I t I ~
I BREASTFEEDING IN A PARIARCHAL WORLD: NURSING CONSIDERATIONS
I I
I "If a multinational company developed a product that was a
nutritionally balanced and delicious food, a wonder drug that both ! prevented and treated disease, cost almost nothing to produce and I could be delivered in quantities controlled by the consumers' needs,
the very announcement of their find would send shares rocketing to the top of the stock market. The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence, yet they form half of the world's people who are the least wealthy and the least powerful" (Palmer,1993).
"
KATHLEEN QUINN-JACOBS HA, RNC, IHCLC JEANNE-MARIE HAVENER, MS, CNS, IHCLC
SIXTH ANNUAL CONFERENCE ON CRITICAL AND FEMINIST PERSPECTIVES IN NURSING
JUNE 30,1995
305
Breastfeeding in a Patriarchal World: Nursing Considerations r ! Havener/Quinn-Jacobs .!
BREASTFEEDING IN A p A TRIARCHAL WORLD: NURSING CONSIDERATIONS Ii
The purpose of this paper is threefold: ( 1) to examine the issues and conditions that have given rise to the global decline in breastfeeding rates since the turn of the century; (2) to explore
Inursing's role in this problem as both a sub-oppressor and change agent within the healthcare hierarchy; and (3) to describe the Bassett Birthing Center's experience in the global-to-local efforts
underway to promote and support breastfeeding through the Baby Friendly Hospital Initiative.
1The basis for this discussion arises out of an evolved understanding that as providers of women's healthcare, nurses must confront the socio-political realities surrounding the delivery of care within
a patriarchal society in order to bring about positive change for themselves and the women they
Iserve. Throughout the world today, an infant is less apt to receive breastmilk than at any other ~
time in the recorded history of humankind. Until the 1940's the prevalence of breastfeeding was
high in nearly all societies. Although feeding of commercial infant formulas began before the turn . of the century , it achieved widespread success in the years immediately following World Warn in ~ industrialized nations, largely due to the forces of commercial advertising and the medicalization of
childbirth (Coates, 1994; Davis-Floyd, 1992; Palmer, 1993). The use of breastmilk substitutes
Icontinues to i~cre.ase throughout the.world tod~}:', particularly in developing nations. This trend is
due to a combInation of complex SOClal and political forces. Regardless of where formula feeding takes place (in either industrialized or developing nations), the rates of infant morbidity and mo~ty are higher for bottle-fed babies than they are for their breastfed counterparts
l(Cunrnngham, 1991). "
The Rise of Materialism and a Consumer-based Culture ~ In the United States, the rise of corporate advertising in the early twentieth century involved ~
a movement away from the ancient impulse to symbolize the source of plenitude as female. In this '1 new corporate world of advertising, women were reduced to conduits for corporate-sponsored ;:
largesse. Female production within the household was eclipsed by externally generated products of consumption. As purchasing agents and managers of the well-run household, women gradually exchanged their personal generative powers for becoming passive consumers of products provided by the male genius of mass production. Consumerism reshaped the traditional imagery of abundance from that of the female to that of the male (Lears, 1994).
Commercial, scientific and industrial revolutions have encouraged systematic efforts to dominate the natural world and promoted disembodied notions of self. The industrial model of abundance provided support for dualistic thinking, and the tendency to see the human as an isolated self amid an inert world of objects that could be manipulated for the purposes of convenience and efficiency (Lears, 1994). These cultural and technical revolutions encouraged defIning ourselves in opposition to, rather than in connection with, the universe. Technological mastery has depended on the success of the masculine effort to contain and productively channel the chaotic energies of a metaphorically female Nature. This containment of abundance and mechanistic thinking is deeply rooted in Western intellectual tradition (Lears, 1994; Davis-F1oyd, 1992). ~
Consumerism requires the production not just of a product, but the need for a product. Markets are built, not born (Schumacher, 1993). The cosmetics and fashion industry have thrived on creating in women the artificially induced need to maintain certain prescribed ideals of physical attractiveness, stimulating insecurities with advertising images of impossible standards of "beauty". Because stereotyped ideals of breast shape and size exist, women are often self- conscious about their breasts and crave reassurance about their acceptability .The end product of the commercialization of the breast has been an increased value placed on the form of the breast over it's biological function. Women are willing to undergo invasive, risky procedures (breast augmentation and reduction) to achieve this ideal form, often rendering the breast biologically non- functional. Using breasts for feeding a baby has become a cultural paradox in Western society
2 306
Breastfeeding in a Patriarchal World: Nursing Considerations -I
Havener/Quinn-lacobs
where the "lived experience" of women has emphasized breasts for their sexual and aesthetic
functions (Palmer, 1993; Rodriguez-Garcia & Frasier, 1995).
