Dr Jennifer James Breastfeeding Interview

Dr Jennifer James Breastfeeding Interview

Australia's poor breastfeeding rates have been highlighted in a report by the UN Committee on the Rights of the Child.

The low levels of breastfeeding was noted by the committee as a concern, with only about 15 per cent of Australian mothers exclusively breastfeeding until their child is six months old (as recommended by the World Health Organization).

The committee's recommendations included a review of Australia's Paid Parental Leave scheme to ensure it supports "exclusive breastfeeding for six months by working mothers".

Interview with Dr Jennifer James

RMIT University's Dr Jennifer James is an expert on breastfeeding and human lactation. Dr James is a Course Coordinator in the Discipline of Nursing and Midwifery at RMIT.

Question: Does Australia have one of the lowest breastfeeding rates, worldwide?

Dr Jennifer James: Australia has one of the highest initiation rates as more than 90% of women in Australia start breastfeeding but our duration rates are well below, for example, Scandinavian countries. Only about 15% of Australian mothers exclusively breastfed until their child is six months which is certainly much, much lower than countries like Sweden and Norway and well below the World Health Organizations recommendation of exclusive breastfeeding until six months old.


Question: Why do you believe Australia has such a low breastfeeding rate?

Dr Jennifer James: There are a number of reasons: One is that we don't recognise the challenges that women face when having their first baby, in particular that they're not well prepared for breastfeeding and that goes right back to children growing up in a culture that accepts bottle feeding as being normal and not breastfeeding as being normal.

In Scandinavian countries children grow up expecting to breastfeed their babies and they know that they will be well supported right across the culture including in workplaces and shopping centres because everyone accepts that women need that support in early parenting time to establish their breastfeeding. In Australia we are far away from that culture.

Health Professionals are not well educated on breastfeeding and particularly in General Practice, where a lot of women turn when they're having problems. A lot of General Practicians don't really understand the management or mechanism of breastfeeding which is why they tend to tell women to ween unnecessarily. An example is when a General Practician puts a mother on antibiotics and then tells the woman she cannot breastfeed whilst taking them which is far from evidence based.

Another issue surrounds medical management in labour and birth because babies are not going skin-to-skin with their mothers straight after birth which contributes to challenges for the baby who is really relying on the first couple of hours to learn how to latch and breastfeed. Often babies are not going to the breast for a while after birth and a whole lot of things have happened to them in the meantime including not being with their mums. We have an increase in caesarean sections which delays contact between mother and baby after birth.

Women are in hospital for a very short time and there is an enormous amount to learn and Midwives can only give so much in 48 hours which is the average time before a mother will go home, in the public system, these days. Staying in for eight days is not necessarily the answer but the difficulty is that first time mums will hit a whole lot of challenges in the first few days and they are probably getting ready to go home and their milk comes in as they walk in the front door; and they are not well-prepared to manage.

Once a mother is home they're amongst a culture that doesn't provide sufficient support. Often it's Mum and Dad at home, on their own, with the baby and they don't know what to do and they feel a bit desperate as the baby is screaming, mum is crying and Dad runs to the supermarket, in the wee hours of the morning, and grabs a tin of formula and that often signal the beginning of the end.


Question: Why is the low breastfeeding rates a major concern?

Dr Jennifer James: There are a whole lot of risks associated with not being breastfed surrounding health to the mother and baby. Breastfeeding is very protective as it protects the babies gut and increases their immune system. It can take a couple of years before the immature immune system of an infant begins to mature and babies who are bottle fed are at risk of a whole range of infectious diseases and when they do tend to get sick, they get sicker if they're not breastfed.

From the mums perspective breastfeeding protects against breast cancer, osteoporosis and lowers the risk of post-natal-haemorrhage immediately after birth; there is a whole range of protective effects of breastfeeding for the mum, herself.

There are significant health care costs when babies are breastfed.


Question: How does the nutrition value differ if an infant is fed formula instead of breast milk?

Dr Jennifer James: Formula only provides basic nutrition.

Breastfeeding has numerous advantages including teaching babies how to use their orofacial muscles for speech development and eye development. Bottle fed babies tend to be fed in the same position whereas breast fed babies get swapped from breast to breast which provides a different view and aids eye development and their eye muscles are far better utilised and much stronger. As well as using a different side of the body depending on which side of the mother they are feeding at.


Question: Do you believe infant formula is too easily accessible?

Dr Jennifer James: We should be making sure that women have support so they don't hit crisis that result in sending the father to the supermarket for formula.

In the past I have stated that I believe infant formula should be prescribed and what I meant by that was that Midwives, Maternal and Child Health Nurses, General Practicians and Lactation professions (whoever the woman is seeing in terms of a health professional) should be able to provide support so the mother doesn't have to hit crisis points. Women should be provided with troubleshooting tips and management plans put in place so the father doesn't have to go to the supermarket at 3am in the morning.

The cost to formula feed an infant from birth is between $1,500 and $2,000.


Question: How can Australia support breastfeeding?

Dr Jennifer James: The first thing we can do to encourage breastfeeding infants exclusively to six months of age is paid maternity leave for women, for six months. Babies need to be in close proximity to their mothers for the period of time we want them to be exclusively breastfed. Once they get to six months of age their mothers begin to introduce appropriate solid foods gradually and then they can have longer periods away from their babies. Ideally mothers could stagger their return to work in the second six month period such as returning to work part-time as well as working at home however it depends on the sort of work the women does. A professional woman has a whole lot of options as they could go back to work a little earlier but they have access to their babies and somewhere they can express and store their milk; these options are not as readily available to a blue-collar working woman.

We need to support all women if we want all babies to be breastfed optimally then we have to provide every opportunity to support them to do it successfully. If women have support in place they will often be able to go back to work, earlier than six months.


Interview by Brooke Hunter