Meggie

You bring up an excellent point, and one to which 
you've clearly already given enormous thought, 
looking at the question from all sides....You 
query if  your Breastfeeding Advisory Council 
should have its name changed to the Baby Friendly 
Initiative Committee, so that it is more 
inclusive of non-breastfeeding mothers who either 
can't or choose not to breastfeed and so that the 
group is not constrained by its focus to protect, 
promote and support breastfeeding, but can 
"support _all_ mothers/babies/families with best 
practices and honoring the choices they make".

Whoa!  Firstly, let's just look more closely at 
the last sentence, which I copied directly from 
your post.  There isn't necessarily a correlation 
between best practice and honoring the choice a 
mother makes.  In other words, if a mother 
chooses to breastfeed , fine, but if she chooses 
to formula-feed, what then?  We can accept her 
choice, but is there any obligation on an IBCLC 
to "honour" a poor choice?   When anyone talks 
about infant feeding choice, they are talking 
about the _mother's_ perspective, and they rarely 
actually mention the infant....an interesting phenomenon...

Another closely related and terribly important 
aspect is to realize that this is 
industry-inspired language (read the 
ads).  Unfortunately it's been co-opted by many 
respected organizations who should know better, 
including WHO and UNICEF, maybe as a consequence 
of the rash of recent public-private 
partnerships, and as a consequence of economic 
necessity - who knows? -  but I think it's 
important for us to expose it whenever we find it.

If you read anything from the 80s, breastfeeding 
was heavily promoted, and it was very clear that 
this was due to the protective effects on infant 
morbidity/mortality of breastfeeding.  But things 
began to change in the 90s.  The term "infant 
feeding" covers such a multitude of sins, doesn't 
it?  Thus I act on my mistrust of the push to be 
more "inclusive" by _changing_ the words "infant 
feeding" to "breastfeeding" in any document I'm 
given to review.   For those of you I've worked 
with, be warned, I've even done this 
surreptitiously over many years and without a 
shred of remorse :-).  I believe that it's 
crucial that we say what we mean and that we 
continue to keep "breastfeeding" as the main 
focus.  It's interesting to me to reflect that if 
the mother makes the infant feeding choice, then 
her counsellor, her advisor, her healthcare 
provider cannot be held responsible for the 
consequences, but isn't this a cop-out?   As an 
expert in the physiology of lactation and 
breastfeeding I know which women can breastfeed 
but choose not to, and I can distinguish them 
from the women who really "cannot" and whose 
babies absolutely need to receive formula - 
either temporarily while they work to rebuild a 
mismanaged breastmilk supply, which may or may 
not have been their fault - or permanently due to 
insufficient glandular tissue or some other 
physical cause. Of course I'll provide every 
support to mothers who absolutely have to use 
formula.  But it's not possible for me to be 
fooled into blurring the difference between 
capacity and choice.  And I don't have to support 
infant feeding _choice_ - I 'll go even further 
to suggest that I have an ethical obligation not 
to.   I'm very fortunate to have lived so long in 
a place where not to breastfeed was risky, and 
where mothers were _not_ encouraged in any 
circumstances to "choose" to formula-feed, but 
were seen to have an absolute duty to breastfeed 
their babies and in fact believed that 
breastfeeding elevated their status as wives and 
mothers.  So I'm not seduced by European/Western 
human rights language (?jargon) which implies 
that maternal choice trumps infant health.  I 
also happen to know a fair bit about the health 
consequences for the baby (the end-user) of the 
so-called choice to formula-feed.  Consequently, 
even as I can't always persuade a reluctant 
mother to breastfeed, I feel that I do have an 
ethical obligation to expose this verbal jargon 
for what it is (not just semantics, but an effort 
to hide what is really happening) and to actively 
protect, promote and support breastfeeding.

So I'd honour your uneasiness in the situation 
you describe Meggie, and I'd celebrate your 
instincts to resist this kind of messing with the 
primary focus of your important steering 
committee.  If you possibly can, I think it's 
really crucial to the continued best health 
outcomes of the babies you serve that you keep 
the focus on "breastfeeding."  Well done!!

Best wishes

Pamela Morrison IBCLC
Rustington, England (formerly Harare, Zimbabwe)
-------------------------
Hi all
A discussion has arisen recently in a couple 
groups I have involved with. We have a large 
health authority steering committee that is 
currently called the ‘Breastfeeding Advisory 
Council’. In the terms of reference, we are 
responsible for all things breastfeeding related 
(protection, promotion, support…). Naturally, a 
key function of the group is too work towards BFI 
designation for all our facilities (hospital and 
community). This council is designated as the BFI 
implementation steering group in the Terms of 
Reference. We have had a request by some higher 
up admin leaders to change our name to the 'BFI 
Committee'. The reason given is that the term 
‘breastfeeding’ is limiting the understanding 
of  the group’s focus. There is the perception 
(by admin) that the current title suggests (to 
the uninformed) we are not supportive of mothers 
who for some reason can not or choose not to 
breastfeed. (this of course in not true, our 
mandate is very much along the lines of BFI - 
working to support all mothers/babies/families 
with best practices and honoring the choices they 
make or are necessary for medical indications). 
There was even the suggestion that maybe we 
should be called the Infant Feeding Committee  - 
because, for similar reasons, our draft policy 
was changed from the ‘Breastfeeding Policy’ 
to the ‘Infant Feeding Policy’ even though 
the content of this high level policy remained 
the same - basically to work towards BFI.
This came as a surprise to me. I am aware that 
there is some backlash against BFI (thinking that 
BFI isn’t ‘mother friendly’) so this is the 
exact opposite thinking. These admins like the 
term  BFI (because who wouldn’t like that we 
are ‘baby friendly’). The difficulty I have 
with this is that I have always considered that 
breastfeeding promotion, prevention and support 
involved more than just BFI. Sure, if an 
institution decides to embark on the journey to 
BFI a lions share of the committee work will be 
BFI related. And really, for most breastfeeding 
related work we do we could massage it to fit 
under the 10 steps. Especially since Step 10 is 
so broad that any community breastfeeding work 
can fit under population health. I guess I’m 
thinking, for example, that our Perinatal Network 
Steering Committee would have a large amount of 
their work focused on meeting Accreditation 
Canada Obstetric Standards, but the committee 
isn’t called the Accreditation Obstetrics 
Standards Committee. Breastfeeding Committee for 
Canada isn’t called the Baby Friendly 
Initiative Canada, but Breastfeeding Committee 
for Canada - with a large portion of the work 
directed to BFI (but not all?). I see BFI a very 
important tool we can use to advance our work, 
but not as the defining concept.
I’d love to hear your thoughts on this issue. 
Is it just semantics? Is it important to 
acknowledge, by title, that ‘yes, the work that 
we are doing is breastfeeding related’?  By 
eliminating the word ‘breastfeeding’ from our 
policy title, our committee name etc are we 
playing it smart? or being disingenuous? 
Remember, the public doesn’t know the name of 
our committee  - our audience is health care providers.
Many thanks - TIA, Meggie


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