Overview

The barriers to initiation and continued successful breastfeeding are diverse and varied across different populations.² They include community attitudes and perceptions about breastfeeding, structural barriers such as lack of facilities to support combining breastfeeding and work, workplace policies and legislative gaps, such as the lack of entitlement to maternity leave. Other barriers identified included lack of partner or family support and inconsistent health care provider information and advice.³

Other barriers can include

• cultural perceptions, beliefs and practices;
• low levels of education and or literacy;
• low socioeconomic status;
• lack of ongoing breastfeeding support, or access to such support; and
• lack of appropriate education and ongoing advice on techniques for successful breastfeeding establishment in the first six weeks after the birth.⁴

Hospital practices can be a barrier to breastfeeding⁵ but with the implementation of programs such as the Baby Friendly Hospital Initiative (BFHI) (see chapter 6) hospital practices can encourage and support breastfeeding.⁶

The online parenting forum www.bellybelly.com.au, in response to this inquiry, surveyed its users on the biggest barrier to breastfeeding. 361 participants took part; most participants were mothers who had recently had children. The results indicated that they felt lack of education was the biggest barrier, followed by conflicting advice after the birth.⁷

Table 5.1 What do you think is the biggest barrier to breastfeeding in Australia

Source: BellyBelly forums, viewed on 30 July 2007 at http://www.bellybelly.com.au/forums/showthread.php?t=38097.

The interaction between these barriers and strategies to promote breastfeeding needs to be considered. Ngala, a family resource centre in Western Australia, noted that initiatives to encourage breastfeeding are often too targeted and do not take into account the multitude of issues that are barriers to breastfeeding, such as the father's opinion, cultural roles and expectations, responsibilities, as well as the belief or assumption that using developed world products are better than old world strategies such as breastfeeding.⁸

Returning to work

A high proportion of the workforce is made up of women of childbearing age who play a substantial role in the national economy. The committee considers that it is a woman’s right to choose whether or not to enter the paid workforce after the birth of a baby and that she should be supported in her choice.

Evidence shows that families are increasingly struggling to combine work commitments with family needs and mothers need real and supported choices in order to return to work.¹² Female employees have needs related to pregnancy, birth and lactation which need to be recognised.¹³ There is a real risk that if women are not supported, returning to employment can be an obstacle to breastfeeding to the point of affecting the duration and exclusivity of breastfeeding, or even to the degree of weaning their infants.¹⁴

I have seen first-hand how disempowered women can feel in trying to negotiate to return to work and continue breastfeeding. Many of the women I have spoken with have said that they will not even attempt to combine the two activities as they know that their workplace facilities and culture are inadequate to meet their needs.¹⁵

When women return to work and continue breastfeeding, they may also not be able to physically express or find the process too difficult and may prematurely wean their baby. Expressing on a lactation break can take practice but many mothers find it gets better with time. One woman indicated to the committee that:

I think also there is an assumption that returning to the workforce early is viable, but even returning part time trying to express, to maintain breastfeeding and then still have interrupted sleep is unrealistic, women will soon become exhausted and that does not go well for family life.¹⁹

Breastfeeding and work

I am interested that my youngest sister, whose first baby is 11 months old, has the encouragement of working in a Breastfeeding Friendly Workplace, the Department of Education (etc) in Canberra. She was given a maternity package before she left work, and on return she was given the information for how to access the expressing room and support for her part-time hours. She has said all the staff speak positively to her about going out to express, including the security guard who gives her the room key.²²

Workplaces such as Queensland Health have developed a policy on work and breastfeeding. Queensland Health supports staff wishing to continue breastfeeding on returning to work by:

• allowing paid lactation breaks of up to one hour per day;
• providing facilities suitable for breastfeeding or expressing milk; and
• providing supportive management to assist the needs of both the staff and their work commitments.²³

The committee supports employers who help their female staff combine work and breastfeeding. The committee encourages all employers, large and small, to support breastfeeding employees and at the very least, offer them paid lactation breaks.

Breastfeeding-Friendly Workplace Accreditation (BFWA) Program

The ABA has a 'Breastfeeding-Friendly Workplace Accreditation (BFWA) Program' which can accredit workplaces as being breastfeeding friendly. The accreditation process provides:

• resources from the ABA and access to information from Australia's leading source of breastfeeding resources and support;
• information for the workplace to develop their own personalised information pack to give to employees going on maternity leave, or access to the ABA's 'Come Back Pack'
• heightened awareness within the workplace of the importance of breastfeeding and therefore the positive spin-offs that breastfeeding provides in the longer term;
• the increased opportunity to attract and retain female employees and reduce on-going training and recruitment costs; and
• recognition of supportive workplace policies and practices.

Since July 2002, the ABA has accredited more than 40 workplaces across Australia. This has included six major Commonwealth government agencies, several hospitals, health service providers and tertiary education institutions. State and Territory Government agencies have also gained accreditation for their agencies.

Breastfeeding equipment

The complexity of the tax system makes issues such as this rarely as straightforward as they may appear but the committee is concerned that GST-free status for infant formula may create the perception that it is perceived by the tax system to be the default food for an infant.

Family Law

There appears to be a lack of understanding on the part of the legal profession dealing with family law matters of the mechanics of breastfeeding. It is not simply a process which can be stopped and started on cue and where milk can be extracted to send with the child to the other parent for days at a time.

The committee encourages Family Relationships Centres and the Family Law Court to ensure that breastfeeding is given suitable consideration in the making of interim and final orders regarding the placement of children with separated parents.

