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Lactivism and the homelessness problem

It's turning out to be a good week. First, I was called pushy for having a birth plan. And then today, a commenter on my blog told me to "grow up and quit making such a big deal out of nothing" when referring to one of my posts on breastfeeding on airplanes. Well that was part of what she said. She also said that "if you guys made such a big deal out of something that actually mattered, like how solve the homelessness problem then it would have been solved by now."

Thank you Maggie, for the excellent opportunity to make an important point about lactivism and poverty.

Let's start here:

As you can see from this graph, poor women are less likely to breastfeed than women that are not poor (more details available in the Breastfeeding article in the Child Trends DataBank). The further you are from the poverty line, the more likely you are to breastfeed.

My first reaction to a chart like this is to ask why do those women that can least afford to buy formula choose not to breastfeed?

We could get into a whole chicken vs. egg or cart vs. horse debate here about whether being poor causes women to not breastfeed or whether not breastfeeding perpetuates poverty, but ultimately I think both are true. Let me explain.

Poverty makes breastfeeding difficult

A lot of women face challenges with breastfeeding in the early days and weeks. Women with a decent income and a car to get around can easily see a lactation consultant or can use their computers and high speed Internet access to go on-line for support. But poor women may not be able to afford a lactation consultant and even if they can find free support (e.g. La Leche League, government or not-for-profit breastfeeding clinics, etc.) they may have difficulties getting to the appointments. They may not own a computer or have Internet access and in some cases literacy rates may pose challenges for finding and accessing support on-line. Often having a pump is useful when getting through tough times (e.g. a baby that won't latch) and a poor woman might not be able to afford one. They may not be able to afford books that could provide additional assistance.

Women that are poor are also less likely to be able to afford to take time off from work to stay home with their babies. If there is a grandmother, an aunt, or neighbour that can care for the kids for free or for a minimal charge, then the mother is probably under great pressure to get back to work and continue to contribute to the family's bottom line. Going back to work in a minimum wage job is often not easy to combine with continued breastfeeding. Shift work, insufficient breaks, no clean facilities to pump in, the expense of the pump, and attitudes of bosses and colleagues make it tough to keep it up.

Not breastfeeding perpetuates poverty

In individual families, not breastfeeding perpetuates poverty by having an immediate impact on the family's finances. Formula is expensive and can cost between $750 and $3200 for a year. For a poor family, that can be a substantial amount of their budget. It can perhaps mean the difference between keeping their home and losing their home. In addition, breastfeeding helps with natural family spacing because women that are exclusively breastfeeding see a delay in the return of their fertility. This could mean that a family ends up with 2 children instead of 4, 3 children instead of 6, or 4 children instead of 8. Each additional child that is brought into a family puts another significant strain on that family's budget and increases their chances of ending up homeless, especially if you end up with several of them in diapers at the same time (another huge expense, especially if you use disposables). Babies that are not breastfed are more likely to get sick. In Canada this is less of an issue than in the United States due to our medicare system, but it can still mean that parents have to take unpaid leave from work to care for sick kids, which results in lost income.

Beyond individual families, not breastfeeding perpetuates poverty through increased risk of anemia, which is linked to deficits in language development. Formula feeding generally involves less mother-child interaction (think bottle propped up in stroller or bouncy seat) and skin to skin contact, which results in less sensory stimulation during brain growth. Not breastfeeding means more ear infections, which result in worse hearing, verbal and speech development. Not breastfeeding results in lower IQ levels. All of these things decrease the chances of a child that is raised in poverty being able to break out of that cycle (source: INFACT Canada).

And it is not just me that says this, take a look at this quote from James P. Grant, former Executive Director of UNICEF:
Breastfeeding is a natural "safety net" against the worst effects of poverty. If the child survives the first month of life (the most dangerous period of childhood) then for the next four months or so, exclusive breastfeeding goes a long way toward canceling out the health difference between being born into poverty and being born into affluence .... It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born

What can we do about it?

