Friday, 7 October 2011

Which part of baby-friendly do you have a problem with?

So since I wrote my screed, more has happened (all forwarded to me by the endlessly helpful Beth!) At the end of my last post, I linked to a post by Gina at Feminist Breeder called "Why I am a Feminist AND a Lactivist", responding to Jessica and talking about why she supports Baby-friendly. Apparently some Twitter activity around the past happened (I try to stay off Twitter - I'm already addicted to the Internet enough as it is!) Then Jessica Valenti wrote a response to the tweets (hard to tell if she actually read Gina's post). Jessica said:

I’m sympathetic to Catilin’s argument that there are problems with the way that formula companies market their products (there’s quite a long history there). That said, of course free formula in hospitals is done from a marketing perspective, not for the good of women. Companies are companies and they’re targeting their audience. But I’ll tell you what - when my breastmilk ran out while Layla was in the NICU, I was sure as shit glad there was formula there to feed her. ...

But the marketing/corporate aspect was not really what Hearts’ post and my response was about - we were addressing the hypocrisy of judging women who choose to formula feed and the way they are made to justify their choice. In this case, the fact that the hospital would make formula available to women who “medically” needed it - what constitutes medical need? And what if women simply didn’t want to breastfeed? Isn’t that her right, and shouldn’t she be equally supported for that decision in the same way a breastfeeding mom is?


Except, you know, that wasn't what Jessica's original post was about. Maybe that's what she THINKS it was about, because it triggered feelings around formula feeding, breastfeeding, guilt, shame, expectations, etc. But her original post was about Baby-friendly, and criticizing hospitals for "denying" women the opportunity to use formula. Gina was pointing out that she was incorrect; Baby-friendly is about denying formula companies the opportunity to use hospitals for marketing purposes, and getting hospitals to adopt best practices to support breastfeeding.

But Jessica also covers that in her second post (which is confusing because she also said in the second post that's not what the debate was about), and says she thinks limiting formula marketing is paternalistic:

... the argument that women are “vulnerable” to free formula is just plain insulting to women’s intelligence. I trust women to make their own decisions.


As Gina points out, that's not the case for a lot of other marketing efforts that feminists take issue with:

Feminists are constantly calling out “Pregnancy Crisis Centers” for being predatory. They snag women who may be alone, scared, and confused by a major reproductive choice, and they offer them freebies to gain their trust. They tell them they’re helping them make a decision about parenting, but what they’re really doing is piling their Anti-Choice agenda on them, promising the mothers they’ll help, and then vanishing when it comes time to foot the costs of raising this baby. Feminists recognize that these centers are preying on a woman during a vulnerable time in her life. We’re not saying these women are stupid or that they’re being duped. We’re not saying that one choice is better than the other. We’re saying that the marketing is absolutely unethical.

Feminists are constantly calling out and boycotting the beauty industry for shaming women about their bodies, their lifestyles, and their choices. Why do we do that IF we think women are immune to marketing influence? Isn’t a woman smart enough not to fall for that “skinny is better” imagery? Don’t we trust her to recognize the airbrushing for what it is?


I am very curious to see how (and if) Jessica responds to that argument. But in the meantime, let's move on to her conclusion:

Listen, I support breastfeeding women - long before I had my daughter I was blogging about the heinous lack of resources for breastfeeding mothers and the various ways they are discriminated against. I think we need mandated paid maternity leave, insurance that pays for lactation consultants and breast pumps, employers who are required to have a space and breaks for pumping moms, hospital- and state-funded breastfeeding support groups and more. But I also believe that formula feeding your child is just as valid and healthy a choice as breastfeeding - it’s not something women should have to justify or be denied resources for or access to.


I agree with her! Breastfeeding women deserve time, space, resources, and support? yes! Formula feeding as valid a choice as breastfeeding? Yes! As healthy or even MORE healthy than breastfeeding? Yes, sometimes! Should you have to justify it to anyone else? No! Should you be denied resources for formula feeding? No! Wow, look, me and Jessica agreeing on everything. Except the part where she slams me, the organizations I work with, and the work that we do. Because she still thinks Baby-friendly can "suck her left one". I wrote in my last post that she doesn't seem to actually understand what Baby-friendly is. But maybe it didn't get through. So here's a little review for Jessica Valenti and anyone else who's confused:

Here are the Ten Steps to Baby-Friendly, from the UNICEF Baby-Friendly page.

