Breast still best

LAST SUNDAY’S Inquirer had a large banner headline photo showing a woman breastfeeding, as well as a smaller photo and articles to promote National Breastfeeding Month.

All that brought back to me memories of the long struggles to promote breastfeeding in the Philippines, dating back to the late 1970s, with the Philippines often hailed as a pioneer for reforms.

I never forgot one of the early slogans: “Breast is best.” All the scientific evidence was certainly pointing to this. The two most frequently cited and most important benefits related to child survival: stronger immune systems to fight many diseases and full nutrition, at least for the first six months of childhood.

The campaigns were strongly anti-bottle feeding, directed against the deceptive marketing of infant formula manufacturers. For example, they would station sales agents in hospitals handing out free samples of infant formula.  Doctors were also given incentives to convince new mothers to bottle-feed. These marketing tactics tried to promote the view that bottle-feeding was modern and breastfeeding was “backward.” Most of those marketing gimmicks are banned now, but the companies continue to bombard mothers with advertising, sometimes with claims that the milk powder increases intelligence. (Such claims are banned too by law, but the companies use indirect methods now, like sponsoring contests or “educational” symposia.)

The early campaigns had a strong element of social justice, highlighting the way bottle-feeding was particularly dangerous for infants born to poor parents.  Infant formula is expensive, now running to more than a thousand pesos each week for some brands. It’s money that’s better spent for the other needs of the infant, as well as the mother.

Because of the high cost of infant formula, the poor often economize, using less powder and therefore reducing the nutritional content of the milk. There are also problems when the household’s water supply is contaminated, and the family does not use boiled water, resulting in diarrheal diseases which aggravate malnutrition or even cause deaths. All these problems don’t exist with breastfeeding.

Through the years, I’ve seen more studies confirming that breast is still best with an ever expanding list of benefits for the breastfed child. (See www.breastfeeding.com for a long list of benefits, backed by medical research.)  There’s also a growing body of research findings showing that breastfeeding mothers themselves have many health benefits from breastfeeding, including lower incidence of heart disease.

Given all these advantages, why does breastfeeding continue to drop each year?  One reason is that our maternal leaves are just too short. There is now a law requiring workplaces to provide facilities where mothers can breastfeed (rather inelegantly called pumping stations), but this is easier said than done.

Cultural myths

There are also cultural reasons behind the reluctance or even opposition to breastfeeding.  It’s a dimension that’s often overlooked by health organizations and educators, so I thought I should emphasize this aspect by discussing three of the most prevalent clusters of myths or fallacies in the Philippines.

A first myth is that bottle-fed babies are “healthier,” the “proof” being that they are usually fatter than breastfed ones. Fortunately, there is still folk wisdom here, with breastfeeding mothers pointing out: “Siksik ang laman,” a reference to the taut muscles of a breastfed child, contrasted with the “tabang hangin” (“windy fat”) or sometimes “tabang lamig” (cold fat) of bottle-fed infants, which mothers recognize can be unhealthy.  The Department of Health and media need to do more to show this “siksik na laman” and how it translates into boundless energy, physical strength and mental alertness.

A second problem is a cluster of beliefs found even among mothers who do breastfeed. This is the idea that one should not breastfeed when tired or angry, or if the mother has taken certain “strong” (matapang) foods, like hot and spicy ones. I do recognize that a very tired or angry mother may not want to breastfeed, but educational campaigns have to send the message that milk quality does not deteriorate because of the emotions, or because of what mothers’ eat.  In fact, I was surprised to learn only recently that even smoking mothers can, or rather should breastfeed. (They shouldn’t smoke though while breastfeeding.) And good news for breastfeeding mothers: moderate alcoholic intake is fine, but don’t drink while driving, oops, I mean, breastfeeding.

The third cluster of beliefs revolves around the capacity to breastfeed. The most frequent myth I hear is that Filipinas (or Asian women) are “small” and therefore will produce less milk.  This is based on a false analogy with gasoline station pumps. The anatomy and physiology for breastfeeding is a natural wonder. All kinds of stimuli—even hearing a baby cry—sets off hormones that in turn trigger the production and a “let down reflex,” bringing milk to the breasts. The child’s suckling keeps the flow going.

The fact that the brain governs breastfeeding can be a disadvantage. If a new mother believes she cannot breastfeed, a belief reinforced by people around her, she will have difficulties getting breastfeeding going, until she gives up.

The capacity to breastfeed defies the imagination. When I was a college student doing volunteer work in Kalinga, I met a woman who would go around the village carrying two infants, and breastfeeding them, not simultaneously of course.  Curious, I approached her and asked, “Twins?” She laughed; it turned out one was her child and the other her grandchild.

Censoring breasts

Our TV networks should be featuring such stories to dispel the myths of limited milk. And I hope that when they do feature breastfeeding stories, they don’t censor out the breasts.  One of the biggest obstacle to breastfeeding is the mothers’ fears that they will look immodest if they breastfeed in public.

It’s not just gawking men who can be problematic but prudish women too. Last year I wrote about seeing a beautiful image of the Nuestra Señora de Leche (Our Lady of Milk) and commented that she should become a patron saint for breastfeeding, as well as for natural family planning.  Shortly after the column was published, I received a most nasty e-mail from a woman, incensed that I dared talk about a lactating Virgin Mary and family planning, and accusing me of having maligned Catholics!

The letter-writer was probably not aware that one of the natural family planning methods approved by the Catholic Church is LAM, or the lactational amenorrhea method, which involves sustained and exclusive breastfeeding up to the first six months of the infancy.

I pity the poor woman for not appreciating a lactating Mama Mary. We forget that until the 20th century all mothers breastfed. They did it in public. They helped to breastfeed each other’s babies. They shared tips on how to deal with lactation difficulties, and I am sure that included getting husbands involved in ways our moral guardians would probably declare obscene.

If breastfeeding activists seem so passionate it is because breastfeeding is both private and public, a matter of nurturing and bonding with children, as well as an act of nurturance of social ties and community life.