By Amy Harris
The first week of August is World Breastfeeding Week, celebrated since 1992 in over 120 countries to highlight the enormous benefits of raising a baby on breastmilk for at least the first two years of life, with exclusive breastfeeding – or feeding a baby nothing but breastmilk – recommended until six months of age. The annual observance is organized by the World Alliance for Breastfeeding Action, the World Health Organization, and UNICEF, along with governments and organizations worldwide.
Breastmilk is the perfect food for almost all babies who live with their birth mothers, packed by Mother Nature with the nutrients an infant needs for optimal development and the prevention of disease. Breastfeeding is also associated with numerous health benefits for the mother. However, fewer than 40% of infants younger than 6 months are breastfed exclusively worldwide and only half continue to nurse after 6 months of age.
Current data indicates that the social determinants of health influence who breastfeeds, and that differences in breastfeeding rates are reflected in health disparities across gender, racial, and socio-economic lines. A lack of stable housing, food insecurity, difficulty accessing breastfeeding support and equipment, the stress of unsupportive work environments, and inadequate education about the benefits of breastfeeding are major barriers for many mothers. In addition, mothers who are refugees and asylum seekers suffer from the stresses associated with living in an unfamiliar country.
In Maine, efforts are underway to share information with newcomers about the benefits of breastfeeding and the resources that are available to support breastfeeding. The Opportunity Alliance was awarded a large grant from the federal government for this purpose, and the Maine Immigrant Rights Coalition will be translating posters, brochures, and websites into more of the languages spoken by Maine’s immigrants and refugees.
Benefits of breastfeeding
Breastfeeding delivers lifelong health benefits to mothers and babies. The practice lowers a woman’s risk of developing breast cancer, diabetes, high blood pressure, and ovarian cancer. Breastfeeding stabilizes maternal mental health and reduces the risk of postpartum depression. Breastfed infants have lower rates of respiratory disease (like pneumonia or bronchitis), fewer ear infections, and are less likely to catch diarrhea or stomach disruptions in their first years of life. As they grow up and become adults, breastfed children are less likely to have chronic health conditions such as asthma, obesity, and diabetes.
Angelique Bitshiluala, originally from the Democratic Republic of the Congo, and a Maine resident for the last six years, believes that breastfeeding her four children is at least partly responsible for their good health. She said she has never had to take any of her four children to an emergency or urgent care center and that they are rarely sick. She recalled her obstetrician-gynecologist saying: “If you breastfeed your kid, you will be healthy, they will be healthy, and they won’t be sick all the time, like with formula. Your milk is better than formula.” But she said that even if many mothers in her network of fellow immigrants initially breastfeed, “After six months, [most women] say, ‘I can’t do it anymore – it takes too much work or time.’ ”
Breastfeeding advocates believe that investing in breastfeeding promotion is one way to reduce health disparities for generations to come. They point out that it makes economic sense too, on a national level. The U.S. Centers for Disease Control and Prevention estimates that low breastfeeding rates add more than $3 billion annually to medical costs for mothers and children in the U.S.
Barriers to breastfeeding
Just under 75% of Black infants born in 2019 were ever breastfed, which is below the national average of 83%, according to the U.S. CDC. The World Breastfeeding Alliance reports that workplace breastfeeding challenges remain the most common reason for women to never breastfeed or stop breastfeeding earlier than recommended. In the U.S., mothers have a legal right to pumping breaks and a private, secure space to pump – working mothers with adequate time and space to pump are 2.3 times more likely to exclusively breastfeed when their babies are 6 months old than those without these breastfeeding-promoting accommodations. But immigrant and refugee breastfeeding mothers may not know their rights or feel they can safely advocate them.
However, according to a review of 29 breastfeeding studies conducted between 1950-2016, which looked at data from more than 1,539,659 women from 14 countries, immigrant women are more likely than non‐immigrants to initiate breastfeeding and continue breastfeeding at 12 and 24 weeks after delivery. In the U.S., according to a 2006 study by Christina Gibson‐Davis and Jeanne Brooks‐Gunn, published in the American Journal of Public Health, with each additional year of residency, the odds of an immigrant breastfeeding decreased by 4%.