Dualism: Male-identified Technology, Female-identified Nature
The Cartesian insistence on the separation of the isolated human subject from the material world of objects ~einfor~ed the emer~e~t notion of an autono~ous self. Cartesian philosophy favored mathematIcal kinds of certaInties and encouraged ffilStruSt of nature and embodied knowledge. The rhetoric bred by this kind of thi.nking created ~ dominant/submissive duality between the genders. Nature was female (mystenous and chaotic) and men were obligated to assert their masculine prerogative and control it for the greater good of the social order (Davis- Floyd, 1992; Lears, 1994; Northrup, 1994).
In an industrialized nation, the severing of production from consumption (and the gendering of both) symbolically divested women of their generative powers. The evolution of this imagery took place slowly, over the course of many decades and was not decisively accomplished until the early twentieth century .For much of the nineteenth century , commercialism officially promoted the prevailing morals of the times, but beneath that thin veneer, subcultures of fantasy and consumer seduction flourished. To the technically oriented consumer, mass produced products enjoyed (and still do) a seductive appeal simply by virtue of being made in the "controlled" arena of the factory floor. The belief that industrialization improved on nature gave rise to the preeminence of mass produced goods and trivialized their chief competitor: natural or home-made products (Lears, 1994).
Not surprisingly, the rise in industrialization constructed, through a combination of social change and smart advertising, a collective consciousness that bottle-feeding is normal in Western society (Newman, 1992). While it is well known that forms of artificial feeding have existed since antiquity, they had never been intended for mass consumption. Alternate means of supplying nutrition for ill mother-infant pairs was regarded as potentially hazardous and they were used only as a last resort. It was not until the late 1800's that commercial breastmilk substitutes were introduced to the marketplace. By the turn of the century, these products were sold in 17 countries, largely to affluent families who formerly had relied on wet-nurses to suckle their infants (Walker, 1993).
In the late 1800's and ~arly 1900's, both the medical profession and the public were concerned with high infant mortality rates. Nutrition was seen as one means of attaining good health. Despite scientific evidence at the time demonstrating the superiority of breastmilk in the prevention of disease, advertisers played on the emotions of the public by making claims that their formulas were an improvement on mother nature (as was the aim of all technology). Advertising promoted bodily cleanliness and equated breastmilk with body fluids that were unclean or noxious- a notion that still prevails (Morse, 1989). Even the use of the word "formula" to describe breastmilk substitutes evoked the seductive magic of scientific control. What better place to apply mastery over the chaotic whim of nature than in the heartbreaking realities of infant mortality .
Science as Religion: the Emergence of Technological Ritual
In the early 1900's advances in the prevention of disease, largely through public health and sanitation measures, gave rise to a greater faith in medical science. Transfer of the birthplace from the home to the hospital and the rise in physician-attended births, resulted in a proliferation of rituals surrounding the birth process that assisted in conveying th~ core mechanistic/dualistic values of society to birthing women. In the process birth was transformed from a normal human process to a medical condition requiring medical and technological manipulation to ensure a safe outcome. The body of the woman, according to medical wisdom, was abnormal (non-male), inherently defective and dangerously under the influence of nature, which due to its unpredictability and occasional destructiveness, was itself regarded as defective and in need of constant manipulation and control by man (Northrop, 1994). The practice of obstetrics was enjoined to develop tools, technologies and practices for the manipulation and improvement of the birth process.
