Mary Kay and Lactnetters,
   This idea of "doing both" keeps coming back.  The demographics might change, though the lowest socio-economic groups tend to figure largely.  Bottles have for so long been a symbol of babyhood (just take a look as the signage on baby-change facilities or baby features in newspapers), that the community doesn't seem to notice that this is strange.  The message is almost subliminal: babies and bottles, like cart and horse, Superman and Lois Lane.
   During the post-World War II period, before the WHO Code on marketing, companies had access to mothers in hospitals through "free gifts" of their advice booklets on infant feeding.  Later, free cans of artificial baby milks on discharge, or other discharge packs, became a means of direct marketing to mothers in many countries.  (But you know all this.)
   30-40 years ago, in the hotter parts of Australia, mothers and their advisers considered a bottle essential for giving water at least once a day between scheduled feeds (which we now know is totally unnecessary - and inadvisable - for babies breastfed on demand in hot climates).  Lists of baby "needs" to be bought before the birth included a certain number of bottles and teats on the list for "breastfed babies", though fewer than for "bottle-fed babies".  (How the two groups overlapped!)  In the mid-1960s, I encountered the attitude that I was depriving my baby by not giving food that cost money, out of utensils that cost money.
     A lot of today's grandmothers had their babies 20-40 years ago, during the period of non-exclusive breastfeeding, and it may be difficult to target them all in pre-natal classes, especially if they come to visit from another city to "help" with the baby.  Lactnet has recently had some good sharing on involving grandparents in prenatal education classes.  I like it when a mother brings the grandmother with her and the baby for a private consultation.
     Further issues, today, include the direct advertising to consumers on the internet, and the increased advertising of breastpumps, complete with bottles.  Message - if you are going to breastfeed, you need this product and the bottles it comes with.  In some areas, mothers planning a return to work 3+ months postpartum somehow get the idea that they need to pump and store from day 1, or soon after.  Advertising since the late-1990s promotes the idea that Dads will be deprived if not given the chance to feed the baby - by bottle.  Let's remember that, back in the bottle-feeding 1950s and 1960s, Dads weren't expected to bottle-feed or do baby care.  (I wonder if promotion of that idea has anything to do with the increasing incidence of breastfeeding?)
     Then there are the dolls which come in boxes complete with nursing bottle, and have done for very many years.  What do you see in dolls' corners in kindergardens? - bottles.  And there's the ubiquitous television entertainment which plonks a bottle on the scene as soon as a baby comes into the story.  A recent article by Henderson et al, published in the BMJ in November (from memory, 11 November 2000), surveyed British media representations of infant feeding during one month.  Bottle feeding greatly predominated and was shown more naturally (ordinary Mums in everyday situations) and only once were problems mentioned (the effort of bottle preparation).  Breastfeeding was more likely to be mentioned verbally than shown visually, was less likely to involve ordinary Mums and problems were commonly mentioned.  No matter how well prepared for breastfeeding by the hospital, mothers going back into the community on discharge are going to encounter all these subtle and non-subtle influences, as are her support persons.  This is true for other countries, not only Britain.  The well-educated, highly motivated mothers (and not all of them, even) are the ones who can withstand all this, far less mothers with lower socio-educational backgrounds.
    Education for breastfeeding needs to start long before the first pregnancy, preferably in kindergarten (no bottles for the dolls, and some good picture books with baby humans and baby animals drinking milk from their mothers), and then through the school curriculum, in human relations classes, biology, economics.  Social marketing of important health messages, including breastfeeding, through the media needs to involve the sorts of programs low-income mothers watch, e.g. soap operas and sitcoms.  Market research can find out what is actually watched.  Perhaps others on Lactnet have experience of how positive messages about breastfeeding have been incorporated into television programs in their countries, whether through department of health influence or through approaches by and cooperation from breastfeeding support groups or professional bodies.
      Sorry this is long, but I still haven't touched on all the influences.
          Virginia
           in Brisbane

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