Families do not breastfeed, mothers do…and we need to say so

Madeleine Munzer
Sydney, Australia

This article was first published in World Nutrition https://worldnutritionjournal.org/ind…/wn/article/view/825


It seems obvious that support for mothers is central to global breastfeeding advocacy. The Global Breastfeeding Collective, WHO and UNICEF all emphasise the importance of supporting mothers to breastfeed their infants (World Health Organization, 2018b; Global Breastfeeding Collective et al., 2020; UNICEF, 2018). Yet increasingly, some breastfeeding organisations, particularly those based in the USA, appear to be avoiding referring to “breastfeeding mothers”, favouring a different term, that is, “breastfeeding families” (US Breastfeeding Committee, 2021; International Lactation Consultant Association, 2018). This term is being exported around the world through social media and online support groups (International Lactation Consultant Association, 2019) (La Leche League International, 2020; La Leche League International, 2021; International Lactation Consultant Association, 2019; International Board of Lactation Consultant Examiners, 2021).

As the old saying goes, it takes a village to raise a child. Within this framework, the World Alliance for Breastfeeding Action (WABA) chose it’s theme for World Breastfeeding Week 2021 to be Protect Breastfeeding: A Shared Responsibility (World Alliance for Breastfeeding Action, 2021). Indeed, breastfeeding is a public health issue that requires effort and investment at a societal level. It is critical for governments, health systems, workplaces, and communities to dismantle barriers and to create a breastfeeding-friendly culture and environment for every breastfeeding woman and child (Rollins et al., 2016). As a concept, the “breastfeeding family” is an extension of the idea that no one breastfeeds alone. Yet “families” only breastfeed in the same way that a society or country breastfeeds, i.e. , where breastfeeding is supported as a normal event, each of them will serve as a facilitator of mothers breastfeeding.

What appears to be happening is a shift away from focussing on mothers to families instead. However, “families” is not a synonym for mothers. Have mothers themselves asked for this change, and if not, why is it is being imposed upon them? Why are families being entrusted politically with breastfeeding? Families do not suffer mastitis or cracked nipples, nor do families face increased risk of breast cancer due to not breastfeeding. With only 44% of infants under six months of age exclusively breastfed worldwide (World Health Organization, 2021), risking breastfeeding support and advocacy in this way is unhelpful.

Subsuming women into a family unit with an intention of supporting both parents, and at times also mothers who do not wish to be referenced as mothers, has the unintended consequence of undermining women’s rights in relation to breastfeeding. If you cannot describe the person who has breastfeeding rights and who needs support, then you cannot protect those rights and that relationship. What is being presented as inclusive practice is an approach that places the human rights of mothers and infants in jeopardy.

The WHO Code of Marketing of Breast Milk Substitutes (the Code) and subsequent WHA resolutions exist for the purpose of protecting women’s reproductive rights and children’s right to health (Gribble et al., 2011; Gribble and Gallagher, 2014; World Health Organization, 2018a). Families are referenced in these documents in as much as they are relevant to mothers and infants, because family members have a responsibility to the mother-infant dyad. Mothers and infants are vulnerable groups in their own right. It is mothers and infants whose rights are breached through the unethical marketing of breastmilk substitutes with catastrophic consequences for theirhealth. This is why women’s breastfeeding rights were codified in the first place, and these rights have not yet been fully realised (World Health Organization et al., 2020).

Anyone who replaces the term mothers with “families” is also assuming that mothers have autonomy around breastfeeding. Very often they do not (Aubel, 2021; Fjeld et al., 2008). As a breastfeeding counsellor, I work to protect mothers and infants – not families – because very often it is family members who are undermining breastfeeding, and this is an issue around the world (Negin et al., 2016; Fjeld et al., 2008; Thet et al., 2016). Many advocates will be familiar with the famous photo of the Pakistani mother with twins, one who was breastfed and thriving, and one who was bottle-fed and who died not long after the photo was taken. That tragic situation arose because the decision around infant feeding was made by the mother-in-law(Anonymous, 1991). It is a clear illustration that families do not breastfeed.

Breastfeeding advocates the world over need to support the human rights of women and children and understand the importance of being clear about who holds breastfeeding rights. This is particularly the case for countries where women have few rights, where children belong to their fathers (Sayeed et al., 2012), and where mothers are prevented from making infant feeding decisions (Negin et al., 2016). This newly exported terminology, “breastfeeding families”, can only undermine the breastfeeding rights of women and children. Failure to be explicit that it is mothers who breastfeed risks negating the responsibility that international organisations have to the global breastfeeding community.

This change has been occurring within many breastfeeding organisations based in the USA with a (good) faith belief that it makes for better practice. However, it is yet to be seen who benefits from this language shift. I would argue that thebreastfeeding rights of women and the importance of mothers to infants is not something that should be broadened to include others. Mothers and infants are the only people who have rights in relation to breastfeeding; families have the role to support those rights. Families do not breastfeed, mothers do, and we need to say so.

