, Taussig LM. Breastfeeding and lower respiratory tract illness in the first year of life. British Medical Journal 1989: 299. 946-949. Dewey KG, Heinig J, and Nommsen-Rivers L. Differences in morbidity between breastfed and formula-fed infants. Journal of Pediatrics 1995; 126: 696-702.

4. Cunningham Allen S. Morbidity in breastfed and artificially fed babies. Journal of Pediatrics 1979; 95: 685 - 689.

5. Mayer EJ, Hamman RF, Gay EC, Lezotte DC, Savitz DA, Klingensmith GJ. Reduced risk of insulin-dependent diabetes mellitus (IDDM) among breastfed children. Diabetes (1988) 37: 1625-1632. Tanoue Y and Oda S. Weaning time of children with infantile autism. Journal of Autism and Developmental Disorders 1989; 19(3):425-434. Infante-Rivard C. Childhood asthma and indoor environmental risk factors. American Journal of Epidemiology 1993; 137:834-44.

6. Jones EG, Matheney RJ. Relationship between infant feeding and exclusion from child care because of illness. Journal of the American Dietetic Association 1993-7, 93(7): 809-811.

7. Radford A. The ecological impact of bottle-feeding. Breastfeeding Review 1992-5, II(5): 204-208.

8. Lucas A, Morley R, Cole TJ, Lister G, Lesson-Payne C. Breastmilk and subsequent intelligence quotient in children born preterm. Lancet 1992: 339; 261-64.

Rogan WJ and Gladen BC. Breastfeeding and cognitive development. Early Human Development 1993; 31: 181-93.

9. Bauer G, Ewald LS, Hoffman J, Dubanoski R. Breastfeeding and cognitive development of three-year-old children. Psychological Reports 1991; 68: 1218.

10. Birch E, Birch D, Hoffman D, et al. Breastfeeding and optimal visual development. J Pediatr Opthamol Strabismus 1993; 30: 33-38.

11. "Breastfeeding provides many documented benefits for infants and their mothers. It should be encouraged as an accepted community norm. The Ohio Department of Health (ODH) joins the U.S. Surgeon General and the medical community in the belief that many more mothers will elect to breastfeed when given enough information to make an informed decision. Therefore, it shall be the policy of ODH to promote breastfeeding through education and to support is practice as part of quality health services provided in all public health settings. ODH recognizes that primary responsibility for children rests with their families. As such, ODH will assist and support all families in making infant feeding decisions." Policy statement adopted Aug. 5, 1992.

12. Newcomb PA, Storer BE, Longnecker MP, et al. Lactation and a reduced risk of premenopausal breast cancer. New England Journal of Medicine 1994, 330: 81-7.

13. Freudenheim JR, Marshall S, Graham et al. Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology 1994; 5: 324-31.

14. Gwinn, ML et al. Pregnancy, breastfeeding, and oral contraceptives and the risk of epithelial ovarian cancer. J Clin. Epidemiol. (1990) 43(6): 559-568.

15. Cummings RD, Kelsey JL, Nevitt MD, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985: 7: 178-203.

16. Pisacane A, Impagliazzo N, Russo M, et al. Breastfeeding and multiple sclerosis. British Medical Journal 1994; 308: 1411-1412.

17. The US Agency for International Development (USAID) recently awarded a $32 million grant to teach Lactation Amenorrhea Method of family planning on a global basis. Kennedy K, Labbok M, vanLook P. Consensus statement: Lactation Amenorrhea Method for Family Planning. International Journal of Gynaecology and Obstetrics 1996: 54, 55-57.

18. Chua S et al. Influence of nipple stimulation and breastfeeding on postpartum uterine activity. British Journal of Obstetrics and Gynaecology 1994; 101: 804-805 Dewey KG, Heinig MJ, Nommsen, LA. Maternal weight-loss patterns during prolonged lactation. American Journal of Clinical Nutrition 1993, 58: 162-66.

19. Altemus M, Deuster PA et al. Suppression of hypothalmic-pituitary-adrenal axis responses to stress in lactating women. J Clin Endocrinol Metab 1995;80: 2954-59. Uvnas-Moberb K and Eriksson M. Breastfeeding: physiological, endocrine and behavioural adaptations caused by oxytocin and local neurogenic activity in the nipple and mammary gland. Acta Pediatrica 1996; 85:525-30.

20. Acheson L. Family violence and breastfeeding. Archives of Family Medicine 1995; 4:650-562.

21. Waggett Gordon G and Rega Richardson Waggett. Breast Is Best: Legislation Supporting Breastfeeding Is an Absolute Bare Necessity - a Model Approach. Maryland Journal of Contemporary Legal Issues, Vol. 6, No. 1, March 1995.

22. Waggett, p. 27. (United States Court of Appeals for the Fifth Circuit)

23. Block Grant testimony on behalf of breastfeeding during 1992-1996 has consistently been ignored by ODH.

24. Elizabeth Baldwin, JD and Susan Brasier, JD, personal communications. I have testified as an Expert Witness in several custody cases, and have observed that there is widespread lack of understanding of breastfeeding and maternal-infant attachment as critical to the baby's development by the legal and judicial community.

25. Two mothers in the Cincinnati area were recently harassed when they attempted to breastfeed their 2-month old infants at a health club nursery and a Wal-Mart store respectively. Legislation to protect a woman's right to breastfeed her baby anywhere she is legally entitled to be was proposed in 1994 and is still desperately needed.

26. "When it comes to attitudes about women breastfeeding in a public place, two-thirds of Americans feel positive or neutral. More than one-quarter (27 percent) think that women should not breastfeed in a public place, but only 14 percent said that it makes them feel uncomfortable. Less than one quarter of all males felt women should not breastfeed in public and men were generally more likely to be neutral or positive." Breastfeeding Public Opinion Survey. Washington DC: Department of Health and Human Services, 1987. Available from Healthy Mothers, Healthy Babies Coalition.

27. Several large Ohio corporations, including NCR, have implemented workplace breastfeeding programs with astounding success for all concerned. The Family and Medical Leave Act is a step in the right direction, yet needs to be strengthened to protect future employees.

28. This issue is just beginning to be addressed. Recently President Clinton reported that home visits to at-risk families are a significant factor in reducing crime. Babies separated from their mothers due to incarceration may be further compromised by being denied breastfeeding and human milk.

29. Similar legislation has been passed in 13 states including Florida, New York, Texas, North Carolina, Illinois, Iowa, Michigan, Utah and Virginia. Legislation is pending in New Jersey and California.

30. The Chicago and Washington DC Breastfeeding Peer Counselor programs have consistently reported that breastfeeding has strengthened the self-esteem and improved the economic well-being of the peer counselors themselves.