One of my oldest friends recently had her first child and said to me, “now I see why you need a whole association!”. She referred to my work with the Australian Breastfeeding Association (ABA), where I trained to become a Breastfeeding Educator after the birth of my first son.
My breastfeeding journey has been complicated, with supply issues, refusal, nipple thrush, mastitis, and supplementing with formula and donor breastmilk. Despite these challenges, I have reached my own breastfeeding goals with the support of my partner, lactation consultants and my ABA network. Unsurprisingly ABA volunteers are the “outliers” in statistics for breastfeeding, with the information and peer support we access leading to extended breastfeeding, often to the World Health Organisation (WHO) recommendation of two years and beyond.
In my ABA role, I recently hosted a Breastfeeding Education Class (BEC) for the first time since I birthed my second child in 2020. It’s one of the first BECs ABA SANT had offered face-to-face since the other significant event of 2020, the pandemic (when we switched to an online offering).
At the BEC, I remembered how much I enjoyed meeting parents to be. Their excitement and anticipation for the arrival of their little one are contagious. Dads and support people write copious notes while heavily pregnant Mums squirm, trying to get comfortable in the hard plastic chairs the community centre provides. For this session, we had both first-time parents and second-time, which is not unusual. Often parents receive unhelpful or conflicting information the first time, which means their breastfeeding experience doesn’t go the way they wanted. The second time, they come along to debrief and prepare as they consider how it could be different.
Participants seem genuinely surprised that the BECs are non-judgemental and discuss how ABA supports mothers and families to reach their individual breastfeeding goals. In contrast, breastfeeding advocates are depicted as “lactivists” intent on pushing breastfeeding no matter what. This has not been my experience at ABA and is also not how I approach the work.
ABA (or Nursing Mother’s Association of Australia), as it was known, was started by Mary Paton when she began hosting catch-ups in her Melbourne loungeroom with six friends in 1964. Mary wanted to breastfeed and wanted to connect with other mothers who were doing the same. She found this was a shared goal amongst women and the organisation grew to what it is today. In 1964 breastfeeding rates were steadily declining. In the late 1960s to early 1970s, breastfeeding rates in Australia bottomed at around 10% (exclusive breastfeeding at six months).
The declining breastfeeding rates were linked to the advent of mass production of formula, with companies embarking on well-funded campaigns to convince health professionals and mothers that breastmilk was inferior. Additionally, the women’s liberation movement of the 1970s provided scope for women to re-enter the workplace after having children with important campaigns for equal pay, childcare and anti-discrimination legislation. Remember, there were legal constraints on mothers, including the Commonwealth Public Service policy held until 1966, which saw married women prohibited from returning to their job after marriage.
In 2022, tension remains between the expectation for women to return to paid work and public health messages regarding the importance of breastfeeding. Additionally, there are gaps in the policy framework to support breastfeeding adequately. The Australian Government’s Infant Feeding Guidelines, developed by the National Health and Medical Research Council (NHMRC), recommends breastfeeding continue until 12 months alongside the introduction of family food at six months. However, the federal government Paid Parents Leave (PPL) Scheme only offers mothers 18 weeks at minimum wage rather than the 24 weeks needed to support women to reach the recommended duration of exclusive breastfeeding.
Funded support for women to reach their breastfeeding goals is also patchy. The ABA relies on a primarily unpaid workforce, with volunteers delivering the Breastfeeding Helpline, LiveChat, BECs and group meetings. The Medicare rebate for lactation consultants (who are also registered midwives) finishes when your child is six weeks old, despite breastfeeding challenges continuing well beyond this time. Support through Child and Family Health Services in South Australia is limited, and resources are stretched. Dedicated services have also been reduced over the years, including the closure of the Women’s and Children’s Hospital breastfeeding day service. Additionally, many state-provided services are not currently offering face-to-face services due to the virus, including the WCH antenatal breastfeeding education, which is now only available online.
Some families turn to their GP for support to overcome breastfeeding challenges. However, most medical healthcare providers receive between zero to three hours of dedicated breastfeeding education in their undergraduate courses. Online breastfeeding forums capture stories of mothers told by a trusted but ill-informed healthcare professional to wean their baby for reasons ranging from incompatibility with medication to declarations that breastmilk has no nutritional value past a certain age.
In fact, breastfeeding can continue alongside a range of medications. The Women’s and Children’s Hospital Pharmacy provides an excellent Medicines Information helpline. Additionally, breastmilk continues to provide nutritional benefits beyond babyhood, including minerals, vitamins, and anti-infective factors.
An effective strategy for advocacy and evaluation is access to statistics and measures. Despite the National Breastfeeding Strategy: 2019 and beyond recommendation to track breastfeeding rates, our most recent data comes from the 2010 Australian National Infant Feeding Survey, which was the first large-scale Australian-based survey of feeding attitudes and behaviours. The survey found that 15% of babies aged six months were still exclusively breastfed, which has only marginally increased since the 1970s. The survey remains a once-off, and recommendations for breastfeeding support remain unfunded.
To me, a lack of investment in breastfeeding correlates with a lack of valuing the role of mothers, whether breastfeeding or not. The average Australian mother spends 40 hours per week looking after their baby, including 18 hours of breastfeeding. But we don’t tally this anywhere, which leads to an undervaluing of mother’s contribution to the economy, public health and the environment. Australian National University researcher Dr Julie Smith found breastfeeding is worth $3.6 billion to the economy, but breastmilk is left out of our national food statistics.
This year’s World Breastfeeding Week (1-7 August 2022) theme is ‘Step up for Breastfeeding: Educate and Support’. The focus is on strengthening the capacity of actors to protect, promote and support breastfeeding across different levels of society. The World Alliance for Breastfeeding Action (WABA) curates World Breastfeeding Week. Their work seeks to ensure breastfeeding can improve nutrition, ensure food security and reduce inequities between and within countries.
An academic from La Trobe University examined what makes a city breastfeeding-friendly. They found a range of strategies for ensuring mothers feel confident and supported to breastfeed. The city design guidelines they developed include offering dignified, safe, and physically comfortable places to breastfeed, accessible spaces compatible with mothers’ other needs and responsibilities, and a high level of amenity.
The creation of mother-centred communities relies on us valuing all aspects of mothering, including breastfeeding. Through MGM and my work with ABA, I will continue to be a fierce advocate for the rights of mothers to breastfeed and for the policies and supports required to reach our breastfeeding goals.