A Consideration of Choice (in the Absence of Systemic Supports)*

Camille Abbe, USBC Senior Campaign & Convening Manager

*The opinions stated in this blog are from the writer, and should not be perceived as a position statement from the U.S. Breastfeeding Committee.

We hear the word choice a lot these days. During National Breastfeeding Month, I am taking a moment to reflect on what we mean when we talk about "choosing" to breastfeed. Or when we use that word to validate the "choice" that someone is making about whether or not they breastfeed (a term I am using to include chestfeeding, bodyfeeding, and/or human milk feeding). I'm interested in exploring the implications of using the word “choice.” My inclination is that if roadblocks exist at every turn, is our ultimate path one that we have truly and freely chosen if all options were fully and legitimately available to us? Or, were we backed into a certain decision because the alternatives were not available, attainable, or viable?

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For example, if you are separated from your baby after birth (for reasons medical or otherwise) and are thus unable to initiate lactation, was that a choice that you made? I submit that it was not.

If, because our country lacks paid leave at the federal level, you have to go back to work just weeks after giving birth and you are exhausted and haven't yet had an opportunity to establish a sleep and feeding routine, are you really choosing when you decide to stop breastfeeding and pumping in favor of formula that can be given by anyone? I submit that was not a choice you might have otherwise made.

If you are denied the opportunity of time and space to pump at work and your milk supply dwindles or you develop an infection, are you really choosing when you need to switch to formula?

If you are shamed, excluded, or sexualized for nursing in public, is it really a choice when you then feel more comfortable bottle feeding (with formula or human milk)?

If you are sent misleading and manipulative marketing materials about the benefits of formula-feeding from the moment you announce your pregnancy on social media, are you sure that some of that messaging has not influenced your choices? (The commercial milk formula industry makes billions through these techniques, so the business model would suggest this is effective.)

If you were provided coupons or samples from your doctor or hospital after delivery as a goodie bag doesn't that imply that the formula is the option they'd recommend? And furthermore, doesn’t it create a nice association with a brand when they give you a "gift"?

This is what is happening now. These are everyday situations that illuminate the existing barriers to human milk feeding. With so many of these barriers standing in their way, many (if not most) families are denied the opportunity of full choice as to how to feed their babies. Recently, I heard the statement "It's a miracle that anyone in the U.S. breastfeeds." That is our current reality.

Too often, savvy marketing groups and companies that stand to profit contort lactation support efforts as something designed to shame parents, make them feel guilty, and remove their choice. This couldn't be further from the truth. Statements describing human milk as the optimal food for babies reflect continually reaffirmed and robust science. They are not a judgment. Efforts to make our country a friendlier place for lactating parents are not removing choice. They are creating choice.

Passionate and dedicated individuals and organizations work day in and day out to make breastfeeding easier. They undertake these efforts for the young families of today, the families of tomorrow, and all the families of the past who were failed by society.

Let’s take a moment to vision. What if, instead…
What if all birth locations followed internationally recognized best practices to support breastfeeding and you got to room-in and be skin-to-skin with your baby right after birth?

What if hospital and birth center staff were provided (or mandated) more lactation training, to encourage and support you?

What if you were sent home with a goody bag of culturally informed information about the benefits of human milk and breastfeeding, practical information on latch and feeding, a breast pump if you need it, and phone numbers that you could call or text for help when you needed it? And the dates and locations of support groups near you?

What if trained lactation support was integrated into your postpartum care? For free.

What if you had federally mandated paid leave, and when you returned to work you had break time and a pleasant space to pump?

What if you saw "breastfeeding is welcomed here" signs in every store, school, transit station, and library?

What if you felt encouraged and celebrated by your family, workplace, and community for the time and commitment you are giving to feeding your baby? (Because it takes a huge amount of time and commitment!)

What if safe donor human milk was available at no or low cost, or covered by insurance, so there was a human milk supplementation option if needed?

What if it was illegal for commercial milk formula companies to imply a health benefit when they are marketing their products to you? And what if they were not allowed to overwhelm you with marketing materials in the first place?

Some of this is happening now in certain hospitals, in certain medical practices, and in certain communities. But we need these policies, systems, and environments to make change now for all families. That is what creates the conditions for someone to be able to make full and complete choices, rather than being forced to make decisions based on current, sub-optimal realities. When all of those "what if" conditions are fulfilled, it is at that point that we can name and celebrate choice!

It may well be that very few of us have access to the environmental opportunities and bodily sovereignty to which we are entitled, but I feel confident that our work together spanning the country, from the grassroots to the treetops, is creating opportunity. And opportunity allows for real choice! At that point – when information, access, and culturally-aligned support are bountiful, when paid leave is a reality, and when marketing is regulated – choice becomes a word with meaning. Until then, it’s a decision. One to be respected, for certain, because it's hard enough to parent in this country with roadblocks at every turn. There's no shame in the decisions that parents make. But let's not confuse matters by calling it a choice.

In light of these current realities, this piece is a celebration of intention and effort. If you wanted or tried to feed human milk but didn't meet your goals, National Breastfeeding Month is for you. If you were able to meet your goals and want to help others meet theirs, National Breastfeeding Month is for you. If you have a young baby and are facing infant feeding challenges and meeting them in any of the ways that work best for your family, National Breastfeeding Month is for you. If you or your loved one might someday have a baby to feed, National Breastfeeding Month is for you.

The U.S. Breastfeeding Committee and our network of members, partners, and supporters are working hard to remove the policy, system, and environmental barriers that stand in families' way. I hope you will join us and support us in our efforts to realize our vision of thriving families and communities!