Western culture, whose conceptual systems are founded on man's superiority over nature, are especially challenged to develop successful ways of dealing with powerful natural phenomena that demonstrate the inadequacy of their beliefs (Davis-Floyd, 1992). Breastfeeding poses such a
3 307
Breastfeeding in a Patriarchal World: Nursing Considerations
IHavener/Quinn-Jacobs
.Ienge to the Western belief system because despite nearly a century of chemical manipulation fonnula industry has not been able to improve upon woman's breastmilk. Breastfeeding fronts us with graphic knowledge that women's bodies are not inherently defective, and thus ~s a conceptual threat to cultural assumptions of male superiority .,
Our society's ability to remain a patriarchy requires that women internalize the basic tenets lis technocratic model of reality. The cultural responsibility for conveying these tenets lies in institutions and their leaders. The response of the maternal-infant healthcare community to this ural challenge has been to develop rationales for the management of childbirth based on a :hanistic model, to develop rituals that reinforce the model, to play upon women's fears 'ounding childbirth and to withhold knowledge from women as consumers of healthcare vis-F1oyd, 1992; Wertz & Wertz, 1989).
Since medical science began to supervise the practice of breastfeeding it has become the om to restrict it. In most traditional societies where commercial interests have not pervaded, ng breastfeeding support mechanisms exist to ensure that lactation is established. Techniques learned unconsciously at an early age through observing breastfeeding as a part of life. men's sexual attractiveness is not linked to her pre-fertile shape (more linear = more masculine) the capacity for economic production is not a priority. Consequently, breastfeeding does not rfere with the social image or role of the woman (Palmer, 1993).
With increasing commercialization, technology and a shift to hospital-based deliveries, the port system for breastfeeding has been disrupted. Faith in the process of breastfeeding is spicuously lacking in the modern healthcare system. Most women who want to breastfeed are 19 so without a wealth of personal knowledge to draw upon, some never having seen a woman lStfeed before. Our cultural experience is that of bottle-feeding as nonnal and because of this nen have learned to distrust their own breasts. This distrust has been reinforced by commercial gery and ritualized practices perpetuated by nurses such as pre-Iacteal feeds, nipple washing )re feeds, supplemental feeds, and a pre-occupation with the breastfeeding woman's diet. :se simple practices, based on no scientific rationale, reinforce the mother's sense of inadequacy the view of breastfeeding as difficult and breasts as potential carriers of disease. Other rituals
tI as maternal-infant separation, limited suckling time and scheduled feedings are known to give ! to lactation failure, but are still routinely practiced today. With the institutionalization of \!
dbearing much of the spontaneity of the maternal-infant relationship has been superseded by
itutional concerns for asepsis, efficiency and convenience for healthcare professionals. Nurses ' I"king within the confines of patriarchal healthcare institutions have been enculturated to I Jetuate these practices that negatively influence breastfeeding (Ellis, 1992). .
lions of Neutrality in the Medical.Technical.Industrial Oligarchy II Feminist analysis of women's health provides insight into the oppressive effects of our !1
;ent healthcare delivery system (Sherwin, 1992). In the case ofbreastfeeding, this analysis can
ignore the economic rewards to the fonnula industry and healthcare workers who actively or I Isively promote the practice of bottle-feeding. The healthcare profession has attempted to ! ntain 'neutrality' with regard to the choice of breast and bottle- feeding. The notion of neutrality , \ fever, belies the integration of commercial interests with health issues and underscores the true io-political climate that mainly serves male interests. The concept of 'neutrality' in a patriarchy I Inherently deceptive and naive. In a patriarchy, neutral by defInition perpetuates the male- l med status quo and ignores the interests of women. Meeting the needs of women within the
iarchy by definition requires advocacy, not neutrality .
(INurses who attempt to promote breastfeeding are often marginalized as fanatics within the Ithcare system. Viewed as "extremists", their efforts are persistently undercut by the medical-
llStrial machinery that they are trying to change. Working against the interests of the fonnula
ILlStry who provide free fonnula and bottle feeding supplies, research grants, building mo.nies, I lth education materials, gift packs, advertising dollars and conferences to professIonal I anizations (including the Association of Women's Health and Neonatal Nurses, AWHONN)
llenges the authority of the healthcare hierarchy. Nurses trying to break this cycle of ' Iendency between industry, technology and professional interests often find themselves t culed by colleagues and peers. It takes a fInn commitment to promoting women and infants'
4 308 ~ J
l~
;
~-
Breastfeeding in a Patriarchal World: Nursing Considerations Havener/Quinn-Jacobs
health and a larger vision of the ethical compromises one must take in accepting formula manufacturers' freebies to face the overwhelming power of the dominant belief system. But it is precisely this "larger vision" which our cultural bias works so hard to obfuscate. In fact, most nurses never see beyond the medical-technical-industrial oligarchy they serve.