People with compounding issues

Drug use when breastfeeding

The 2004 National Drug Strategy Household Survey found that women who were pregnant and/or breastfeeding in the previous 12 months were less likely to consume alcohol (47 per cent) and any illicit drug (six per cent), compared with when they were not (85 per cent and 17 per cent respectively). Pregnant and/or breastfeeding women appeared less likely to reduce their tobacco consumption, with 22 per cent smoking when they were not pregnant and/or breastfeeding, and 20 per cent continuing to smoke during pregnancy and/or while breastfeeding.³²

Table 5.2 Drug use in the last 12 months, pregnant and/or breastfeeding women and all other women, women aged 14-49 years, Australia, 2004

Source: Australian Institute of Health and Welfare, Statistics on Drug Use in Australia 2004 (2005), cat no PHE 62, pp 62-63.

Mothers who are drug dependent should be encouraged to breastfeed with appropriate support and precautions. In addition, it is now recognised that skin-to-skin contact is important regardless of feeding choice and needs to be actively encouraged for the mother who is fully conscious and aware and able to respond to her baby's needs.³³

The committee considers it important that pregnant women are educated on the appropriate use of drugs, including tobacco and alcohol during pregnancy. The committee commends the work of health professionals with mothers who are drug dependent in ensuring the best possible outcomes for the baby and the mother.

Postnatal depression

In most cases, PND starts before breastfeeding commences and women who have PND are more likely to stop breastfeeding early. Therefore, it is possible that a mother’s perception of her breastfeeding ability, caused by PND, as opposed to actual physical difficulties, may influence her decision about how long she breastfeeds.

The Post and Antenatal Depression Association (PANDA) advocates that breastfeeding should be encouraged for women with PND, or those at risk of developing it. PANDA notes that the physical and psychological importance of breastfeeding for the mother and baby is likely to outweigh any potential negative effects of antidepressant medication on the baby via the breast milk.³⁶

Too depressed to get dressed and too exhausted to move. Certain I was a failure as a mother because I couldn't nourish my daughter as nature intended. Certain she hated me since she screamed so much and fought me. Certain I was judged by everyone as a failure because I wasn't perfect enough. Deliriously tired from lack of sleep and little support. I was obsessed with breastfeeding, and felt my value as a mother depended on my ability to perform this simple task. Since I couldn't do it, I must be a bad mother and unworthy of my beautiful child.³⁷

Breastfeeding and medical treatment

One example reported to the committee of how breastfeeding is not actively supported is in the situation of women who are breastfeeding and need to be admitted to hospital for other reasons than breastfeeding.  These women may have great difficulty continuing to breastfeed with reports of hospitals telling them there is no way to support their breastfeeding and they need to wean or health professionals not understanding the effect that a mother’s medication may have on the breastfeeding child.³⁸

When breastfeeding does not work out

The WHO in the Global Strategy for infant and young child feeding states that the vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed.³⁹ Physiologically almost all women can breastfeed.⁴⁰ It is estimated that two to five per cent of women are not able to make enough milk to support an infant. However, the rates of breastfeeding in Australia, as discussed in chapter 2, indicate that despite this ability to breastfeed, many women are not continuing with breastfeeding. The Australian Lactation Consultants Association noted that breastfeeding is complex:

It is not simply putting a baby to the breast; it is totally encompassing of a woman and her family and learning about her child. When things get difficult, which they do with children, it is the one thing that women can give up.⁴¹

Our society does not do enough to support breastfeeding, leaving women with the only choice or option of giving their babies artificial milks. It is this lack of real choice that hurts the health and wellbeing of current and future mothers as well as their babies.⁴²

And it is about choice. If mothers choose, that is their choice. But why should the rest of the population pay in terms of the health care costs for not breastfeeding that baby later on down the track?⁴⁴

These mothers have no reason to feel guilty. They have not 'failed'. Our community has failed them by not giving them timely support and accurate information to prevent the problems from developing.⁴⁵

…as soon as it gets difficult they give up as they don't know how to work through these issues and say things like, "I couldn't breastfeed" which is usually not the case, they just couldn't be bothered or didn't know how to work through the problem.⁴⁷

Guilt and anger

It does not impact on their breastfeeding per se; we find with a lot of women that their feelings about breastfeeding and their performance as a breast feeder are very mixed up with their feelings about their performance as a mother.  If a woman is unable to breastfeed for one reason or another, it affects her confidence in her mothering ability.⁵¹

I spent many weeks of heartache and pain, using breast pumps and other devices, to assure myself and others that my baby had to have formula as there was no possibility of breastfeeding. The distress and total disruption to the rest of my family from trying to achieve what was expected of mothers then, and I believe today, was a very unnecessary experience. The guilt still remains.⁵³

Emotionally, it was incredibly hard to bond with my son when our sole interaction was him crying, followed by the most excruciating pain that continued at all times, not just with feeding. I did not become strongly attached to him until our breastfeeding relationship finished….I believe I should have been counselled to stop breastfeeding.⁵⁵

Mothers, of course, are great blamers of themselves, whatever they do, but so also are the community, particularly other women...It is not so much breastfeeding; it is the fact that mothers are full of self-doubt, and the community will often back up that self-doubt.⁵⁸

IFMAA fully supports the Committee's desire to promote breastfeeding but requests that any campaign to promote breastfeeding be sensitive to the needs of women who are unable to or make an informed choice not to breastfeed. Infant formula is the only suitable alternative to breast milk. If a campaign to promote breastfeeding can be executed without any accompanying hostility towards formula-feeding, the needs of both breast-feeding and formula-feeding mothers can be met as well as the needs of their infants.⁶¹

Health professionals such as the Australian College of Midwives have a code of ethics which ensures that midwives need to continue to support people who are not breastfeeding and there is recognition that with the high rates of infant formula use, these mothers and babies need support and the correct information.

Stavrakis C, sub 433, p 1. Back