Breastfeeding advocacy: Who is responsible?

Article Outline

• References
• Copyright

The Australian Bureau of Statistics data shows that nearly 90% of Australian mothers initiate breastfeeding at birth or soon after.¹ However, within weeks or months the majority of these mothers stop breastfeeding. At 6 months of age less than half of all babies born in Australia are receiving any breast milk at all.¹ Given the World Health Organisation’s (WHO) recommendation of exclusive breastfeeding for the first 6 months of life and continued breastfeeding for 2 years and beyond,² the duration of breastfeeding in Australia is a major health issue. With such dramatic declines in breastfeeding duration in Australia it is fair to ask ‘are midwives doing enough to promote breastfeeding as the normal way to feed babies beyond the post partum period’? And furthermore ‘whose responsibility is it to advocate for breastfeeding in accordance with the WHO recommendations’?

The international definition of a midwife³ states a midwife is responsible for care of the mother and her newborn infant in the postpartum period. The postpartum period is recognised as the first 6 weeks after birth. From 7 weeks postpartum onwards the care of the woman and baby is assimilated in the general health system. Care is usually provided by general practitioners and child and family health nurses. However, midwives are recognised to have an important and overarching task in health counseling and education. The expectation that midwives will engage in health promotion in relation to breastfeeding is not limited to working with individual women, but also involves the family and community. Given the global endorsement of the WHO recommendations for breastfeeding, midwives should be advocating for breastfeeding to continue for 2 years and beyond.

The Australian College of Midwives (hereafter ‘the college’) is the peak professional body for midwives. The college strives to maximize the quality of maternity care provided in Australia. The college has made excellent links and working relationship with the Maternity Coalition, a national childbirth consumer organisation, with the intent to raise awareness of childbirth issues. Some of the issues raised include midwives as the primary caregivers for normal birth, models of maternity care, promoting women centred approaches to maternity care, emphasizing women’s rights and improving the pregnancy and birth experience for all women. This has been a very effective collaboration. However, are we as a professional group being as equally progressive with health promotion through breastfeeding advocacy?

So what is the college doing to promote breastfeeding? Certainly, the college has been invested the responsibility to administer the Baby Friendly Health Initiative (BFHI) in Australia. To this extent we as a college, do great things to promote breastfeeding. However, there are currently only 64 BFHI accredited health services across the nation out of approximately a possible 500. There is scope for many more health services to achieve this internationally recognised accreditation and to promote and protect breastfeeding for the communities we serve. Are you able to speak to your organisation about their commitment and becoming accredited?

The Australian Breastfeeding Association (ABA) is the peak advocacy organisation for breastfeeding in Australia. The ABA is a volunteer non-profit, self help organisation which is supported by health authorities and specialists in infant and child health and nutrition. It is without doubt that the ABA has been instrumental in promoting and protecting breastfeeding and providing mother-to-mother peer support since its inception in 1964. There is great opportunity for the college to strengthen its links and working relationship with the ABA to continue to promote and protect breastfeeding. The combined strength of the largest breastfeeding advocacy organisation in Australia, the ABA, with the peak maternity care professional college—would increase the profile and success of breastfeeding promotion. At a local level, individual midwives should be aware of their local ABA group and their contact information. Midwives should advertise the ABA to pregnant women and new mothers. This may be through the supply of flyers and ABA publications, display of posters and involvement of the local ABA leaders in the health service such as during antenatal or postnatal education. But is doing these things in isolation truly advocating for the long term benefit of breastfeeding?

To be an advocate is to publicly support a cause; to uphold, defend or recommend a cause. Breastfeeding advocacy is dependant on individuals’ attitudes, family and community attitudes, societal expectations, and the provision of support for the breastfeeding mother. To advocate for breastfeeding is to recommend and protect breastfeeding publicly. This requires advocates to challenge taken for granted views and assumptions, such as bottle feeding as equivalent to breastfeeding and that breastfeeding should cease before an infant turns one. These are remnants of our previous generations and breastfeeding advocacy is needed to stop their perpetuation. Given that midwives claim to be advocates for breastfeeding, are we doing enough to overcome these barriers?

Breastfeeding is a social practice and takes place in private homes and in public places such as shopping centres, parks, childcare centres, restaurants and health facilities; or does it? Our contemporary society continues to see breasts for sexual purposes. Breastfeeding in public continues to be frowned upon by many people. Many women continue to find it uncomfortable to breastfeed in public either from their own willingness to do so, or from the perceived responses of the public to their breastfeeding. This is one of the reasons that women cease breastfeeding within the first year after birth. Breastfeeding a toddler is not well accepted in our society. The high initiation rates of breastfeeding in Australia suggest that midwives are successful in encouraging women to breastfeed. Midwives teach women to breastfeed in the privacy of their own room. Are we doing enough to enable women to feel comfortable to breastfeed in public places and to continue to breastfeed beyond 6 months? Are we doing enough in the community to change attitudes to accept breastfeeding in public and to accept breastfeeding of older infants? If not then perhaps midwives and the college are not doing enough to truly fulfill our role to be advocates. If we are to successfully improve breastfeeding duration then we must now focus on the communities in which we live, and the individual, family and societal values and beliefs in which new mothers choose to breastfeed or not.

Midwives are an influential professional group for new mothers, and therefore having a positive language, outlook and optimism for public and long term breastfeeding may make a significant impact. In your workplace and local community do you see images of women breastfeeding children older than 6 months of age? Do the restaurants and coffee shops display “Breastfeeding Welcome” signs in the window? If we do not include such images, the hidden messages are that breastfeeding beyond 6 months is not right or normal. Does the breastfeeding promotional material you use recommend breastfeeding for 2 years and beyond in line with the WHO recommendations? If it does not we cannot expect women and the community to know and understand the positive benefits of breastfeeding for mothers and babies beyond infancy. Midwives must stop perpetuating the hidden practices of breastfeeding and become true advocates for breastfeeding.

In 2007 there was a national Inquiry into Breastfeeding.⁴ Among the 479 written submissions available online, the college made one submission under the banner of BFHI. There were 22 recommendations made as a result of this inquiry; some of which may directly impact on midwifery practice. These recommendations are publicly available, along with the full report at www.aph.gov.au/House/committee/haa/breastfeeding/index.htm. I urge all midwives to familiarise themselves with these national recommendations. Breastfeeding advocates should make it a priority that each and all of these recommendations are actioned both at a local and federal level. At an organisational level, it is time for the college to take a public stance about breastfeeding, and to be more active in the broader community to promote and protect breastfeeding.

In conclusion, midwives have a responsibility to promote breastfeeding and support the initiation of lactation with mothers and their newborns. Midwives individually and collectively also have a responsibility to examine our own practices, explore what is happening in our own communities and to find ways to protect breastfeeding for many months beyond the postpartum period. Breastfeeding advocacy is a responsibility of all midwives.

Back to Article Outline

References 

1. Australian Bureau of Statistics. Breastfeeding in Australia 2001. Canberra: Australian Bureau of Statistics; 17 September 2003. Contract No.: Document Number.
   • View In Article
2. World Health Organisation. Protecting, promoting and supporting breastfeeding: the special role of maternity units. A joint WHO/UNICEF Statement. Geneva: World Health Organisation; 1989.
   • View In Article
3. Definition of a midwife (29th July 2008, 2005).
   • View In Article
4. House of Representatives. The best start: report on the inquiry into the health benefits of breastfeeding. Standing Committee on Health and Ageing. Canberra: Commonwealth of Australia; 2007.
   • View In Article