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Kimberly Seals Allers's picture

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Breastfeeding: No "culture" required

As a woman born, raised and educated in New York City, I take any and all commentary, critiques, songs or even Haikus about my city, very seriously.

And I admit, as a journalist with degrees from NYU and Columbia J-School (told you I was a New Yorker), I have an unusual predilection to facts. One might even call me "obsessed." Please forgive me.

But the recent New York Magazine, BroadMinded column, “Milk Culture: Rise of the Breast-feeding Obsessed,” penned by Alissa Quart (also a Columbia J-School alumna) is woefully, well, narrow-minded at best and shows a true lack of understanding of the infant feeding landscape for mothers in New York City and across America.

As a maternal and infant health advocate, I am committed to making sure all voices are represented in the breastfeeding table talk and that the health of infants is not prostituted by the media for the next controversial cover or for a spot in the coveted "Most Commented" box.

Over the past few months, I’ve watched with sheer bewilderment at the highly emotional response to New York City’s Latch On initiative, which seeks to monitor not ban infant formula distribution. While there’s been much ado about “choice”  and warnings of a “nanny state” infringing on women’s rights by allegedly removing feeding options, I’ve been shocked about how little most women know about the actual environment of the hospital where they deliver.

While I applaud Ms. Quart for noting (albeit three-fourths of the way in) that breastfeeding is the healthiest food for infants the rest of her column is blatantly devoid of one critical component: actual facts. You know numbers, data or statistics. The kind typically used by journalists to support a premise.

The other blatant omission is perspective. But I will start with the facts.

Facts which can be obtained by visiting the state's health department website (shout out to Women's eNews for compiling this info).  A few clicks revealed some of New York City’s hospital data as reported by the hospitals themselves. At University Hospital of Brooklyn, in the Flatbush area, for example,  93.6 percent of the babies born there in 2010 were fed any breast milk at all-- a high initiation rate. But the percentage of babies who were being breastfed yet supplemented with formula in those first few days was 96.1 percent.

Spoiler Alert: Once you begin supplementing, you’re much more likely to reduce your own milk supply, which will increase your use of formula. And so on. Early supplementation is the surest and loudest death knell for a successful breastfeeding experience.

Oh and New York State has the second highest supplementation rate in the nation. New Jersey is the worst state.

Indeed, only 3.6 percent babies born at University Hospital are exclusively breastfed by the time of discharge.

At New York Medical Center of Queens, 46.7 percent initiate breastfeeding, but the supplementation rate is 84.5 percent. Only 7.2 percent of babies born there were exclusively breastfed at discharge. I delivered my son at this hospital and experienced nurses repeatedly ignoring my feeding decision and suggesting formula at the slightest sign of common early breastfeeding challenges.

Travel to Manhattan’s Upper East side, to the New York Presbyterian Hospital- Cornell Weill Center where 92.9 percent of babies were fed any breast milk, and the supplementation rate was 74 percent. The percentage of exclusively breastfed babies was 24.1 percent.

These high initiation rates show that most women do want to breastfeed, but somehow, something happens early in their journey and they don't continue. I'll offer up the easy access and excessive promotion of formula by hospital staff as a starting point.

As I travel the country in my breastfeeding advocacy and consulting work, too often I speak with some nurses who have the infant formula rep’s phone number on speed-dial or posted on the nursing station bulletin board. These reps use hospital policy loopholes to sponsor continuing education credits, conference expenses and more lunches than you can imagine for the maternity ward nursing staff.

P.S. infant formula companies know that the hospital is ground zero for a mother's feeding experience, that early supplementation is a breastfeeding "killer" and that the early days will likely shape the road ahead--which is why they spend billions marketing to hospitals and giving away free samples to mothers.

Therefore, no mother can have true “choice” when some hospitals are making back- door deals with infant formula makers and determining maternity ward policy based on (not what’s best for mom or baby) what’s best for profits considering the handsome rebates the infant formula companies provide to hospitals in exchange for access to 100% of  its new mothers.