When industry "donates" monies and materials or supports to an individual or organization, this is not without ethical or healthcare costs: (1) the consumer of healthcare is no longer given the benefit of informed choice or true support for their decision to breastfeed, (2) mothers and infants may not receive the physiologic and psychological benefits of breastfeeding, (3) the potential for increased matemal-infant morbidity and mortality rises, and (4) society bears the direct and indirect costs of perpetuating an inefficient feeding method. The presence of these special interest groups in our healthcare institutions is pervasive and challenges women's rights to adequate support for their decision to breastfeed and the exercise of informed choice.
The Nurse as Sub-Oppressor
Wittingly or unwittingly, nurses have been conduits of free advertising for the formula industry (specifically aimed at the breastfeeding woman) in the form of gift packs, samples or coupons handed out in clinics, childbirth education classes and postpartum units. Aside from endorsing breastmilk substitutes through distributing free handouts, nurses have become partners in the "conspiracy of silence" related to the hazards of formula feeding. The "conspiracy of silence" is evidenced by a reluctance to inform women who voice ambivalence about breastfeeding or, who make a decision to bottle-feed, about the health benefits of breastfeeding because this information might invoke guilt. While some women may voice being "made to feel guilty", this guilt reflects a level of discomfort with their own decision and does not relieve nursing of the duty to informed consent. To avoid educating consumers about the best health choices available to them is unethical and constitutes a breach of trust.
Historically, nursing has been a group controlled and exploited by forces outside of itself that have greater power, prestige and status (Roberts, 1983). Nursing has learoed to denigrate itself and devalue the norms, characteristics, values and theories of nursing because of oppressed group behavior. Typically, oppressed groups internalize the values of the oppressor, in the mistaken belief that this will lead to power and control. In doing this, many nurses assimilate with the norms of the dominant group, perpetuate their own oppression and become submissive. Oppressed group behavior fosters divisiveness or a lack of cohesion in nursing groups weakening nursing's ability to advocate for patients or to produce change within the healthcare system (Friere, 1968; Roberts, 1983)
Within nursing, this oppression is demonstrated by a devaluing of those skills that constitute the essence of "nursing care' and attaching a greater value to technical skills and positivistic medical-scientific knowledge. The patriarchal thinking present in the healthcare institution invokes a duality that sets the mind apart from the body, human's apart from one another, and human's apart from nature; therefore, what it means to be a human in this system is to be separate from others, disembodied, distant from and in control over others with a desire to manipulate the people and world around one's self. What it means to be a doctor, nurse or patient in this system is based on this system of control, manipulation and domination and reinforced by the patriarchal values including an over-reliance on technology. The widespread acceptance of medical science's ability to "cure" and the cultural significance attached to the physician for having this ability , has rendered nursing "care" to be a means to the goal of cure and patients to be objectified and "acted upon" (Watson, 1989).
In maternal/infant health this phenomena is particularly regrettable. Routine hospital practices in birth and breastfeeding are divisive to women as a group. Often matemal-infant nurses are aware of the vagaries of the system in which they work. Still, they are required to enforce a standard of practice that they do not espouse themselves and that is contrary to research findings. Caught between the contradictory expectations of the healthcare hierarchy and what they intuitively understand is good for their clients, nurses must "carry out orders" that they know are detrimental to their patients. This disempowers women on two levels as "care givers" and as generative persons through birth and breastfeeding. The end result of modem hospital birth experiences is that women (nurses) oppress women (new mothers).
5 309
Breastfeeding in a Patriarchal World: Nursing Considerations Havener/Quinn-Jacobs
The Nurse as Change Agent
Despite a seeming lack of organized political support for one another, feminism and nursing have much in common. Since Nightingale, nursing theory has shared much ideological ground with feminist theory .Nursing and feminism disavow reductionist thinking and hold in common the belief that an integral relationship exists between humans and their environments and
,
that the human is more than the sum of her/his parts --holistic and irreducible. Nursing and feminist theory have remained committed to developing interactions based on caring, nurturance and empowerment. Reverence for life, the environment and respect for the uniqueness of individuals are common to both schools of thought. (Chino & Wheeler, 1985).
