Last week, I asked fellow Canadians on twitter if they support breastfeeding. A lot of people asked "what do you mean by support?". I think the answer is different for each person, but I was interested to hear from you. If you do consider yourself a breastfeeding supporter, what does that mean? I wanted to know, so I put together a survey, open to both Canadians and non-Canadians, and asked a bunch of questions about factors that are often or sometimes equated with breastfeeding support. I got 1631 responses to the survey.
What did you say? In this post, I'm publishing the fascinating results from eight out of the ten questions on the survey. One of the other questions was an open-ended question asking respondents if they wanted to add anything else about what it means to support breastfeeding. More than 500 people had a comment to add, so I'll publish some of those comments in a second post later this week. The final question asked people where they lived, because I wanted to see if the answers were vastly different for Canadians versus Americans versus other countries. In the end, none of the answers had significant differences across geography (58% of respondents were from the US, 33% from Canada and 9% from other countries). If you aren't able to read the results in the graphics below, you can also view the results on surveymonkey.
The first question asked people about the extent to which they support a woman's right to choose how to feed her baby. Almost 90% agreed or strongly agreed that women should be able to choose whether to breastfeed or not. Of the remaining respondents, who either disagreed or were neutral, it would be interesting to know why. Is it because they believe babies have the right to be breastfed and that this trumps the woman's choice? Do they believe it should be a joint choice between both parents?
The second question asked people about the extent to which they support some of the Baby Friendly Hospital initiative's steps to successful breastfeeding (with some variation in language) and other factors that are often linked to breastfeeding success in a hospital or birth centre. The first few hours and days of breastfeeding are critical in establishing breastfeeding and breastfeeding problems are often attributed to poor hospital breastfeeding practices. Respondents were overwhelmingly in favour of practices that help establish a strong start to breastfeeding, but were quite split on whether a formula should be made available to a mom who wants to breastfeed without the sign-off of a doctor (I also considered saying "without sign-off of a lactation consultant" in this question, which I think would have conferred greater breastfeeding expertise, but possibly also be seen as more biased toward breastfeeding than a doctor).
Next, I asked how you, as a breastfeeding supporter, would support someone else who is struggling to breastfeed. I was pleased to see that most people suggested having the mom see a lactation consultant, with a breastfeeding support group coming in second. Most doctors do not have sufficient training in breastfeeding and I was glad to see that most people wouldn't suggest the doctor as the first stop. That said, within a Canadian context, the problem with these answers is that visits to the doctor are covered by the public health care system, while visits to the lactation consultant (except in hospital after giving birth) are not covered. That said, ome provinces and some cities do offer weekly drop-ins with lactation consultants (I know I benefited from one to have my low weight gain baby weighed on a weekly basis).
So if a woman does end up in her doctor's office, what should the doctor do? Despite a "celebrity" doctor (well, as celebrity as you get in Canada!) saying that doctors should just tell moms to try formula, most of you didn't think that is what should happen. The number of people who thought the doctor should give breastfeeding advice was a bit scary, given how . Personally, I support the last option. The doctor should start by listening to the mother and understanding her goals. If she wants to breastfeed and is having trouble, the lactation consultant would be the natural next step. But the doctor shouldn't assume that any mom who is struggling with breastfeeding wants to keep breastfeeding (she may not).
Next up was formula marketing. Unfortunately, for the first 200 or so respondents, the second and third items were merged together and I only noticed my typo after an hour or so of collecting answers. However, I got enough responses after fixing it that I feel confident in the results. There was strong support for various restrictions on how formula is marketed and less support for others. Interestingly, there was more support for restricting unsolicited samples (something that is currently not restricted) than there was for the "breastfeeding is best for your baby" statement that is universally used but is also the kind of language that formula feeding moms say contributes to their guilt. Personally, I think that limiting formula companies access to breastfeeding moms (i.e. no unsolicited samples, ending predatory marketing) should be a top priority.
Next, I wanted to know how people feel about human milk. Most people think "breast is best" and "formula is second". However, the World Health Organization puts formula fourth, after the mom's own pumped milk or another mom's pumped milk. Our society pushes breastfeeding, but does very little to support moms who have trouble breastfeeding but still want to give their baby human milk. Almost 90% of you disagreed with the first statement, demonstrating significant support for making human milk banks and human milk sharing a priority. There was mixed reaction to informal milk sharing or moms selling their milk, but quite a bit of support for governments making human milk banks a priority.
Next, I wanted to know how you feel about breastfeeding in public. If moms are forced to hide at home (or in the bathroom) to breastfeed their baby, it will feel like an inconvenience. They will feel like they are being isolated from society, even more than new moms are already isolated. Being able to nurse anywhere and everywhere is critical to a mom's confidence and comfort with feeding. Luckily, most of you seemed to agree with that, with less than 2% disagreeing with the statement that women should be able to breastfeed in public whether they are covered or not. Almost everyone agreed that we need more women breastfeeding in public in order to normalize breastfeeding.
Finally, I wanted to know what you thought the public health care system should support. I thought there would be a huge difference between Canadians and Americans here, but surprisingly there wasn't. Currently, a lot of new moms who struggle with breastfeeding find that it ends up being not only emotionally difficult, but also financially difficult. They end up buying pumps, and nipple shields, and paying for lactation consultants, and laser tongue tie clippings, and more. Sure, formula will end up being more expensive over time if the breastfeeding problems are resolved. However, many moms are on an incredibly tight budget during their maternity leave and these expenses are just too much. The good news is that most of you support having the public health care system pay for some of those expenses. Now how do we make that happen?
On my facebook page, one person noted that I didn't ask about maternity leave and workplace support for breastfeeding. That is true. I initially wrote the survey from a Canadian perspective where we have one year of maternity leave, so it is less of an issue. But they are still important issues. Women should be able to take some time to be at home with their babies and establish a strong breastfeeding relationship. Women should also be able to go back to work and have a workplace that is supportive of breastfeeding when they do.
I've said before, and I'll say again, that there is too much pressure to breastfeed and not enough support for breastfeeding. Moms are told that they must breastfeed. More than 90% of moms in Canada initiate breastfeeding (either because they wanted to or because they felt forced into it). But most of them do not meet their own breastfeeding goals. We need a lot less judgment of formula feeding moms and a lot more support of breastfeeding moms. Without both of those, this will continue to be a huge struggle for many new moms.
What do you think? Were these results what you expected?
...more to come when I share the results of the open-ended question.
Image credit: Kelly Sue on flickr