From "concierge" services to iPads connecting new parents with their babies in the nursery, Kojo explores some of the patient-centered ideas coming from health care innovation labs at local hospitals.
Guest Host: Paul Brown
There are laws in 45 states affirming a woman’s right to breastfeed a baby in public. Yet stories abound of being denied that right — in retail stores, government buildings, and parks. We discuss the challenge of ‘normalizing’ breastfeeding in public.
- Sahira Long President, DC Breastfeeding Coalition; and Pediatrician, Children’s National Medical Center
MR. PAUL BROWNWelcome back to "The Kojo Nnamdi Show." I'm Paul Brown from NPR News sitting in for Kojo today. Breastfeeding, it's as old as humankind. Arguably one of the most natural things in the world, but natural and uncontroversial aren't the same. Regularly, stories hit the headlines as moms are asked to cover up or move to a private place instead of nursing in public.
MR. PAUL BROWNNurse-ins have been staged at malls and at government offices in response, and now two staples of American culture, Facebook and Sesame Street are under attack for their attitudes towards breastfeeding. So we thought we'd talk with a woman who's daily job includes trying to normalize the idea of nursing in public and in private. Sahira Long is a pediatrician at Children's National Medical Center, and she's also the president of the D.C. Breastfeeding Coalition. Sahira Long, welcome to "The Kojo Nnamdi Show."
DR. SAHIRA LONGThank you.
BROWNCan you tell me what you have been doing, and what your organization does every day in the community to help reintroduce breastfeeding into our community in a way that is socially acceptable to people, to sort of move the needle on this and just change the perception of the acceptability of breastfeeding in public places, or even in private places.
LONGSo the D.C. Breastfeeding Coalition has been in existence since about 2004, um, and our work is aimed at addressing some of the barriers to breastfeeding, and also helping to educate women about their rights to breastfeed, while providing them with information and support to make an informed decision about breastfeeding.
BROWNNow, to outsiders, you know, it might seem counterintuitive that breastfeeding would be unpopular in some poor neighborhoods, but I understand that it is. Can you tell us a little more about that and why that is the case?
LONGSure. One of the things that we did in 2008 and 2009 was to evaluate the breastfeeding friendliness of some of the maternity facilities in the city, and we just found that the rates of breastfeeding, and also the support for breastfeeding was most limited in Wards 7 and 8. And so one of the things that we've done to try to address that is to through a collaborative project with WIC and the D.C. Breastfeeding Coalition and Children's National, is to develop the Children's National East of the River Lactation Support Center. And through that, we've provided free breastfeeding education prenatally and also post-partum support to moms in that area of the city.
BROWNDo you know why breastfeeding is unpopular in those communities and not accepted? I mean, why would that be? I don't understand. What have you found out about it?
LONGWhat we've seen is -- I mean, it's generationally, that area of the city has -- the majority is African-American...
LONG...and nationally, as well as in D.C., we're no different than the nation. The rates of breastfeeding are lower in African-American, and also in women in impoverished cities.
BROWNWhat do we know about why that's the case?
LONGWhat we've seen is the culture in those areas tend to be less accepting of public breastfeeding.
LONGAnd so that tends to leads moms to be less willing to try it, and if they do try it then they're often ashamed to do it when they go out. I'll see moms in my health center which is in southeast, that will breastfeed fine at home, but the when they're out in public, and even in the health center where we definitely promote and support breastfeeding, they'll give bottles just because they don't want people looking at them funny, or they don't want, you know, people to say anything to them.
BROWNWhat are the advantages of breastfeeding?
LONGSo breastfeeding provides advantages for moms in that it decreases your post-partum bleeding or blood loss, and also decreases the risk of pre-menopausal breast and ovarian cancer.
LONGSo it helps mothers, and what does -- how -- what does it do for children?
LONGFor children it decreases lots of different infections, both ear infections, gastrointestinal infections, upper respiratory infections, it lowers your risk of sudden infant death syndrome, and also decreases children's risks of obesity and diabetes.
BROWNSo you see this as a really important thing to promote, to get breastfeeding back into an acceptable place in society on an everyday basis?
LONGI do. Breastfeeding is the only thing that you can do in infancy that confers a lifetime of health benefits.
BROWNMm-hmm. What do you tell young mothers in communities in particular where it's not accepted? How do you help them make that change to make the transition to accepting this themselves, and being willing to breastfeed in public?
LONGOne of the things I do is try to share with moms the risks of not breastfeeding. A lot of moms think, you know, it's okay because I was breastfed, and they don't really know that there are risks associated with not breastfeeding, which include the health risk that you're not protecting your child against by doing something else. And then I also try to remove some of the stigmas and myths around breastfeeding.
