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Advocacy Issues |
Breastfeeding and the Determinants of Health
from the OPHA Breastfeeding Workgroup
The Breastfeeding Promotion Workgroup of the Ontario Public Health Association (OPHA) seeks to provide leadership in strengthening public health practice by addressing the broad determinants of health as they relate to breastfeeding, thus contributing to equity in health for all.
The key determinants of health are those factors which have the most predictive effect on health outcomes for populations of people. Breastfeeding has been referred to as "a natural safety net" because of its mediating effect on the determinants of health. Breastfeeding helps reduce health inequities among population groups, as follows:
The Breastfeeding Promotion Workgroup applies the principles of population health, including the implementation of multiple strategies to act on the determinants of health, and evidence-informed best practice.
Best practice in breastfeeding is represented in the Global Strategy for Infant and Young Child Feeding (WHO/UNICEF, 2003), which emphasizes the critical importance of implementing the Baby-Friendly Initiative and the International Code of Marketing of Breastmilk Substitutes ("the Code") globally. Through our collective efforts may we achieve improved health for all.
Income and Social Status
Income and social status are considered the most influential determinants of health status. The many benefits of breastfeeding help to offset the negative impacts that poverty imposes on children and their families. More of the family’s income is available for other needs because infant nutrition is supplied at a low cost to the family.
Social Support Networks
Breastfeeding thrives with and also inspires social support networks. When group and peer supports for breastfeeding are improved, access to additional social supports for women is facilitated, thus benefiting other aspects of her health. Breastfeeding peer supports have been identified as effective mediating links between mothers in the community and health care professionals, which may be particularly beneficial for socially disadvantaged breastfeeding mothers (Dennis, 2002).
Education
A child's education is impacted by early childhood development and intelligence factors. These are directly correlated to the grade levels a child ultimately attains. Breastfeeding affects cognitive development (Angelsen, 2001). This is particularly true for preterm and small-for-gestational-age infants ((Lucas et al, 1992; Rao et al, 2002; Slykerman et al, 2005).
The population health strategies of the Baby-Friendly Initiative affect breastfeeding initiation and duration rates across all sectors of the population, including women at risk of not breastfeeding or at risk of not succeeding at breastfeeding. This helps to reduce the significance of the mother’s educational level as a predictive factor for her breastfeeding success.
Employment / Working Conditions
Better policies for breastfeeding can improve work environments and help to foster less stressful work environments for women and their families. Policies which incorporate provisions for pumping or feeding at the workplace, allow women to have more control over their work environment and the health of their children. Because breastfeeding prevents early childhood illness, workplace stress related to arranging care for ill children is reduced. The results of several studies have shown that providing a lactation program in the workplace saves companies money by decreasing absenteeism and increasing employee job satisfaction (Wyatt, 2002).
Social Environments
Human rights policy as it relates to breastfeeding in public is an example of a community providing social stability and acceptance for women, as well as a recognition of diversity. In turn, increased breastfeeding rates can improve the overall health of the community.
Physical Environments
Breastfeeding is an ecologically sound natural resource. It is a resource which can be crucial to the health of children during natural disasters and states of emergency when clean water is not available or when access to food is threatened or impaired. Breastfeeding does not contribute to environmental waste.
Personal Health Practices and Coping Skills
Because family poverty issues are ameliorated by breastfeeding, the potential effects of early socioeconomic hardship on later risks to health are lessened. It is also true that the activity of breastfeeding creates the capacity to rely on personal resources instead of depending on outside wealth and consumer products as a resource. In short, breastfeeding makes a mother feel capable. This message resonates with a mother herself but also to her other observing children, conveying to them that, “I can sustain my child this way and contribute to our family”. Breastfeeding helps a mother cope in a family crisis by providing an available food source. Many women will make healthier choices, such as quitting smoking or improving their nutrition, because they are breastfeeding.
Healthy Child Development
The effect of breastfeeding on attachment, nutrition and prevention of early childhood diseases, including obesity, is evident in the research. This decisively translates into a healthier early childhood development process. It is also not influenced by wealth, thus relieving another key determinant of health.
Biology and Genetic Endowment
Breastfeeding can ameliorate disease processes and potentials as in the case of early childhood diabetes and allergy conditions (Fewtrell, 2004). Breastfeeding helps protect women against diseases such as pre-menopausal breast cancer and ovarian cancer. (Tung et al, 2005; Zhang et al, 2004).
Health Services
Though health services and access to them can determine health, when breastfeeding is prevalent in populations families are less reliant on access to medical services for early childhood illnesses. This is because the need for medical intervention for common early childhood diseases is reduced. Medical and health care costs are reduced due to a healthier population. The Baby-Friendly Initiative is an evidence-based approach to maternity and community care which ensures that families receive the information, education and support they need to make informed decisions about infant feeding.
Gender
Measures to address gender inequality and gender bias within and beyond the health system will improve population health. Breastfeeding women become more self-reliant and valued as providers of nutrition for their families, increasing their perceived status. When public policy is congruent with this societal value, there are more public provisions for breastfeeding women, and more personal recognition for this status. Breastfeeding helps protect women from diseases such as pre-menopausal breast cancer, and can also provide natural child spacing.
Culture
Many women experience breastfeeding as the cultural norm in their country of origin, only to discover when they move to "developed" countries that breastfeeding is not the norm. Best practices in health environments can improve this by normalizing breastfeeding, thus shaping societal perceptions and attitudes.
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