Enlightened nurses and feminists have long recognized that two important concepts in defining women's health are totality and centrality. Totality refers to holistic concepts of health. This recognizes that the major determinants of women's health are non-medical. Totality takes into account that the acculturation of violence against women, commercially-motivated beauty ideals, poverty, discrimination and the socialization of females that leads to lowered self -esteem and disembodiment are all important determinants of the health of women in our society .Totality helps us to understand that the health problems of women are deeply rooted to our diminished status in society and our disengagement from our generative powers.
Centrality refers to the need to use women's "lived experience" as the basis for developing knowledge in women's health. Centrality beckons nursing away from the hierarchical model of the "expert" nurse who has all the knowledge to care for the "ignorant" patient, toward a recognition that the patient brings important embodied knowledge to the interaction and that decision-making is shared. Medical science offers an incomplete understanding or solution to women's health care issues, including breastfeeding. Nurses playa vital role in educating other health care professionals to employ interventions that empower women rather than reinforce their victimization in the healthcare setting (LaRosa, Dan, Haseltine & Creasman, 1993).
By recognizing our oppression and rejecting the negative image attached to nursing culture, nursing may be able to bring about a collective consciousness that fosters change. By becoming politically committed, nurses can bring the "lived experience" of women to the political arena. Nurses need to understand that urgent public health matters are an extension of the problems existing on a smaller scale in the every day life and circumstances of their clients. The personal is the political (Chino & Wheeler, 1985).
Feminism provides powerful insights about the world that create shifts in how we think, what we consider important problems and the solutions we envision. Feminist thought provides us with explanations of how the personal and political realities central to women's lives have come to be. Feminism allows us to explore factors that sustain oppression and project possibilities for change. A central goal of nursing should be to incorporate the best of feminist insights to empower all women and all nurses to create a healthier, more caring, humanistic environment for the future.
Breastfeeding offers an opportunity not only to examine the orchestration of cultural factors involved in circumventing nature within the patriarchy, but also an opportunity to integrate our understanding of these issues with actual practice. Change in awareness necessitates a complementary change in practice.
Toward an International Breastfeeding Public Health Initiative
Currently, there is a global effort underway to reverse the .trend toward artificial infant feeding: the Baby Friendly Hospital Initiative (BFHI). The BF~I ~s sponsored by the l!nited Nations Children's Fund (UNICEF) and the World Health OrganIzatiOn (WHO). It provIdes a framework for establishing an international standard of excellence in the support, promotion and protection of breastfeeding. The glDbal to local implementation of this program provides a link between theory and practice.
The need for an international breastfeeding policy grew out of an understanding, in the late 1970's, of the relationship between increased infant mortality rates in developing coun~es (5-10 times higher) and artificial feeding. The Nestle boycott, begun in 1977, drew attention to the complexities of the international marketplace and the appalling lack of responsible action on the part
6 310
Breastfeeding in a Patriarchal World: Nursing Considerations. 1 Havener/Quinn-Jacobs \
of the breastmilk substitute manufacturers' marketing strategies. Consumer pressure achieved some nominal concessions from Nestle Corporation, however the boycott had to be reinstated in 1988, merely four years after it had come to a close in 1984. The boycott is still in place and will continue until Nestle meets the requirements stated in the WHO. A series of international policy making efforts also began at this time code (Marmet, 1993; Palmer, 1993).
The WHO International Code of Marketing of Breastmilk Substitutes was adopted by the United Nations (UN) in 1981. The code restricts breastrnilk substitute manufacturers by providing an internationally recognized set of expectations for responsible marketing practices that such manufacturers must meet. At the UN, 122 countries voted on the proposed code. There were 118 "yes" votes, 3 abstentions, and 1 "no" vote. The United States stood alone in its opposition to the code. Although the code was "officially" recognized by the major breastmilk substitute manufac~rers! the industry continued to vi?late its c~ntents. Free samples, direct advertising to the publIc, guts to healthcare workers, mappropnate storage of the product, and industry representatives posing as health workers continued (Palmer, 1993). In areas where artificial feeding increased, so did infant mortality and morbidity .
Eight years later, as the crises in infant feeding worsened, at the United Nation's Convention on the Rights of the Child, 80 countries ratified a statement guaranteeing a child's "right to the highest attainable standard of health and medical care" which included parents ' access to education and support in the use of child health, basic nutrition and the advantages of breastfeeding. The United States did not ratify this right.