LONGA lot of women think if they don't eat a healthy diet that they shouldn't breastfeed or, you know, another myth that I address often is if they smoke tobacco products that they can't breastfeed. And while we don't encourage smoking in any woman, we definitely see tobacco smoking as a reason that you cannot breastfeed.
BROWNIf you're listening now, do you feel uncomfortable, embarrassed if you see a woman nursing in public, and if so, what is it that bothers you, or if you're a parent, if you're a mom, how have public attitudes affected your decision to breastfeed or not. We'd love to hear from you. Here's the number to call, 800-433-8850. That's 800-433-8850. And let's go to the phones now. Emmanuel is on the line. Emmanuel, how are you?
EMMANUELGood afternoon. I'm very well, thank you.
BROWNGood, what's on your mind?
EMMANUELI am a little bit amazed at the idea that people would be embarrassed to do breastfeeding in public.
BROWNWhy are you amazed? Why are you surprised?
EMMANUELWhen you look on tellies and even in real life, the number of people who are willing to go naked for a brief moment in fame on a TV, it's astounding. So which is more, uh, embarrassing, being naked or, you know, feeding a baby in public?
BROWNSahira, do you have a response to that?
LONGI completely agree. I mean...
LONG...when mothers nurse discreetly, you actually see less breast than you see on Victoria's Secret commercials. So it's, you know, breasts doing one of the jobs that God intended them to do is a problem, but breasts for a sexual gratification, people don't raise their arms at all. So it's interesting, the breasts in the United States have become so sexualized that when they're thought to be doing something other than that, people get a little up in arms about it.
BROWNIt would seem that it might be difficult to communicate the need for change to people in public places, schools, government buildings, corporations, employers, how do you reach out to people in those settings to encourage them the not only be more accepting of breastfeeding, but perhaps even provide locations for mothers to breastfeed.
LONGWell, actually one of the things that the Coalition does is an annual recognition program for employers that do such, as you just said. We started it as a party of a business case for breastfeeding that we got through HRSA with the Maryland Breastfeeding Coalition and we, you know, had criteria that we look for employers to meet, and we asked that they nominate themselves, or that the employees nominate them for the job that they're doing, and we hope that by showcasing the ones that are a doing a good job, that'll inspire others to take what isn't really a great deal of effort to support women in their workplaces.
LONGAnd then as far as government agencies, this is near and dear to heart because of some of the issues that we've seen in D.C. recently with the mom at the Department of Motor Vehicles.
BROWNTell me that story, as a matter of fact. I understand that there is a young woman who had her child at the Department of Motor Vehicles' office and was told that she could not breastfeed there and she's filing a complaint.
LONGYes. She was told that she couldn't breastfeed in the -- well, this is her version of the story, of course. She was told that she couldn't nurse in a public corridor of a government agency, and that's actually a violation of the D.C. Child Right to Nurse Law that went into effect in 2007. So one of the things that the coalition has ventured to do as a result of this and other incidents, is, you know, partner with Councilman Graham's office to see if there are ways that we can help to educate not just the public, but folks that work for D.C. in the government agencies where these moms are being told...
BROWNWell, you know, I understand the person you're talking about has called in, and let's see if she's here. Simone, are you here?
SIMONEYes, I'm here.
BROWNThanks very much for calling in and being with us.
BROWNTell us what happened to you and what you're trying to do to change the situation?
SIMONEWell, it's essentially what Dr. Long said. I was at the DMV contesting a ticket, and I was in the main waiting room, and decided to go out into the hall to breastfeed my child, and I was leaning up against the wall, and then sat on the floor to breastfeed. And at the end of the day, I was told that I was not allowed to breastfeed in the, quote, "public corridor of a government building because it was indecent exposure."
SIMONEThat's essentially what happened. And it was the -- the funny thing is I was kind of okay up until the point I was told it was indecent exposure, and at that point was when I was incredulous and said, you've got to be kidding me. I was not aware at that time that there was a law, but instinctively it seemed wrong, and I later did find out, after speaking with my doula and some other people, that there was a law. I then filed a complaint with the D.C. Office of Human Rights.
BROWNAnd where is that complaint now? What's the status?
SIMONEThe complaint has followed the normal process. This incident occurred on a Wednesday, and I followed the complaint on a Friday, I think it was the end of November. And the first of January, I had an intake appointment where the person at the D.C. Office of Human Rights determined that there was enough -- there were enough facts alleged to form a complaint, so she wrote the complaint up.
SIMONEIt was served on the respondents, which is the D.C.'s Department of General Services, and I received an email yesterday that the matter will be set for mediation in early February.
BROWNWhat do you hope to gain from this and what do you hope to gain for your community?
