This past week, British Columbia's Fraser Health caused an uproar when news broke of an infant feeding "contract" which emphasized the risks of using infant formula (even, as they so gleefully proclaimed, "just one bottle!').
The media took up the cause, citizens spoke up, and apologies/retractions were issued. It was a relatively prominent news story, with many major outlets providing significant airtime for debates and discussions on the topic.
While some felt that using a contract was a rather sterile way of handling an intimate, personal decision, most of the criticism centered on the misleading, loaded language it used, rather than its mere existence. The public was rightfully concerned about women being "insulted" or "shamed," especially for something that can be rendered impossible by one's own unchangeable physiology.
So, it might surprise critics that literature like this is rather common in the world of maternal/infant health. In fact, the contract that caused so much outrage has been part of Fraser Health's maternity program since 2007. This is not news, unfortunately -- it's just the first time the news has taken notice.
For example, the text on City of Ottawa's Public Health page eerily echoes the information Fraser Health was providing to new mothers in its hospitals. Same goes for Toronto. Going to HealthyFamilies BC provides a plethora of information on breastfeeding, but is exceptionally scant on resources for formula feeding, or even donor milk feeding.
When Ottawa Public Health was confronted late last year about their Infant Feeding guidelines, they responded that the information they had provided was reviewed by "assessors experienced in infant feeding to ensure quality and currency of the information," and that their "information sources include the World Health Organization, Health Canada, the Best Start Resource Centre." They further assured that "the way in which information is presented on our website is being reviewed with your concerns in mind." More than nine months later, the website and its information remain unchanged.
Aside from making overreaching claims about the risks of formula feeding, Ottawa Public Health provides no guidance for formula feeding families. This information is buried in the city website's "Food Safety & Inspections" section, rather than the "Healthy Baby & Family" section. Breast may be best, but last we checked, healthy babies and families still thrived on (and often because of) formula.
Breastfeeding should be promoted and supported, but what passes for "support" often leaves parents who either choose not to, or prove unable to, bereft. In this context, is it any wonder that those who "fail" at breastfeeding have double the risk of postnatal depression?
While the Baby Friendly Hospital Initiative encourages many worthwhile changes to maternity care, the ultimate goal of this program is to raise breastfeeding rates. But receiving a "Baby-Friendly" designation should not supersede or overshadow the goal of ensuring that both babies and mothers have their healthcare needs met at a time of exceptional physical and mental health vulnerability.
The current policies and information were never intended to cause shame; they were never intended to generate stigma. Unfortunately, that has been the result. Coercion, biased information, shame and stigma can never be the foundation of quality care. Quality care comes from respect, shared decision making, collaboration, and support.
Fraser Health acted admirably in the wake of intense criticism. They listened; they thought; they adjusted. Imagine what might happen if we all took a similar step back and rethought how we are assisting families in being as healthy -- both mentally and physically -- as possible.
It is time to re-evaluate the information and support given to new parents. It is time to collaborate and ensure quality care for all parents, not just those who breastfeed. Let's follow Fraser Health's example and listen to mothers, so that their needs are not dismissed to facilitate an uptick in statistics.
This article was written by Suzanne Barston, author, "Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn't," and Janice Williams, quality care advocate and blogger.
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