Certainly, we need to ensure that there is a stronger support system for economically disadvantaged mothers to ensure that they are able to breastfeed if they want to. Programs such as the Birth and Parent Companion Program offer support to women at risk to support them in areas such as breastfeeding. We need to ensure that doctors and nurses faced with women that are having trouble breastfeeding know where to refer them to for help instead of shoving a few free formula samples in their face and ushering them back out of the office. This could be La Leche League, a drop in lactation clinic or other free resource. We need to give prenatal education programs to the families of at risk women that tell them about the importance of breastfeeding. Those are some of the things that we can do to support those women specifically. And there are many many more.

But beyond that, what we really need to do is to work on society's perception of breastfeeding in general. Women that are poor are at greater risk of giving up on breastfeeding due to the attitudes of others. They may not see other people breastfeeding because their friends and family formula feed too. They may be scared that they will lose their job if they insist on having space and time to pump at work. They are more likely to be in abusive relationships and may have abusive partners that feel that the breasts are theirs and are jealous of the baby or that have an issue with their wife exposing any breast in public and tell her "not to do THAT" when they are out. The don't have the resources to hire a lawyer to represent them if they are discriminated against for breastfeeding. As a result, a poor woman may start giving formula more and more often, resulting in her milk supply diminishing, which then threatens her ability to keep breastfeeding her baby.

So Maggie, one of my contributions to the homelessness problem (and there are others...I don't spend all of my time and resources on lactivism) is to increase awareness of the fact that breastfeeding is normal and important for a baby's health and increase awareness of the fact that women have the right to breastfeed their babies in public and not be disturbed when doing so. One of your contributions to improving the chance that a poor woman continues breastfeeding could be to smile and congratulate her on breastfeeding her baby if you see her doing so in public instead of scowling about the 1/4 inch of breast that you were exposed to.

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Reader Comments (27)

*standing ovation*

September 19, 2008 | Unregistered CommenterCynthia

Very interesting another *standing ovation* to you!

September 20, 2008 | Unregistered Commenterjessyz

Brava! It is time that more breastfeeding activists were willing to stand up to the ignorant remarks regarding the relative unimportance of breastfeeding as a political and social issue. This reminds me of Bill Maher's rant about lactivism as being stupid because it distracts us from the war in Iraq. Well, according to the World Health Organization and UNICEF approximately 1.5 million babies die each year because they are not breastfed. Fewer people than that have died in all the years of U.S. intervention in Iraq. Does that make breastfeeding more important as a political issue? No, of course not. "Number of deaths" is an unproductive and insensitive way of measuring political "importance." But no matter how you look at it, breastfeeding is NOT trivial. One may choose to focus one's energies on another issue - we all have a limited amount of time and resources to devote. But it is not legitimate to merely dismiss an issue because it is not personally important.

September 22, 2008 | Unregistered CommenterJake Marcus

Very interesting....I admire your research and willingness to show the strong correlation between breastfeeding and social economic status.

September 23, 2008 | Unregistered CommenterRebecca

This is a great post. I also started out thinking about the surprising inverse relationship between available money and the tendency to buy formula. I hadn't thought through the lack of breast feeding perpetuating poverty line of thought. Thanks for raising it.

October 15, 2008 | Unregistered CommenterMom On The Go

Excellent post! Free access to breastfeeding information and support for all - particularly the less wealthy - should be a key part of any programme aimed at improving public health. And it makes economic and environmental sense to boot.

November 24, 2008 | Unregistered Commentermymilkspilt

[...] past, I’ve turned comments that upset me into great posts (like Birth Plan: Yes or No? and Lactivism and the Homelessness Problem), so I thought perhaps the best way to get past what bothered me so much about this post was to [...]

I am considering doing my masters in Social Work with a focus on this issue. Thanks for linking this amazing post to your current one.

March 9, 2009 | Unregistered CommenterMelodie

Excellent post. One point not made here (I suspect because you are in Canada and may or may not be aware of it) is the role that WIC plays in formula feeding in the US. WIC (Women, Infants, and Children) is a US government program that subsidizes certain food purchases for low-income families. It is only for pregnant women and children under 5, and provides vouchers for certain staple food items, such as milk, cheese, carrots, tuna, and cereal (with some variations by state).

