The Global Breastfeeding Collective, a multi-international agency initiative, led by the World Health Organization and the United Nations Children’s Fund, recommends that each country should have 70 percent of its infants nursed by breastfeeding by 2030, according to their 2021 Global Breastfeeding Scorecard. The Department of Health (DOH) has recognized this goal and aims to achieve it within seven years, with around 50 percent of Filipino babies currently being raised by breastfeeding. To achieve this goal, the DOH is intent on launching more and more human milk banks, with 21 already in place in various hospitals nationwide, 12 of them in Metro Manila. I have heard of these milk banks from friends who struggle to breastfeed yet remain fully committed to purely breastfeeding their children. While thankful that these human milk banks exist to begin with, the demand, I am told, still far outweighs the supply. Donors are few, and more and more mothers struggle to produce their own milk.
On its face, you would think that breastfeeding is an easy sell. It comes with many health benefits for the child, and it is a free renewable source of food for your baby. Yet for many decades, the DOH has struggled to effectively convince mothers to continue breastfeeding. In my early days as a researcher, I was initially commissioned to come up with a study proposal on increasing and maintaining mothers’ motivation to breastfeed, as even back then the government was already worried about the low uptake of breastfeeding among poor mothers. They felt that mothers were making a counterintuitive choice: Choosing to spend their hard-earned money toward baby formula, rather than choosing the more nutritious breast milk that comes at zero cost.
The literature review yielded that the research direction should head toward the extended family, specifically the mother-in-law. For Filipino families, multiple generations tend to live in one household. When a new baby is born, it is not only the parents who influence their upbringing; grandparents get a very influential say on how their grandchild is raised, even when it comes to breastfeeding.
We found that mothers with heavily involved in-laws tend to switch to baby formula faster than new mothers who are more autonomous in their parenting decisions. In-laws tend to get more impatient when breastfeed supply does not seem enough, and strongly advise their daughters-in-law to switch to baby formula for fear of starving the baby. This is a common fear that both mothers and their families hold that make them more likely to give up breastfeeding. You can imagine how these fears increase the lactating mother’s stress levels, further exacerbating the irregularity of her breast milk production.
Most public health initiatives rightly focus on proper psychoeducation, skills training for breastfeeding with the help of lactation coaches, and human milk banks.
One significant factor that seems to be missing, however, is addressing the lactation mother’s psychological condition to help facilitate regular milk production. Too much stress affects the body’s various rhythms and cycles. Breast milk production is no different. Ideal conditions include being well-rested, and eating regularly and with proper meals. Any new mother would immediately point out that these are the very conditions that disappear the moment your infant is born. New parents face sleepless nights and highly irregular mealtimes as a result of constant baby care. Additional stresses such as work, finances, and household management also contribute adversely to breastfeeding issues.
When our quality of life suffers, so does breastfeeding. No wonder more and more mothers are having difficulty lactating. Living with one’s in-laws can be both cause and cure for this challenge. Having in-laws take care of you and the household can ensure that the new mother gets proper rest and respite from childcare and other household stresses. On the other hand, their well-meaning but poorly executed advice-giving (or nagging) can contribute to further stress, as the daughter-in-law feels pressured to show that she is feeding their grandchild well. Many mothers have lamented in my therapy room about the pressure to always provide the best conditions for their child, and how challenges with breastfeeding were seen as a sign of weakness by their in-laws.
The in-law double bind has led other countries like South Korea to establish birth care centers, where mothers go after they give birth so that they and their child can both be taken care of. South Korean mothers have said that they prefer these centers, despite their high cost, so as not to burden their in-laws. While such a program may not be feasible in our country, we can still think of many ways to improve the quality of life of new mothers, which in turn will improve the quality of life of their babies.
——————
aatuazon@up.edu.ph