Do Celebrities and the Media Combat or Perpetuate Stigma Around Breastfeeding?

This week's guest post was written by Jennifer Breaux, DrPH, MPH, CHES.  She is an Assistant Teaching Professor & Director, Undergraduate Education at the Drexel University School of Public Health.  Her work is focused on maternal & child health, nutrition, and health as a human right.

Over the past month, Alicia Silverstone has entered the public health conversation once again by launching a vegan mother breast milk sharing program through her website The Kind Life.  The program has been featured by several national media outlets.  Although her idea of milk sharing is not a new one, it has reignited arguments and opinions on both sides.  For example, US Weekly ran a short piece about the proposed milk sharing program where it provided the information but did not give an opinion.  Unfortunately, many uneducated and harsh opinions were given in the comments section of this piece.  They ranged from stating that this was a horrible idea that would give babies diseases to questioning why someone would choose to give breast milk in this situation when there is formula.

I felt compelled to write this blog post because issues relating to breastfeeding and breastfeeding policies are extremely near and dear to me both personally and professionally.  The issue is also quite timely considering that August 1-7 is World Breastfeeding Week and the month of August is Breastfeeding Awareness Month.

Combating Stigma
Alicia’s program was first reported on by Good Morning America (GMA) and I was struck by the uncomfortable nature of the anchors when the health reporter presented breast milk on the table.  Seeing the breast milk out in the open resulted in a visceral reaction of unease for some of the hosts.  I was happy to see the reporter debunk some milk sharing myths like (1) the milk is unsafe, (2) it transmits disease and (3) it is an unnecessary service.  Overall, I thought that GMA did a balanced job of reporting the story.

Perpetuating Stigma
While stories like that on GMA  (in which a medical professional reinforced the safety of breast milk sharing) can help combat stigma, stories like the one in Life & Style can perpetuate it.  The Life & Style magazine ran a story with a quotation by TV host Wendy Williams who basically equated milk sharing with slave nurses and the Civil War.  

The roots of milk sharing date back to wet nursing and this practice actually dates back to before Christ and has been practiced through the centuries.  Yes, wet nursing did exist during times of slavery but it is also something that still exists today – largely invisible to the general population.  However, it did make main stream news outlets a few years ago when Salma Hayek breastfed a malnourished infant during a humanitarian trip to Sierra Leone.    The whole concept of wet nursing and milk sharing is not new and truly a selfless act that has become a life saving option for mothers who can’t or choose not to breastfeed.

The Facts About Safety
The Human Milk Banking Association of North America (HMBANA) was established in 1985 and remains the largest group to acquire breast milk.  It is a lifesaving organization for premature and ill infants and has locations across the country.  One of the main arguments against something like milk sharing is the spread of disease.  Milk that is obtained for the HMBANA meets rigorous standards.  Milk donors are screened and once the milk arrives at the bank it is:

Pasteurized to eliminate harmful bacteria,Lab tested to make sure the milk is safe and free of any communicable diseases that are able to be spread in milk, andOnce it is ruled free of any cultures, the milk is able to be shipped to recipients
These standards enable parents to give donated milk knowing that it is safe and what is best for their infant.

That being said, there are informal milk sharing programs that are not regulated; the milk does not go through the rigorous testing done by HMBANA, which could pose a public health risk for those receiving the milk.  However, those who choose to participate in these networks are aware of the risks and feel that the benefits provided by breast milk outweigh possible consequences because the amount of external substances absorbed in breast milk is quite small.   An additional reason that families may choose this alternative route is cost.  Babies drink A LOT of milk and to get certified milk from HMBANA for the first year of life is extremely expensive and is only covered by insurance under certain circumstances.

A Call To Action
We, as a society, have opinions on these types of breastfeeding programs, but the debate will continue until we deal with the root cause of the need for increased milk sharing - our poor breastfeeding rates.  According to the World Health Organization and the American Academy of Pediatrics, it is recommended that mothers exclusively breastfeed their infant for the first 6 months of life followed by breastfeeding, in combination with the introduction of complementary foods, until at least 12 months of age and continuation of breastfeeding for as long as mutually desired by mother and baby.  In 2012, the national breastfeeding rate of exclusive breastfeeding at 6 months was only 16.3% with certain subgroups falling far below this percentage.

Stigma surrounding breastfeeding and the lack of support on every level will continue to plague this issue. The irony is that the science is clear – breastfeeding has overwhelming positive benefits for the baby, mother and society.

Some of the proven positive health benefits for breastfed babies are reductions in/of:

Hospitalization from lower respiratory infectionsEar infectionsSerious colds, ear and throat infectionsNecrotizing entercolitisSudden Infant Death Syndrome (SIDS)- after accounting for confoundersAllergic diseaseCeliac diseaseIrritable Bowel Syndrome (IBS)ObesityType I DiabetesChildhood Leukemia and Lymphoma
Some of the proven health benefits for the mother (time dependent) of breastfeeding: Decreased postpartum blood lossMore rapid involution of the uterus (post childbirth)Increased child spacing (lactational amenorrhea)Possible decrease in postpartum depressionDecreased risk of Type 2 DiabetesInverse between breastfeeding and rheumatoid arthritisReduction in hypertension, Cardiovascular Disease (CVD)Reduction in breast and ovarian cancerReduction in osteoporosis
Additional benefits from breastfeeding annually: $13 million in direct health care savingsPrevention of at least 5,000 cases of breast cancerPrevention of at least 54,000 cases of hypertensionPrevention of at least 14,000 heart attacksPrevention of the three outcomes above result in about $860 Million in health care savings
Breastfeeding is good public health.  Maybe we should start investing more in making sure babies are able to be breastfed and, if not- afford them the ability to receive affordable and safe breast milk.  We MUST stop considering breastfeeding as a woman’s lifestyle choice and view it for what it really is:  an important health issue, a public health issue and a human right.

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