WIC is the largest purchaser of infant formula IN THE WORLD. The U.S. govt. purchases formula at a fraction of its manufacturing costs, then gets money back on top of that in the form of rebates. They then turn around and offer infant formula on WIC vouchers. Many low-income women choose formula in our country because it's free to them, and many WIC offices just assume they will be wanting formula, so they give them formula vouchers as soon as the baby is born. Some WIC offices spend more time in breastfeeding education, usually in the form of a 20-minute video that women are required to watch at some point during their pregnancy. Some WIC offices also provide LCs. However, it has been my impression that most WIC offices simply dole out the formula vouchers. Office policies can vary by state, and sometimes even by city.

I plan on writing a blog post about the WIC situation very soon. I'll link you when I get it up.

March 29, 2009 | Unregistered CommenterEmily Jones

"PhD in Parenting makes a case for why breastfeeding is a particular thorny issue for low-income families. In her post, she says..."

April 2, 2009 | Unregistered CommenterEmily Jones

[...] include Adventures in [Crunchy] Parenting on WIC and Infant Formula, and PhDinParenting’s Lactivism and the Homelessness Problem and The Economics of Breastfeeding: A Cost-Benefit Analysis. Looking forward to hearing what [...]

[...] Lactivism and the homelessness problem [...]

September 20, 2009 | Unregistered Commenterphdinparenting

Fantastic post!!!

September 20, 2009 | Unregistered CommenterSarcastica

I love the way you were able to draw the line backwards from what someone assumed was a total non-starter (homelessness) and show how breastfeeding can make that less likely to occur. (If you are living on a low income, the last thing you need is to have to spend money on infant formula.) Bravo! :-)

September 20, 2009 | Unregistered CommenterAnn Douglas

excellent post!!

September 20, 2009 | Unregistered CommenterJulie Cole

**Applause** Excellent work, well researched and very important reading for all of us!

September 20, 2009 | Unregistered CommenterStorkStories

**Applause** This is just fabulous! Important reading for all of us to share. I also love Jake's remarks!

September 20, 2009 | Unregistered CommenterBirth_Lactation

Wow! Great post, great comments. I'm going to post this on my FB profile :)

September 21, 2009 | Unregistered Commentermom4mykids

Excellent post. You drew a strong, logical connection between breastfeeding and poverty. And thinking of breastfeeding as a kind of "fluffy" or frivolous cause compared to homelessness or war is such a failure of imagination. More breastfeeding in the world might help to alleviate some of these problems. It's crazy to think that making available the best possible care for infants wouldn't have an effect on the poverty cycle.
I always wondered why more low-income women didn't breastfeed, but reading your post reminded me how hard it was in the beginning, and how much time and support I had that poor women do not have. Thanks!

September 21, 2009 | Unregistered CommenterCatherine

[...] to make good considered choices if more barriers are removed. I do use strong words when someone has upset me or when people are sticking their heads in the sand. Sometimes when playing nice isn’t [...]

September 26, 2009 | Unregistered Commenter“Don’t Judge Me&#8

[...] much better. While the circumstances here are not as dire (we have clean water and many, but not all, parents have the means to purchase formula), the fact remains [...]

[...] Lactivism and the homelessness problem [...]

[...] among women who are not on WIC. At first glance, people might assume that this is simply a case of lower breastfeeding rates among low income women. However, it is more complex than [...]

[...] So I told Maggie a little bit about the homelessness problem. [...]

Wow, great post. Sad.

May 26, 2010 | Unregistered CommenterAl_Pal

Also, many women in poverty are disproportionately black. Black women also have the lowest breastfeeding rates. This is actually largely due to their history of slavery, being forced to reproduce, ripped from their own children without being able to breastfeed all to go and nurse the white children. This even happened once slavery was abolished (think black mammies). As such, black women have built up myths and attitudes against breastfeeding, especially in poor communities. It is important we help them understand the origins of the myths and break them down in order to increase breastfeeding.

February 17, 2012 | Unregistered CommenterKarissa

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