It became clear that in addition to the WHO code, an international public policy program was needed to counter the growing bias within the healthcare system toward artificial feeding. Hospital complicity with the marketing efforts of breastmilk substitute manufacturers manifested itself in many ways: ranging from receiving free or low cost formula to accepting large donations from the industry to finance hospital reconstruction projects --in exchange for exclusive "single brand" distribution contracts (Palmer, 1993). Hospitals needed to shift their orientation from promoting artificial feeding through their policies and institutional routines to becoming a resource center within their communities for lactating women and their families.
In 1990, 32 countries (including the US) and 10 UN agencies met at the Innocenti Convention center in Florence, Italy and issued the Innocenti Declaration. The declaration identified the need for a global public health effort based on the support, promotion and protection of breastfeeding in order to reestablish breastfeeding as the cultural norm throughout the world. The issuance of the Innocenti Declaration was a rare achievement as it consolidated more than 10 years of effort in framing an international consensus on the importance of breastfeeding as an essential practice in infant health. The Baby Friendly Hospital Initiative is the program that was developed to meet the objectives of the Innocenti Declaration.
The BFHI was launched in Turkey the following year. A joint WHO/UNICEF project, BFHI is based on the "10 Steps to Successful Breastfeeding". Individual governments have been asked by UNICEF to develop and implement their own national breastfeeding programs consistent with the global criteria set forth in the Innocenti Declaration. Although each host country must meet a core set of essential components, BFHI also allows countries to tailor the program to meet their specific national needs upon UNICEF approval. In this way, participatory governments retain the responsibility for developing and maintaining the BFHI themselves. The WHO and UNICEF play an advisory role and also serve as "watchdog" institutions to assure that the global criteria are met. At the time of this writing, 171 countries have a BFHI in place and over 3000 hospitals worldwide have earned the Baby Friendly designation.
The Baby Friendly Hospital Initiative in the United States
The United States was approached by UNICEF in 1991 to establish the BFHI. The Department of Health and Human Services appointed an ex~rt work group "to determine whether and how the UNICEF/WHO criteria and assessment process for baby-friendly hospitals could be adapted for use in the United States" (Healthy Mothers, Healthy Babies, 2). An expert work group (EWG) was convened by the Healthy Mothers Healthy Babies Coalition (HMHB) in October of 1992 to examine the feasibility of implementing BFHI in the United States. The panel was comprised of the HMHB convener, two technical experts in breastfeeding and 23 healthcare
7 311
Breastfeeding in a Patriarchal World: Nursing Considerations Havener/Quinn-Jacobs
organizations. The healthcare organizations represented professional healthcare provider groups, hospital administration organizations, birthing centers and consumer representatives.
A striking omission to the EWG was the exclusion of the US Committee for UNICEF (USC). This was remarkable considering their ongoing activities promoting the BFHI within the us at that time. USC had launched the BFHI "interim program" in the Spring of 1992. By the time the first EWG session met, close to 100 hospitals had already submitted UNICEF self- appraisal tools to the USC through the interim program. And by end of the feasibility study, approximately 250 US hospitals and birthing centers were actively pursuing the 10 steps of the global criteria. However, because the USC was not permitted to contribute to the proceedings, the experiences of these hospitals were never considered by the EWG. Ironically, the Infant Formula Council was extended an invitation to be on the panel, but declined (BFHI Minority Report, 6). The EWG feasibility study was concluded in the summer of 1994 and a fmal report proposing a national breastfeeding program for the United States was issued.
The proposed program, the Breastfeeding Health Initiative (BtHI), contains substantial deviations from the original WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). There was considerable disagreement among the members of the EWG over whether it was possible to implement the global criteria in US hospitals. In fact, eight of the 23 organizations* who participated in the EWG did not endorse the panel' s final report. (Lazarov, 1 ). A "Minority Report of the US BFHI Expert Work Group" was submitted to DHHS criticizing not only the recommendations of the panel, but the management of the deliberations that had taken place. One of the two breastfeeding technical experts, Kim Bugg, assigned to the EWG had resigned in protest over the conduct of the proceedings before the conclusion of the study. Given the departure ofEWG's final report from the intent of the global initiative, it was not surprising that UNICEF also withheld its endorsement of BfHI.
