This observation is confirmed by a 2009 study from Stanford University School of Medicine, California, which found that “pump suction alone often fails to remove a significant fraction of milk as more can be expressed using manual techniques”. So pumping needs to be done in combination with hand massage techniques - something few women are aware of.
Barriers to breastfeeding
New Zealand's National Breastfeeding Advisory Committee (NBAC) in its 2008-2012 national plan for breastfeeding detailed a list of 13 social and environmental barriers to breastfeeding. These included the perception that artificial feeding enhances the father’s opportunities to bond with the infant; attitudes that make breastfeeding embarrassing or uncomfortable for the woman; a culture that portrays bottle feeding as normal; and returning to work.
The World Health Organization (WHO) says that “virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large”.
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These sentiments are reinforced by the pro-formula backlash, for example the book Bottle Babies by Adelia Ferguson (1998), which catalogues letters from bottle feeding mums - many of which are a testament to a fundamental lack of support around their breastfeeding experiences.
In 2008, the UK's Scientific Advisory Committee on Nutrition said of the latest Infant Feeding Survey in 2005 that “The reasons mothers gave for abandoning breastfeeding suggest that relatively few mothers truly chose not to breastfeed ... Most women ... stop because they encounter problems and find that skilled support is not readily available.”
In recognition of this, CBAS provides not just information about breastfeeding but practical support in the form of networks between health care professionals, local groups and mothers. Commenting on needs at a national level in New Zealand, outgoing LLLNZ Director Barbara Sturmfels, says: “Legislative changes to improve conditions for breastfeeding mothers in the paid workforce, a public advertising campaign to promote breastfeeding in public, and support for the implementation of UNICEF’s Baby Friendly Initiative in New Zealand are some of the ways that the government is seeking improvements in breastfeeding rates through institutional and societal change.”
WHO recommends that infants be exclusively breastfed for the first six months and for breastfeeding to continue “up to two years of age or beyond”.
New Zealand's breastfeeding rates compare favourably with other developed nations. Different countries measure the rates in different ways and for different years, but for a broad comparison, rates for exclusive breastfeeding are: New Zealand 2008 16 per cent at eight months; Canada 2008 14.4 per cent at six months, Australia 2007 14 per cent at six months, USA 2006 13.6 per cent at six months, UK 2005 less than 1 per cent at six months.
However seen globally it is clear the impact Western values may have on breastfeeding. The top five countries for exclusive breastfeeding at six months (Unicef 2008) are Rwanda 88 per cent, Kiribati 80 per cent, Sri Lanka 76 per cent, Solomon Islands 74 per cent, and Peru 69 per cent. At aged 20-23 months, Sri Lanka, Burkina Faso, Ethiopia, Bangladesh and Nepal all had breastfeeding rates of over 80 per cent, with Nepal at 95 per cent.
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In New Zealand, rates for Māori and young mothers are much lower than average. As Glover et al explain in Māori Women and Breasfeeding (2008) “Beliefs and practices introduced to Māori by European immigrants to New Zealand have supplanted Māori infant feeding practices”.
Christchurch is fortunate in having the Young Parents' Breastfeeding Group Whāngai U “Mātua Puhōu”. Headed by public health advocate and breastfeeding peer counselling administrator Susan Procter, the group has more than 20 regular members and meets regularly to support breastfeeding families where the mother is aged under 25.
Breastfeeding as patriarchy
A further irony of the breastfeeding debate is that when a mother does successfully breastfeed, she is likely to be censured if she continues past an arbitrary cut off point of a few weeks or months.
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