References

Anonymous (1991) The lesser child. Extracts from SCN News: News from the United Nations Administrative Committee on Coordination – Sub-Committee on Nutrition (ACC/SCN).
https://www.unscn.org/files/Publications/SCN_News/extractscnnews.pdf

Aubel J (2021) Grandmothers — a neglected family resource for saving newborn lives. BMJ Global Health 6(2):e003808.

Fjeld E, Siziya S, Katepa-Bwalya M, et al. (2008) ‘No sister, the breast alone is not enough for my baby’ a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia. International Breastfeeding Journal 3(1):26.

Global Breastfeeding Collective, UNICEF and World Health Organization (2020) Global Breastfeeding Collective: A Call to Action.

Gribble KD and Gallagher M (2014) Rights of children in relation to breastfeeding in child protection cases. British Journal of Social Work 44(2): 434-450.

Gribble KD, McGrath M, MacLaine A, et al. (2011) Supporting breastfeeding in emergencies: Protecting women’s reproductive rights and maternal and infant health. Disasters 35(4):720-738.

International Board of Lactation Consultant Examiners (2021) Twitter: IBLCE will continue to work to advance the IBCLC certification to support breastfeeding families. https://archive.vn/wip/YgUAm

International Lactation Consultant Association (2018) ILCA Statement on WHA Resolution on Infant and Young Child Feeding. https://lactationmatters.org/2018/07/12/ilca-statement-on-wha-resolution-on-infant-and-young-child-feeding/?fbclid=IwAR2AQB6L5diqlhcS002k1TjfOtMwJth2mnpTAqrX5Sj45s7b_6jSTRLITJg

International Lactation Consultant Association (2019) Twitter: For 40 years, IBFAN has worked to protect the rights of breastfeeding families. https://archive.vn/wip/yt1ZZ

La Leche League International (2020) Twitter: Today La Leche League continues to be a gloabl network supporting breastfeeding families. https://archive.vn/wip/15EarLa Leche League International (2021) Instagram:

La Leche League International, Supporting Families Since 1956. https://archive.vn/wip/R6eVu

Negin J, Coffman J, Vizintin P, et al. (2016) The influence of grandmothers on breastfeeding rates: a systematic review. BMC Pregnancy and Childbirth 16(1):91.

Rollins NC, Bhandari N, Hajeebhoy N, et al. (2016) Why invest, and what it will take to improve breastfeeding practices? Lancet 387(10017):491-504.

Sayeed S, Padela A, Naim MY, et al. (2012) A Saudi family making end-of-life decisions in the PICU. Pediatrics 129(4):764.

Thet MM, Khaing EE, Diamond-Smith N, et al. (2016) Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands. Appetite 96:62-69.

UNICEF (2018) Breastfeeding: A Mother’s Gift, for Every Child. New York: UNICEF.

US Breastfeeding Committee (2021) Ask Congress to Invest in Breastfeeding Families https://usbreastfeeding.salsalabs.org/fy21cdcbreastfeedingfundingactionalert/index.html?eType=EmailBlastContent&eId=0780b59f-c9a6-4a89-9edb-b1d82222b622

World Alliance for Breastfeeding Action (2021) World Breastfeeding Week 2021: Breastfeeding a Shared Responsibility. https://worldbreastfeedingweek.org/

World Health Organization (2018a) Code and Subsequent Resolutions.

World Health Organization (2018b) Guideline: Counselling of Women to Improve Breastfeeding Practices. Geneva: World Health Organization.

World Health Organization (2021) Infant and Young Child Feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

