Abstract
What is the basis for this seemingly presumptuous statement? Again, based on my over 30 years of personal activity it is clear to me that major conceptual changes have recently occurred and that these changes will in turn impact on the ultimate success of mothers' initiating and sustaining exclusive breastfeeding for the recommended first 6 months of the infant's life and continuing breastfeeding for at least 1 year while complementary foods are introduced, and longer as long as nursing is mutually desired by the mother–infant dyad.
The major, and I dare say, revolutionary conceptual change is that breastfeeding is no longer conceived as a lifestyle choice, but rather as a basic health issue that has implications for optimal medical and developmental welfare of the infant and mother. Furthermore, the disadvantages of not breastfeeding has both short- and long-term consequences, including an increased risk of infection, immunological diseases, allergies, sudden infant death syndrome, obesity, leukemia/lymphoma, and diabetes. 1 Thus, in a seemingly paradoxical fashion the well-worn slogan “Breast is Best” is now being discarded into the junk heap, as it suggests that breastfeeding is “best” (i.e., a luxury item). In retrospect it is clear that the slogan has been counterproductive, as it implies that as a luxury item breastfeeding is a lifestyle option of choice for those with the resources, both financial and logistical. However, for the majority of mothers and infants “good” is enough, and thus formula is adequate.
This marketing error was clarified for me by my professional advertising colleagues who have emphasized to me that if you want to sell a Mercedes luxury car, you can say it is the “best,” but what you can hope for at most is 10% of the general market. If, on the other hand, you want to sell family sedans to 80% of the public, then advertise them as the proper item to meet all the family's basic transportation needs. To put it simply, if we want to sell breastfeeding to the public we cannot sell it as the best item (as “good” may be enough for most), but rather as what should be the normative standard for all.
In current culture, breastfeeding is now (finally) being conceived as mainstream and not limited to the leisured, educated upper-middle class. The best evidence of this welcome phenomenon is the promotional campaign for a new science fantasy comic book series of a statuesque superhero woman pictured in a family unit with her male companion while she is nursing her infant. Such an image is in contrast to the previous ones of scantily clothed buxom women in various erotic poses and is confirmation that defines what is the normal activity for even our superwomen who are out to save the world. 2
The second major conceptual change relates to the realization that if we wish to increase the success of breastfeeding we need to build on and go beyond the care and support of the individual maternal–infant dyad based on the traditional doctor–patient relationship model. Yes, increasing our educational program through regional conferences worldwide in addition to our annual international meeting, publishing in multiple languages clinical protocols, and developing a certification process for physicians in breastfeeding medicine must continue and expand. However, if we conceive that breastfeeding and the feeding of human milk are public health issues, organizations such as the Academy of Breastfeeding Medicine must devote and focus no less a part of their efforts on assisting in creating environments that make it easier for mothers to breastfeed, be it the hospital setting or the workplace. Thus, our support for the Baby Friendly Hospital program. Similarly, our enthusiastic support for the recent decision of the Joint Commission to include exclusive breastfeeding rates as a Perinatal Core Measure. This decision highlights the acknowledgment that breastfeeding is the norm and that it is a measure of quality of hospital care and that in the end that by creating a supportive and noninterfering environment higher breastfeeding rates will ensue. Similarly, the passage of the labor regulation “The Patient Protection and Affordable Care” that mandates that employers provide both reasonable break time and physical facilities for employees to express milk or nurse during their workday is a measure of how one need not be an individual health professional to further encourage the success of breastfeeding.
So what is the message? It is clear that we both as individuals but surely as an organization have to function on both levels: The care of the individual mother–infant dyad and the support of organizational, public policy, and legislative actions that further establish and enhance an environment where in the words of the patriarch Jacob we can be worthy of “the blessing of the womb and the breast.” 3