As part of National Breastfeeding Week (01-07 October) in the Republic of Ireland, IPH launched a report on breastfeeding on the island of Ireland. The report presents up to date figures on breastfeeding patterns and on attitudes, perceptions and experiences of breastfeeding.
Dr Helen McAvoy is co-author on the report and in 2 blog posts reflects on findings and potential implications for public health policy and practice.
The posts focus on two inter-related themes – Part 1: ‘starting to breastfeed’ and this is Part 2: ‘infant feeding culture’ on the island of Ireland.
Infant feeding culture
Strategies in both jurisdictions recognise the importance of creating environments and ‘infant feeding cultures’ where mothers feel confident to breastfeed as a natural part of parenting. I must confess that some of the concepts around what culture is and how to change it are difficult to understand and even harder to translate into action. This is really a concern for breastfeeding strategies and action plans in light of the truism that ‘culture eats strategy (or indeed formula) for breakfast’.
The Northern Ireland data shows that more than half of babies are put to the breast in the maternity hospital but less than half of all babies are breastfeeding on discharge from hospital. Our report highlighted some of the reasons given by mothers for breastfeeding or for choosing infant formula from the beginning. The reasons cited in surveys in both jurisdictions are largely similar. However, what would now be beneficial is a better understanding of the social and cultural contexts in which these decisions are being made.
The new breastfeeding action plan in the Republic of Ireland, the first under the wing of the Healthy Ireland Framework, intends to rise to this challenge. The strategy commits to convening a working group on culture change involving inputs from outside the health sector. It will be exciting to see what experts in psychology and the behavioural and social sciences can bring to the approach.
How is the culture around infant feeding created? It is unhelpful to frame the breastfeeding debate around a dated rhetoric of ‘good’ or ‘bad’ mothers. Infant feeding decisions are based, not on some spurious idea of moral fibre, but on the unique context of a mother’s own needs and beliefs, her family context and her understanding and confidence in meeting a momentous challenge - the first 12 months of parenting. Information and awareness campaigns operated by the statutory and community sector have successfully presented breastfeeding as natural, normal and healthy and also social, empowering and rewarding. Relentless marketing by the commercial sector has undoubtedly presented formula use as all those things…and, in many ways, so much more. We know far too little about the social, economic and emotional worlds of pregnant women and new mothers to truly understand the contexts in which decisions about infant feeding are made. Survey data and administrative datasets provide far less data, if any, on the physical and mental wellbeing of mothers of infants in the first year of life than they do about the babies that rely on them. Why is that?
Our report highlighted some useful insights from variables recorded in the general adult and child population in Northern Ireland. It would be particularly valuable to see similar data recorded in the South. While attitudes and perceptions of breastfeeding are improving, it is worth noting that nearly one in eight adults in Northern Ireland consider breastfeeding in public to be embarrassing and one in six school children report that they have never seen a woman breastfeeding in public. It is an important time to widen the focus from mothers and set our sights on the determinants of infant feeding culture in communities North and South.
Dr Helen McAvoy
Director of Policy
Institute of Public Health in Ireland
For local and reliable support and advice on breastfeeding:
Northern Ireland: www.breastfedbabies.org
Republic of Ireland: www.breastfeeding.ie
Resources mentioned in this blog:
Breastfeeding on the island of Ireland – all sources mentioned in terms of the Republic of Ireland and Northern Ireland are cited within this report