The outcome of the Healthy Mothers, Healthy Babies feasibility study was a disappointment to those who wished to establish the BFHI in the United States. Hopes of having US healthcare institutions participate in the global effort to reverse the trend toward formula feeding dwindled. At the grassroots level, it seemed that little consideration was given to the hospitals and birthing centers which had already been working on the program for over two years. Their input would have been invaluable in settling the EWG's underlying doubts about the feasibility of the BFHI. Yet information from the USC's interim program was not incorporated into the discussions of whether US hospitals could meet the global criteria. Ironically, as the EWG argued about the feasibility of the BFHI, 250 US healthcare institutions were in the trenches pursuing the objectives ofUNICEF's 10 Steps to Successful Breastfeeding.
In spite of the HMHB's feasibility study, grassroots support for BFHI continued. Following the release of the EWG's final report, USC has been working on establishing a vehicle for the BFHI in the US without involving US government agencies. Wellstart International is currently collaborating with USC to organize a national network of BFHI authorities. A fund raising campaign is underway and USC plans to launch its BFHI program in the Spring of 1996.
*The eight organizations who did not endorse the EWG's final report were the American Academy of Pediatrics, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, the Asian American Health Forum, the American Osteopathic Hospital Association, the International Lactation Consultants Association, La Leche League International, and the March of Dimes, (It is noteworthy that the Association of Women's Health, Obstetrics, and Neonatal Nurses (A WHONN) endorsed the EWG's recommendations,)
"
Implementing the 10 Steps at the Bassett Birthing Center
The BFHI was first introduced, by a staff nurse, to the Birthing Center in June of 1992. Shortly thereafter, an interdisciplinary task force of nurses, nurse-midwives and physicians was formed to consider the possibility of Bassett participating in the USC interim project. The task force felt that the BFHI criteria offered a framework that could be used to upgrade our farnily- centered approach to birth and breastfeeding. We recognized that there were substantial advantages in adopting the BFHI model of care for all new mothers (regardless of feeding method), as well as to ourselves as providers of maternal/infant care and to the Birthing Center as a healthcare setting.
8 312
Breastfeeding in a Patriarchal World: Nursing Considerations Havener/Quinn-Jacobs
At the onset of the effort, Bassett met roughly half of the requirements listed in the UNICEF Self-Appraisal Tool. Among other deficiencies, we had no breastfeeding protocol, no certified lactation consult~ts or lactation coordinator and we accepted free breastrnilk substitutes. In short, although w~ belIeved ourselves to be supportive of breastfeeding, we had no lactation management support In place.
We then set about the task of meeting the goals outlined in the 10 Steps to Successful Breastfeeding. Our fIrst goal was to write a breastfeeding protocol that met the UNICEF standard and that expresse~ our.shared philosophy of care. Having a common vision of where we wanted to be. shaped ~h.e dir~ctiOn .o~ ?ur efforts. A great deal of co-operation and co-ordination between hospital adffilrustratlon, c1Iruc!ans, and educators has been required to foster change.
Today, our breastfeedmg protocol has been recognized as a model within the Central New
York region and has been included in UNICEF's Best of the Best publication. We have two board
certified lactatio~ consultants .on staff and eight more staff members pursuing certification this year. In January of this year, we hired our first full-time Masters prepared lactation coordinator/clinical nurse specialist. In the Fall of 1994, we broke our dependency on breastmilk substitute hand-outs and began to purchase formula and bottle feeding supplies. At the time of this writing, Bassett has completed approximately 90% of the glabal criteria and we anticipate receiving the BFHI designation when a US program becomes available to us.
Through the BFHI, we have created in our setting a collective consciousness of breastfeeding as normal. BFHI has given us a larger vision of how to provide quality maternal/infant care, heightened our awareness of the global issues surrounding infant feeding, and increased our ability to work collaboratively to meet a new and challenging standard.
