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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