World Health Organization, UNICEF and IBFAN (2020) Marketing of Breast-milk Substitutes: National Implementation of the International Code Status Report. Geneva: World Health Organization.World Nutrition 2021;12(3):30-3331Subsuming women into a family unit with an intention of supporting both parents, and at times also mothers who do not wish to be referenced as mothers, has the unintended consequence of undermining women’s rights in relation to breastfeeding. If you cannot describe the person who has breastfeeding rights and who needs support, then you cannot protect those rights and that relationship. What is being presented as inclusive practice is an approach that places the human rights of mothers and infants in jeopardy.The WHO Code of Marketing of Breast Milk Substitutes (the Code) and subsequent WHA resolutions exist for the purpose of protecting women’s reproductive rights and children’s right to health (Gribble et al., 2011; Gribble and Gallagher, 2014; World Health Organization, 2018a). Families are referenced in these documents in as much as they are relevant to mothers and infants, because family members have a responsibility to the mother-infant dyad. Mothers and infants are vulnerable groups in their own right. It is mothers and infants whose rights are breached through the unethical marketing of breastmilk substitutes with catastrophic consequences for theirhealth. This is why women’s breastfeeding rights were codified in the first place, and these rights have not yet been fully realised (World Health Organization et al., 2020). Anyone who replaces the term mothers with “families” is also assuming that mothers have autonomy around breastfeeding. Very often they do not (Aubel, 2021; Fjeld et al., 2008). As a breastfeeding counsellor, I work to protect mothers and infants – not families – because very often it is family members who are undermining breastfeeding, and this is an issue around the world (Negin et al., 2016; Fjeld et al., 2008; Thet et al., 2016). Many advocates will be familiar with the famous photo of the Pakistani mother with twins, one who was breastfed and thriving, and one who was bottle-fed and who died not long after the photo was taken. That tragic situation arose because the decision around infant feeding was made by the mother-in-law(Anonymous, 1991). It is a clear illustration that families do not breastfeed. Breastfeeding advocates the world over need to support the human rights of women and children and understand the importance of being clear about who holds breastfeeding rights. This is particularly the case for countries where women have few rights, where children belong to their fathers (Sayeed et al., 2012), and where mothers are prevented from making infant feeding decisions (Negin et al., 2016). This newly exported terminology, “breastfeeding families”, can only undermine the breastfeeding rights of women and children. Failure to be explicit that it is mothers who breastfeed risks negating the responsibility that international organisations have to the global breastfeeding community.This change has been occurring within many breastfeeding organisations based in the USA with a (good) faith belief that it makes for better practice. However, it is yet to be seen who benefits from this language shift. I would argue that thebreastfeeding rights of women and the importance of mothers to infants is not something that should be broadened to include others. Mothers and infants are the only people who have rights in relation to breastfeeding; families have the role to support those rights. Families do not breastfeed, mothers do, and we need to say so. World Nutrition 2021;12(3):30-3332ReferencesAnonymous (1991) The lesser child. Extracts from SCN News: News from the United Nations Administrative Committee on Coordination – Sub-Committee on Nutrition (ACC/SCN). https://www.unscn.org/files/Publications/SCN_News/extractscnnews.pdfAubel J (2021) Grandmothers — a neglected family resource for saving newborn lives. BMJ Global Health 6(2):e003808.Fjeld E, Siziya S, Katepa-Bwalya M, et al. (2008) ‘No sister, the breast alone is not enough for my baby’ a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia. International Breastfeeding Journal 3(1):26. Global Breastfeeding Collective, UNICEF and World Health Organization (2020) Global Breastfeeding Collective: A Call to Action.Gribble KD and Gallagher M (2014) Rights of children in relation to breastfeeding in child protection cases. British Journal of Social Work 44(2): 434-450.Gribble KD, McGrath M, MacLaine A, et al. (2011) Supporting breastfeeding in emergencies: Protecting women’s reproductive rights and maternal and infant health. Disasters 35(4):720-738. International Board of Lactation Consultant Examiners (2021) Twitter: IBLCE will continue to work to advance the IBCLC certification to support breastfeeding families. https://archive.vn/wip/YgUAmInternational Lactation Consultant Association (2018) ILCA Statement on WHA Resolution on Infant and Young Child Feeding. https://lactationmatters.org/2018/07/12/ilca-statement-on-wha-resolution-on-infant-and-young-child-feeding/?fbclid=IwAR2AQB6L5diqlhcS002k1TjfOtMwJth2mnpTAqrX5Sj45s7b_6jSTRLITJgInternational Lactation Consultant Association (2019) Twitter: For 40 years, IBFAN has worked to protect the rights of breastfeeding families. https://archive.vn/wip/yt1ZZLa Leche League International (2020) Twitter: Today La Leche League continues to be a gloabl network supporting breastfeeding families. https://archive.vn/wip/15EarLa Leche League International (2021) Instagram: La Leche League International, Supporting Families Since 1956. https://archive.vn/wip/R6eVuNegin J, Coffman J, Vizintin P, et al. (2016) The influence of grandmothers on breastfeeding rates: a systematic review. BMC Pregnancy and Childbirth16(1):91. Rollins NC, Bhandari N, Hajeebhoy N, et al. (2016) Why invest, and what it will take to improve breastfeeding practices? Lancet 387(10017):491-504. Sayeed S, Padela A, Naim MY, et al. (2012) A Saudi family making end-of-life decisions in the PICU. Pediatrics 129(4):764. Thet MM, Khaing EE, Diamond-Smith N, et al. (2016) Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands. Appetite 96:62-69. UNICEF (2018) Breastfeeding: A Mother’s Gift, for Every Child. New York: UNICEF.US Breastfeeding Committee (2021) Ask Congress to Invest in Breastfeeding Families. World Nutrition 2021;12(3):30-3333https://usbreastfeeding.salsalabs.org/fy21cdcbreastfeedingfundingactionalert/index.html?eType=EmailBlastContent&eId=0780b59f-c9a6-4a89-9edb-b1d82222b622World Alliance for Breastfeeding Action (2021) World Breastfeeding Week 2021: Breastfeeding a Shared Responsibility. https://worldbreastfeedingweek.org/World Health Organization (2018a) Code and Subsequent Resolutions. World Health Organization (2018b) Guideline: Counselling of Women to Improve Breastfeeding Practices. Geneva: World Health Organization.World Health Organization (2021) Infant and Young Child Feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feedingWorld Health Organization, UNICEF and IBFAN (2020) Marketing of Breast-milk Substitutes: National Implementation of the International Code Status Report. Geneva: World Health Organization.

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