Compare that with NYU Hospital Centers, one of New York City’s Baby Friendly hospitals, which only gives infant formula when medically directed. The initiation rate is 96 percent, the exclusive breastfeeding rate is 95 percent and the supplementation rate is 0.9 percent. Wow! It's amazing what moms can successfully do, if its their choice, without any other influences.

Later, Ms. Quart attempts to delve into the complicated space of race and class and the impact on breastfeeding. Very important. Yet, I find it confusing how she seeks to buttress a comment about a New York City initiative and speak to the barriers of low income women by…(Wait for it…) speaking to a Rockville, Maryland-based physician.

Cue head scratching here.

Yes, Rockville, Maryland—a suburb about 20 miles from Washington, D.C. where the median family income is $102, 544 and the median home price is $390,000.

Quoting from her BroadMinded column:

When I spoke to Suzanna Martin, a pediatric emergency physician who works at Shady Grove Adventist Hospital in Rockville, Maryland, she was critical of Latch On.

 "Women arent stupid theyve got the information, said Martin. They know breast-feeding is better than formula. But Martin notes that not everyone can afford pumps, Those suckers are $300. And how easy is it for low-income woman to pump at work?

 And while Dr. Martin correctly mentions the price of pumps as a key barrier for low-income women, she fails to mention that most health insurance providers now cover the cost of a pump or that her own hospital rents high quality pumps for $75.00 per month. Her own hospital, Shady Grove Adventist, also offers a free breastfeeding "warm" line where mothers can get their questions answered by lactation consultants or visit the free weekly breastfeeding support group--the kind of group that was invaluable to me for help with navigating the back-to-work challenges.

Also, the low-income women Dr. Martin cares so much about would likely qualify for WIC (Special Supplemental Program for Women, Infants and Children), where in New York City currently employs 210 breastfeeding peer counselors. Free pumps, internationally board certified lactation consultants and other support is also available.  All women can find great tips on making use of the federal law and Affordable HealthCare mandate which allows for pumping breaks at the United States Breastfeeding Committee website.

And if she really wanted to speak to the plight of low-income women particularly as it relates to their breastfeeding experience, I would encourage Ms. Quart to skip Maryland suburbia and take a train ride over to Jamaica Hospital in my home borough of Queens.  Out of the nearly 5,000 births in 2010, 96.5% were initially breastfed but the actual number of exclusively breastfed babies at time of discharge was a whopping 2.

One. Two.

What's most egregious, however, is Dr. Martin's comment that "Women aren't stupid," as if the decision to breastfeed or not is a purely intellectual one, based on education or good ole' common sense. How insulting and short-sighted. Overly simplistic comments like these ignore the more powerful influences of cultural nuances, a lack of multi-generational support, company policies and communities that are a virtual desert of  support mechanisms.

Now for some perspective.

By using the word "culture" repeatedly in her headline and body paragraphs, Ms. Quart seeks to define and stereotype mothers, as if being a breastfeeding proponent means you are akin to the Mayim Bialiks (with all due respect) of this world. Breastfeeding my baby does not mean I subscribe to any "natural" parenting, "attachment" parenting or any other parenting "culture," league or clique--it simply means I want to give my baby the healthiest first food possible. Point blank. Period.

I breastfed both of my children for at least one year each, while hiding my recyclables in black bags to avoid a fine and always carrying an overpriced (and probably not eco-friendly) designer diaper bag.  We slept with our baby in our bed before I knew of any "co-sleeping" parenting "strategy" because it just seemed easier to scoot over and pop it out for middle of the night feedings. And because my British-born but of West Indian parentage husband grew up poor, babies sleeping with their parents just seemed normal to him. Please don't put me in the Bialik box. Or any other.

Words like "obsessed" and "culture" are trigger words that fuel the so-called "mommy wars" and the "us vs. them" environment among parents that is already at fever pitch. Fanning these destructive flames, at a time when mothers need more support is irresponsible.

In fact, it’s the media who are "obsessed" with mothers and breastfeeding. Women just want to make the best decision for their lives and their infants without the influence of corporate interests or media desperation. I implore all mothers to ignore attempts to alienate, define and divide us. And its high time that "not stupid" women like Ms. Quart stop being complicit in this tactic.


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