Conclusion
Findings of scientific research have always favored breastfeeding over the promises of scientifically "improved" products. Paradoxically, we ignore scientific recommendations in the
face of slick advertising campaigns --exposing a cultural confusion derived from the competing interests of science and industry .The inability to separate actual science from the marketing of
science is Western culture's Achilles heel. This, coupled with a staunch belief in the "free market" which does not require ethical conduct from corporate bodies (only profits), opens the door for inconsistent standards of practice. That we as nurses are more susceptible to the overtures of formula manufacturers seems logical given the three-fold pressures we are exposed to as a predominantly women's profession, as a caring profession in a technologically driven healthcare industry , and as consumers of institutional healthcare products. However, we need not fall prey to the seductive forces of materialism and technology worship. The formula industry's obsolescence is inevitable as we become better informed and begin to promote wellness in our work. The breast/bottle debacle provides us with the opportunity not just to rectify past errors in infant feeding methods, but to expose the influence of patriarchal cultural bias wherever we practice the art and science of Nursing.
References
Chinn, P. & Wheeler, C.E. (1985). Feminism and nursing. Nursinl! Outlook, n (2),74-77.
Coates, M. M. (1993) Tides in Breastfeeding Practices. In Breastfeedinl! and Human Lactation. Riordan & Auerbach, eds. Boston: Jones & Bartlett.
Cunningham, A. (1991). Breast-feeding and health in the 1980s: A global epidemiologic review. J Pediatrics. ill.(5), 659-66.
Davis-Floyd, R. E. (1992). Birth as an American Rite of Passag~. Berkeley: Universityof California Press.
Ellis, D. J. (1992). The impact of agency policies on breastfeeding. NAACOG's clinical Issues in ~rinatal ani :Women's Health Nursing, .3. (4),553-559.
Friere, P. (1968). Peda2o2v of the onl2ressed. New York: Seabury Press.
9 313
Breastfeeding in a Patriarchal World: Nursing Considerations Havener/Quinn-Jacobs
Healthy Mothers, Healthy Babies National Coalition (1994). Baby Friendly Hospital Initiative Feasibility Study Executive Summary of the Final Report.
LaRosa, J. H., Dan, A.J., Haseltine, F. & Creasman, W. (1993). Women's health research. Jacob's Institute of Women's Health, .3. (2), 86-92.
Lasarov,M. (1995) U.S. Baby-Friendly Hospital Initiative: Where it is --Where it is Going. ILCA Globe .3.(3), 1.
Lears, J. (1994). Fables of Abundance. New York: Basic Books.
Marmet, C. (1993). Summary of Institutional Actions Affecting Breastfeeding. J of Hum Lact 9(2), 109-113. McBride, A. B. & McBride, W.L. (1982). Theoretical underpinnings for women's health. Women and Health, .6.
(1/2), 37-55.
Minchin, M. (1987) .Infant formula: A mass uncontrolled trial in perinatal care. Birth, H (1), 25-35.
Minority Report from Select Members of the Healthy Mothers, Healthy Babies National Coalition (1994). Baby
Friendly Hospital Initiative Feasibility Study Executive Summary of the Final Report.
Morse, J. M. (1989). Euch, those are for your husband! Examination of cultural values and assumptions associated with breastfeeding. Health Care Women International, 11, 223-232.
Newman, J. (1990). Breastfeeding problems associated with the early introduction of bottles and pacifiers. Journal of Human Lactation, .6. (2), 59-63.
Northrop, C. (1994). Women's Bodies. Women's Wisdom. New York: Bantam.
Palmer, G. (1993). The Politics of Breastfeedin~. London: Pandora.
Roberts, S.J. (1983). Oppressed group behavior: Implications for nursing. Advances in Nursin& Science, .1, 21-30. Rodriquez-Garwin, R. & Frazier, L. (1995). Cultural paradoxes related to sexuality and breastfeeding. Journal of
Human Lactation, 11 (2), 111-116.
Schumacher, E.F. (1973). Small Is Beautiful. London: Blond & Briggs.
Sherwin, S. (1992). No longer patient: Feminist ethics and healthcare. Philadelphia: Temple University Press. Walker, M. (1993). A fresh look at the risks of artificial infant feeding. Journal of Human Lactation, 2 (2), 97-105. Wertz, R. W. & Wertz, D.C. (1989). L~in&-ln A Histo~ of Childbirth in America, (Expanded Edition). New
Haven: Yale University Press.
Woods, N.F. (1994). Frameworks for nursing practice with women. In C. Fogel & N.F. Woods (Eds.), Healthcare for women (2nd ed.). Philadelphia: Springhouse.
10 314
-
