I have class M-F from 9 to 5 most weeks (is it just me, or is that the most intense schedule for a taught graduate degree?), so naturally by 4pm on Fridays my mind starts dozing elsewhere, dreaming about crossing over Dwayne Wade and hitting the winning shot to take the New York Knicks to the NBA Finals (Jeremy Lin is beating me to it).
On this particular Friday class we had a lecturer who was speaking about his work at a clinic north of the Liffey. Just as I began daydreaming, he mentioned that Ireland’s breastfeeding rate has risen to about 25%*.
Wait! What?!
In the last blog post, you learned about my love for sports and why it is more than just a game for me (click here for my predictions on Ireland’s 2012 Euro Cup run). In this post, you will learn about my other love – enhancing access to health resources and improving health care by through the design of communication programs that influence behavior change. (One of my dream jobs is to work on child health programs for the television program “Sesame Street” – check out “Sesame Street”’s new launch in Pakistan.)
Okay, back to breastfeeding. Probably the best part of my degree program in Ireland are my classmates who are from different parts of the world and have no problem expressing their opinions. For each module so far, there has usually been someone who has had extensive personal experiences on the discussed topic and who helps us better understand the practical situations attached to the subject, ultimately enhancing everyone’s academic experience. This time around, we were missing a student who was also a mom. I’d like to think that I could be a substitute, given my interest in neonatal care, my having been raised by a kindergarten teacher, and my having inherited the maternal instincts that seem to have skipped my older sister.
Shocked at how low the breastfeeding rate is in Ireland, I asked my Irish classmates why this is and got answers including: mothers not being provided much support or counseling during the “fifth trimester,” public discomfort with public breastfeeding, breast milk being viewed as unhealthy after World War II, and mothers being told that formula—introduced to the Irish in the mid 1950s—is a viable option for working mothers. Curious to see what random Dubliners thought about how long a mother should breastfeed, I got a mix of answers ranging from “none, because it’s embarrassing” to “you don’t have to for more than six months.” (Imagine how awkward it was having these conversations! Story of my life…)
One of the most interesting classes I ever took during my undergraduate years at Johns Hopkins discussed the perception of motherhood in the media (I was one of three guys in a class of about 20, so you bet we stayed quiet). I learned that breastfeeding is recommended for about two years (yes, ‘a dó’ for you Gaelic speakers) or more, and that a child should have breast milk exclusively for the first six months since it has everything the child needs for proper development. Studies have shown that breastfeeding helps protect the child from illnesses including diarrhea and pneumonia–which are two main causes of early childhood deaths around the world. The benefits continue after breastfeeding stops. Breastfed babies are less likely to be overweight, and have food allergies or diabetes. While breastfeeding is great for the child, it also helps mothers lose post-pregnancy weight in a healthy way and reduces a mother’s chance of getting breast and ovarian cancer. So what’s the deal? Why is less than 5% of the Irish population breastfeeding?*
The typical problems are the first ones most people will think of. Time: How can a mother schedule her time around feeding a child every couple of hours as she tries to maintain a work schedule? What about if she has problems producing enough milk? What if she is in pain (a problem few mothers speak out about)? What if she feels embarrassed? Why even bother when you can just use formula, which is the same, right?
But what is actually so bad about formula? First, it does not provide the child as many nutrients as breast milk. Formula is also expensive. Many children die every year because of formula that is diluted too much by parents who try to make the solution last longer, not realizing how deadly this is for the child. Also, formula is dependent on clean water and in many developing countries that is hard to find. In cases where formula has been used but becomes unavailable, chances are slim that a mother can go back to breastfeeding since she has lost a significant amount of her milk production. HIV+ mothers in developing areas who have little access to clean water are still encouraged to exclusively breastfeed for the first six months (adding solid foods to the mix increases a child’s level of transmission). HIV+ mothers in developed areas (where clean water is available) are not recommended to breastfeed but rather to find alternative methods.
I would like to see three changes in Irish society to better promote breastfeeding, from the hospital to the office.
The Irish could learn from the Iranians, who initiated a mandatory two-hour family planning class for couples applying for a marriage certificate (along with other interventions that have led to a very effective family planning program). Such a class could include breastfeeding.
The role of the community is crucial. In a country like Ireland where religious beliefs have historically influenced how a woman can treat her own body, the Irish must refocus on how women are treated in all aspects of health.
The services that are provided to mothers from antenatal to postpartum reflect this. While paid maternity leave has increased to about 26 weeks, new mothers should be allowed an additional six months to properly feed their children without any pressure to go back to work. Interestingly, working mothers actually have higher initial breastfeeding rates than those who don’t, showing how influential education is to initiating breastfeeding. Adjustments should be made in all facets of life. Malls, restaurants, and offices should have designated spaces where mothers can feel comfortable feeding their children and putting them to sleep. Who likes to lunch sitting on a toilet? Then why should a newborn have to be fed by her mother in a smelly bathroom?!
The role of the health professional and health system must also change:
1. No health professional should be allowed to recommend formula when the mother can breastfeed.
2. No formula company should be allowed to provide free samples and market their products in or around health care facilities. Many US organizations are pushing to get formula products labeled with health warnings similar to cigarettes. While Irish hospitals continue to give out free formula samples (which are given in a kit with a bottle, a couple of diapers, and other baby supplies), this is in violation of World Health Organization’s International Code of Marketing of Breastmilk Substitutes (1981). Rather, doctors must voice their concerns about formula, work with the Irish government to ban the solution and its aggressive advertisements from health facilities, require the restoration of funds for breastfeeding clinics that have been shut down across the Island, and give out their own free kits.
3. While formula seems to be the only option a mother has at the hospital if she cannot produce milk to feed her child in the first hours after birth, “breastfeeding help” can be recommended with available bottled breast milk until the mother has had time to relax and produce milk properly after counseling.
4. Because the general practitioner is the first health professional mothers go to for their health needs, the doctor must educate the mother about breastfeeding during pregnancy and after giving birth.
5. Surprisingly, Ireland lacks a nationwide monitoring system for breastfeeding. This is something that can start and end with the general practitioner who can collect the mother’s feeding rates at specific times. This is vital in order to better monitor and evaluate the situation and to work on how to increase the national breastfeeding rate.
Now don’t get me wrong, US and many many other countries are in the same situation. While American mothers start off breastfeeding at just above 70%, they fall to 40-something after six months, and just over a quarter percent at the one year mark. In parts of Africa, there is belief that you cannot have sex with a mother who is breastfeeding! This has created a massive stigma, which has helped create a market for formula. I’m writing about Ireland’s breastfeeding rate in particular because I live here at the moment, but also because Ireland has the youngest population in Europe. One of the first things I notice every time I come back to Ireland after visiting another European country is the abundance of babies. This year, Ireland had its highest birth rate since 1861 (walk around the main streets of Maynooth and you’re bound to trip over a baby stroller or two). Besides having one of the highest birth rates in Europe, Ireland also has one of the fastest-growing child and adult obesity rates in the region).
If nothing in this post has gotten you to think more about breastfeeding, I hope actress-activist Salma Hayek can change your mind! We need to change our perception of breastfeeding around the world to create a culture that accepts the most natural way of feeding our newborns, so that we can ultimately create a healthier Ireland, United States, and global community.
*While initiation rates are higher than 25% in Ireland, this percentage is the estimate of mothers who continued to breastfeed for the first six weeks. This number falls to less than 1% of Irish nationals who exclusively breastfeed after the six month time period, according to a 2008 study. Although recent findings show that mothers who were breastfed are more likely to do so themselves, Ireland has lost a great portion of their last generation to mothers who used formula.