But even if a woman tries to breastfeed, housing impacts a mother’s ability to do so. Many of Maine’s immigrant mothers live in congregate shelters that they must leave during the day. And for those who are working, if they live in a temporary hotel room,or a shelter, they may not have refrigerators, freezers, sinks, microwaves, or other equipment necessary to pump and safely store breastmilk.
Mary Anne MacDormand, a public health nurse working for the city of Portland for 25 years, believes that unstable living situations have a direct impact on the well-being of babies. “How can mothers prepare by getting pumps, bottles, and diapers prenatally if they don’t have any place to store them and don’t know where they will be sleeping the night after they discharge from the hospital?” she asked.
Most mothers with uncomplicated vaginal deliveries are discharged from hospitals within 24-48 hours. Hospitals discharge women who deliver by cesarean section (surgery) after three days, even if a baby has been born early, at 36-37 weeks of pregnancy. This is not enough time to confirm that breastfeeding is off to the right start, nor to give new mothers the confidence and skills needed for long-term, successful breastfeeding, said MacDormand.
MacDonald and Pam Tozier, a lactation consultant who has worked at Maine Medical Center’s Family Birth Center for over 35 years, believe that the misperception that breastmilk is available right after delivery drives many new mothers, worried about nutrition, to feed their baby formula in the critical first few days of infancy. But supplementing with formula in a bottle at this crucial time may further delay breastmilk’s arrival, decrease breastmilk supply, and impair latching on.
Tozier encourages supportive teaching of a new mother. “Breastfeeding is something very natural, [but] it does not always come naturally,” she said, explaining that it can take time for breastmilk to come in (two to five days). Waiting is crucial for establishing successful breastfeeding, and early skin-to-skin contact between mother and baby is key to bringing the milk in.
According to the World Breastfeeding Association, it is very rare that someone is unable to produce enough breastmilk to fully nourish her infant – as long as she has sufficient access to safe housing, food, and culturally competent, language-appropriate lactation support.
Supports for breastfeeding in Maine
The Maine Center for Disease Control and Prevention operates eight regional Women, Infant, and Children (WIC) Nutrition Programs to provide nutritional and breastfeeding support and resources to eligible low-income mothers and infants, and children up to age 5 who are at nutritional risk. Maine WIC lactation consultant Michelle Segovias said that WIC offers breastfeeding support groups and prenatal breastfeeding education classes.
In Cumberland County, WIC offers translation services, and their staff includes two peer breastfeeding counselors with personal WIC and breastfeeding experience – one of whom speaks French, Kinyarwanda, and Swahili. These peer counselors responded to more than 135 requests for assistance from clients in June alone. According to Segovias, the clients are primarily “first-time mothers here in Maine without any family – mothers, aunts, grandmothers, or other trusted, experienced breastfeeders – to turn to for advice in the middle of the night.”
Hospitals also provide breastfeeding supports, with most employing at least one lactation consultant or counselor. In addition, each Maine county employs public health nurses through the CradleME program, at cradlme.org or (888) 644-1130.
Despite the clear evidence of health benefits, the reasons some mothers do not breastfeed their babies are numerous, individual, and complex. Bitshillualua breastfed all her children for at least 16 months while working full-time, the first three in DR Congo and her youngest daughter here in Maine, and said her motivation was her doctor’s advice. But conditions can make breastfeeding a challenge.
Dr. Ariel Zodhiates, a family practice physician and Greater Portland Health’s Clinical Program Coordinator of Prenatal and Obstetrical Care, encourages her staff to allow their clients agency over decisions such as whether to breastfeed or not. “The last thing [we] want to do is to put undue pressure on folks who are already in very stressful situations,” she said.
Segovias agreed, echoing the need to respect clients’ decisions. “We do have a lot of families that are combo feeding. We’re just trying to reiterate the health benefits of breastfeeding as often and as long as is realistic for them,” she said.
The theme of this year’s World Breastfeeding Week is “Enabling breastfeeding: making a difference for working parents.” Advocates say the state should do more to require employers to fulfill their legal obligation to provide mothers with supportive and safe environments for breastfeeding.
