Another day when Breastfeeding hits the media (or more specifically, the internet*) The BBC reported this morning (as did all the major British media outlets) that there is a project taking place in South Yorkshire which incentivises breastfeeding for certain groups of women by offering them shopping vouchers. My twitter feed erupted in horror. I wasn't so sure. Here's the thing. I have a degree in Children's Health. I am well educated, come from a family where breastfeeding was the norm, most of my friends breastfed their babies for 6 months and I can afford to pay for private lactation consultants to support me, yet I am STILL far more terrified about breastfeeding than anything else labour, delivery and new motherhood will throw at me. I will do it because I feel like I have to, but I have absolutely no joy at the prospect, and it makes me feel a cold, hard nausea whenever I dwell on it too much. I'm the freakin' poster child for someone who should make this work, and yet I feel this way. So I started doing a bit of reading, thinking about my own experiences as a student nurse working with new mums in both highly affluent and extremely deprived areas, and a few key points struck me.
I should point out, though I'd hope it'd be obvious, that I am writing a silly blog post talking about at a few bits of evidence found when looking at breastfeeding in Scotland and relating them to my own, very unscientific anecdotal experiences. Nor do I pretend to understand the whole picture, to presume to know what is and isn't an issue for a mum in an area of high social deprivation. I'm also not a statistician, so my understanding of some of these documents might not be perfect. This really isn't intended to be an in-depth critique of the subject matter, rather a way for me to get my head around my experiences of a complicated issue.
The first instinct of nearly everyone who read this story and commented seemed to be 'What a waste- much better to fund improved support services for breastfeeding instead'. I find myself thinking 'well, yes and no...' Part of the issue here is that the project is aiming to incentivise breastfeeding to six months- to me this means to encourage women who wouldn't have started at all to give it a go. Am I convinced shopping vouchers are the way to do this? Em, no, not really. But as projects like this show, a support network offering little 'treats' can help women, particularly young women, get involved. This report highlights some really interesting points about why (in this case young) women from areas of high social deprivation are particularly reluctant to start breastfeeding- When age and social deprivation were taken into account, just 4.4% of Scotland's youngest, poorest mums were breastfeeding at 10 days old. The national average was 47.1%.
This case study also shows that it's not necessarily that there are not support services available, but rather they don't feel accessible or appropriate to this particular group of mums. Whilst I'm certainly not arguing that more lactation consultants and specialists are required, I do wonder how many of the young women in Edinburgh from areas like Sighthill and Wester Hailes (two of the poorest communities) felt they could attend any of the city's Breastfeeding clinics, groups or seek peer support? Lack of transport, or available money for paying for public transport are automatic barriers. The breastfeeding group that takes place weekly in the Ikea Straiton cafe sounds simply marvellous to me, but I'm fully aware of why it would sound completely horrifying to someone else. The 2 hour long clinic appointment may also really help those who are having significant difficulty, but who will watch the other kids whilst they are there? And what if there has been previous Social Service involvement- do I want to invite that much intrusion? It's so easy to see why not bothering to begin with, or giving up after the first week or two seems logical for so many people. Especially when the general environment is not pro-breastfeeding. My mum breastfed me and my siblings- it was normalised in my house. I'm not actually sure there were even bottles in the house- I certainly don't remember any. If the normalisation you experience is of bottle feeding, then it would make sense to begin there or switch back to the devil you know as soon as there are difficulties, which almost everybody experiences in the beginning.
The idea that somehow all the public health messages about 'breast being best' are somehow 'not for them' actually resonates with me personally. Nothing turns me off a pro-breastfeeding message faster than someone starting a sentence 'I breastfed my child until they were two/three/went to school'. It's simply not the direction I wish to go in myself, and I find it oddly boastful, as if I am somehow supposed to congratulate them and hand over a shiny rosette. I know breastfeeding is incredibly challenging and breastfeeding for a long time is absolutely an achievement, but I can't help feel this alienates some women, particularly in the first few weeks when the idea of surviving just one more feed seems overwhelming. The talk of tiny increases in IQ points means very little to most in the real world, particularly if they were bottle fed and turned out just fine. As the case study points out, diseases like gastroenteritis and diabetes seem totally alien when you have a teeny newborn you are hell bent on protecting. Even knowing and understanding the research, I find myself dismissing the reduced instances of respiratory infection argument through my experiences of begging mums for just 20ml of breastmilk to pop down a tube in her Bronchiolitis baby's nose, or else they would have to have formula. With serious respoiratory infections tiny, specifically timed feedings were of vital importance. Sick babies in hospital with exhausted, stressed mothers make pumping a challenge.
To me, these points raise the question of the place of an incentivisation scheme. Or even better, a study to assess if such a scheme would be worthwhile. Do I think it has the potential to increase worry and stress in mums who are already struggling? Possibly, but I'm not sure they are the target audience for this particular study. And I'm extremely wary of how such a scheme can be 'policed' and by whom- maintaining involvement and building trust between health care professionals and those parents on the margins is so vitally important. Is it 'patronising and naive?' Well, money alone is, yes. As part of a bigger program of societal change, I would argue no more so than any other kind of incentivisation such as weight loss or smoking groups that offer rewards. Even if the young women themselves in the North Kilmarnock case study did not breastfeed for any length of time, a foundation has been laid whereby it becomes a little more socially accepted than it was before. The danger of all breastfeeding, and indeed all health promotion is viewing it as a target-meeting exercise rather than a longer process of changing things for the better.