I really appreciated Valerie's post on this issue and think her points
cannot be overstated.  We, as health care providers, are not the most
important factor for decision making in an individual person's life.
Whenever I work with students I try to empasize this for any health issue. A
patient may be "non-compliant" for any number of really valid reasons.  In
the exam room, it seems as if there are straight forward facts that any fool
should be able to see and follow, but in real life one's health is simply a
part of the rest of your life and decisions you make have to fit in with all
the other aspects of your life.
When I was a resident, I conducted a survey (with LN's Mary Kay Smith) on
breastfeeding among our WIC patients, who were nearly all African-American
and poor.  To my surprise, every single woman who completed a survey could
list benefits of breastfeeding.  Many of them said health care providers had
encouraged to breastfeed.  But the only thing that was statistically
significant in association with actually breastfeeding was if the woman's
mother or other support person in their life encouraged them to breastfeed.
 Without support where you live, it is very hard to do something as
consuming as breastfeeding
Of course, I'm still trying to provide as much support as I can to every
single mother, but I have to acknowledge that I'm not the most important
factor.
Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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