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic


The Ten Steps prevent hospitals from doing things like routinely supplementing breastfed babies, not training their staff, routinely separating new babies from their mothers, and trying to force babies to feed on a schedule. Good stuff, right? So where is the issue here?

The current debate seems to center around Step 6, Give newborn infants no food or drink other than breastmilk, unless medically indicated. This is an international guideline, and in the U.S. Step 6 has been reworded as "Give breastfeed newborns no food or drink other than breastmilk, unless medically indicated." As the U.S. has a long history of formula marketing via hospital, Baby-Friendly USA has added this clarification to Step 6:

The Baby-Friendly Hospital Initiative supports the International Code on the Marketing of Breast-milk Substitutes ("WHO Code"). The WHO Code stipulates that health care facilities and professionals neither accept nor offer free or low-cost substitutes for human milk. In keeping with the Code, the Baby-Friendly Hospital Initiative asks facilities to purchase all infant formula in the same manner as it purchases all other supplies. Additionally, facilities should not give infant formula samples, literature, or other items bearing the name of an infant formula product to breastfeeding mothers.


Since the original story was about a UK hospital, I looked up the UK guidelines and found their page on Step 6. They have not reworded the guideline from the international version; they have set out the following criteria for following it:

No food or drink other than breastmilk should be given to breastfed babies unless:
- there is an acceptable clinical reason, the baby is unable to breastfeed and there is no/insufficient breastmilk available
- the mother has made a fully informed choice to feed her baby other than from the breast.

No promotion for infant food or drink other than breastmilk should be displayed or distributed to mothers or staff in the facility.


The hospital in the article that sparked all this seems to have drawn ire for asking mothers to bring in their own formula if they decide to formula feed without a clinical/medical reason. But that requirement is not part of Baby-friendly. It's not required in the international guideline, or in the U.S. interpretation, nor in the U.K. interpretation. This hospital has chosen to make this change part of going Baby-friendly, but it is not required. I said in my original post that I thought that whether was a good idea or not was a legitimate subject of debate, but it is not actually being made the subject of THIS debate. Instead I'm seeing people call Baby-friendly shaming and lump it together with the anti-formula douchery on Twitter and that's just plain wrong.

Saying, as Jessica Valenti did in her original post, that "refusing to give mothers access to formula is not “baby friendly” or helpful - it’s shaming and in some cases could be very dangerous" shows that she REALLY didn't understand what Baby-friendly was about, since apparently she never saw "unless medically indicated" in Step 6. No Baby-friendly hospital would put a baby in a "very dangerous" situation by denying them formula. "Medically indicated" is how we avoid "very dangerous". It really bothers me that someone would imply that LCs, nurses, and doctors and those hospitals would shrug and say "Sorry, no breastmilk no eat!"

I made this point before and I make it again now: Baby-friendly is not about you needing to justify your choice to formula feed to hospital staff. It is about the HOSPITAL having to justify its OWN reasons for supplementing breastfed babies. Yes, that hospital in the U.K. differentiates between medical and elective supplementation, and asks the elective supplementers to bring in their own formula, and that may seem judgy and we can talk about that. But let's talk about it WITHOUT bringing Baby-friendly into the mix and WITHOUT implying that health care professionals are starving babies.

I'm glad formula was there for Jessica's baby. I'm glad she likes formula feeding and that it was a healthy choice for her. I'm really sorry people are jerks about how women feed their babies. I just don't see the connection between all those things and Baby-friendly. As I said in my last post: they are different things. Jessica had the opportunity to say "Hey, I get what Baby-friendly is, I just have a problem with this part of it and let's talk about that", but instead off we go on the mommy-wars train to Stopjudgingmeville, complete with opportunities for self-proclaimed lactivists to show off their ugliest, judgiest sides. I get so depressed by how so many feminists hop on this train unquestioningly. Back to my conference proposal in an attempt to encourage more people to think about this in a more critical way...