The One Best Way?: Breastfeeding History, Politics, and Policy in Canada

9. Protecting, Promoting, and Supporting? 1990-2000

152 Chapter 9 Protecting, Promoting, and Supporting? 1990–2000 I n 1990, a journalist in the Vancouver Sun commented, “‘Breast is best.’ That’s the well-worn adage spouted by nearly everyone who knows about feeding Baby. What could be better than Mother Nature’s own elixir, custom made to nourish infants and packaged in portable and attractive containers ? No one has anything bad to say about breastfeeding. But actions speak louder than words” (Priest 1990, 1). During the 1990s, the federal government continued to recognize the value of breastfeeding through WHO/UNICEF agreements on breastfeeding and other international agreements to support the well-being of the child. These commitments resulted in pockets of money and resources being available to support breastfeeding initiatives throughout the 1990s. However, while the official commitment to promoting breastfeeding remained strong, the actual commitment of resources, attention, and advocacy paled in comparison to the campaign of the 1980s. Breastfeeding promotion strategies continued to focus on education regarding the benefits of breastfeeding, the effects of hospital practices, and the marketing practices of the formula industry. While on one hand, promotion efforts expanded to consider broader influences on breastfeeding practices by addressing attitudes towards breastfeeding in public, they also narrowed their focus by shifting to promoting breastfeeding in select target groups or mothers who were perceived as “high risk” for not breastfeeding. Without the implementation of the WHO Code, the marketing practices of the formula industry remained unregulated in the 1990s, while at the same time these became more aggressive as formula companies shifted to direct marketing to mothers as a strategy to increase their market share. As well, controversies over the acceptability of breastfeeding at work, the threatened closure of Canada’s last milk bank, and the use of vitamin D supplements suggested that a “culture of bottle-feeding” still predominated. And, the apparent universal agreement that breastfeeding was “the one best way” contrasted with the results of national surveys in 1994 which revealed that 153 Protecting, Promoting, and Supporting? 1990–2000 breastfeeding initiation rates had changed minimally since the last national survey in 1982. Protecting, Promoting, and Supporting In the early 1990s, the WHO and the United Nations Children’s Fund (UNICEF) coordinated a series of international meetings to support breastfeeding. In 1989, the WHO and UNICEF had issued a joint statement entitled “Ten Steps to Successful Breastfeeding” (the Ten Steps; see Table 9.1). This document listed ten practices and policies that hospitals should adopt to successfully encourage and support breastfeeding. In August 1990, UNICEF and the WHO, with the support of the United States Agency for International Development and the Swedish International Development Agency, sponsored a meeting of policy-makers entitled “Breastfeeding in the 1990s: A Global Initiative.” The meeting was held in a converted orphanage in Lo Spedale degli Innocenti in Florence, Italy, and included representatives from over forty countries (but not Canada). The statement emerging from the two-day meeting was entitled the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. The declaration reflected the content of the original background document prepared for the meeting and the views of the participants. The Ten Steps were one of the recommendations of the Innocenti Declaration , which also emphasized the global importance of breastfeeding and the responsibility of all governments to protect, promote, and support it: As a global goal for optimal maternal and child health and nutrition, all women should be enabled to practise exclusive breastfeeding and all infants should be fed exclusively on breast milk from birth to 4–6 months of age.…Attainment of this goal requires, in many countries, the reinforcement of a “breastfeeding culture” and its vigorous defence against incursions of a “bottle-feeding culture.” This requires commitment and advocacy for social mobilization, utilizing to the full the prestige and authority of acknowledged leaders of society in all walks of life. Efforts should be made to increase women’s confidence in their ability to breastfeed. Such empowerment involves the removal of constraints and influences that manipulate perceptions and behaviour towards breastfeeding, often by subtle and indirect means. (WHO and UNICEF 1990) The declaration also listed several goals that all member states were to accomplish by 1995, including appointing a national breastfeeding coordinator, establishing a multi-sectoral breastfeeding committee, and ensuring that all maternity facilities practise the Ten Steps to Successful Breastfeeding, uphold the WHO Code, and enact legislation to protect the 154 Chapter 9 breastfeeding...