SIMONEI hope that people will take a mother's right to breastfeed seriously, and that other women will not be intimidated in these circumstances where they're, you know, dealing with a hungry child and want to breastfeed, but don't feel that they can. I've been struck since this has happened by a number of my peers who seem to be, you know, confident, you know, self-assured women, who have said to me, gosh, I'm so happy you said something or did something, because if that had happened to me, I don't know what I would have done.
SIMONEI would have just stopped, you know, in the middle of everything. I never would have challenged it. And that's striking. So I hope that more women will feel empowered to breastfeed. I hope especially that D.C. government and the people that they contract will recognize a mother's right to breastfeed, and will not make them feel uncomfortable or say things to them that put them off from exercising what is their right. That's basically what I hope to gain from this.
BROWNWell, thanks for calling in and sharing your story with us. It's a very moving story, and we appreciate you taking the time to be with us. Let's go to the phones and speak with Irene in College Park, Md. Irene?
BROWNHow are you? What can you tell us? What's on your mind?
IRENEWell, I just wanted to say, I work in a shopping mall, and most of the time, the women I've seen who are feeding their babies, sometimes like sitting in the food area or on the benches or something. It's not too often, but most of them take such care to cover up, unless you really know, it's always strange to me when people make comments, because you don't even realize what's going on sometimes and, you know, what they're doing. And then working in a shopping mall, it always incited me when people -- when she said, like indecent exposure.
IRENEI see more skin on more women walking around in their day-to-day clothes then I've ever seen on a nursing mother. So that always just seems odd to me. And I always found when I was -- when my child was that age and I was feeding her, I always got more criticism from women than I did men about it which I always just found interesting.
BROWNThanks very much for your call, Irene. I want to hear from Anne in Vienna, Va., who's a nurse practitioner. Anne, welcome to "The Kojo Nnamdi Show."
ANNEYes, hi. I'm a nurse practitioner and I worked in a pediatric practice for a long time with a very large population of women from Latin America...
ANNE...who had been recently immigrating here, and it was very interesting that to a person they were always breastfeeding the very first child they had, and then almost all of them by the second child started bottle feeding instead, and I think their perception was that in America, you bottle feed. So very interesting of dynamic in their culture.
BROWNAnd have you worked to persuade people that that's not necessarily the way it is?
ANNEI did my best, and I, you know, it was very interesting because a lot of them even just left the babies in the car carriers and would prop the bottle which, again deprives them of that human contact.
ANNEThat's so important as well as part of the breastfeeding. So that was one of the big parts of our program was to try to get them to keep breastfeeding no matter way.
BROWNYeah. Well, thank you very much, Anne. We appreciate your calling in. We have an email from Ellen saying, "I work at an historic site in the area that includes a house and large grounds. We have a no food in the house policy, no food means no food. Please ask the speaker to address this issue. We've had more than one mother walk through the house while feeding her baby." So Sahira Long, what do you have to say about that?
LONGDoes the same policy apply to formula-fed babies? I mean, it's different if you're speaking about a baby whose food is contained, it won't drop anywhere.
BROWNWell, what we understand from this is no food, and the writer says, "It's certainly okay for a mother to breastfeed in public, but not in an historic home. There are plenty of places to sit outside or walk around outside and feed the baby before coming into the house." What about -- what do you say to that?
LONGAs long as the same policy applies to bottle-fed babies and it's enforced, then, you know, if it's no food at all, that's different. But if it's just you can't breastfeed, that's discrimination.
BROWNMm-hmm. Do you think that there are any places that are inappropriate for people to breastfeed?
LONGWell, in D.C., and a lot of states across the nation, a mom has a right to breastfeed wherever she has a right herself to be. So if it's right for the mom to be there, and it's right for her to have her child there, then I feel if the child is hungry, they should be fed.
BROWNAs long as it's legal, basically, as long as it's allowed.
BROWNYeah. And you're going to continue your work, I take it. Do you feel you've made some progress?
LONGI think we have. I mean, we've watched the rates of breastfeeding that are put out from the CDC every year gradually trend up towards where the benchmarks are for the nation. We haven't met the Healthy People 2020 goals, but we're not in Healthy People 2020 yet, so hopefully by 2020, we'll see D.C. as one of the places that actually made the target.
BROWNWell, thank you very much, Sahira Long, for joining us. Pediatrician at the Children's National Medical Center, the president of the D.C. Breastfeed Coalition. Very interesting conversation. Thanks listeners for calling in. Thanks to our "Kojo Nnamdi Show" team for production of this program. I'm Paul Brown from NPR News sitting in for Kojo on "The Kojo Nnamdi Show" from WAMU 88.5
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