Multicolored topic - Feeding the baby / Infant feeding

One of the best parts about being pregnant elsewhere than in your birth country is the possibility to learn several sides of the same matter.  One of the topics, which seems to have many faces is feeding the baby.

As I have had the time in my hands during my past weeks bed/couch rest period, I have observed the discussion forums of expectant mothers and mothers, who have a baby/babies. My observations have been mainly in discussion forums in US and Finland, but parallel I took a peak also to the Swedish and German ones. It inspired me though to get deeper and learn more about also the history of infant feeding.

I am fully aware that this topic is sensitive for many, for different reasons, thus I hope to be able to share my findings rather from "curious mind wants to know" perspective than anything else. Before looking how things are now, one should go back and try to gain a glimpse of the history.
As in everything, I think that in order to know where you are now or heading to, one should know
where you are coming from.

A snapshot of the history:
Finland and US have had very different approaches to this area, which makes the topic even more interesting to look at it from both countries' perspective. My curious mind is already tingling out of joy!

The changes in society have been the triggers to change habits around infant feeding. Thus I limit my snapshot mainly to the era when industrialization started to take its foothold.

US was big step ahead in the industrialization, which drove changes to infant feeding as well.
Through the 1800s most mothers breastfed their children. In the cases, where it was not possible or the mother died during labor, wet nursing was used as an alternative. In South, during the years of slavery, slave women were used as wet nurses. When all else was out of the question artificial aka home grown infant feeding methods were used. This meant animal milk, broth, tea, bread soaked in water or animal milk. Feeding bottles made of glass, tin or other metal were used for this. Sometimes adult food was mashed to feed the child. Basically anything was tried to keep the baby alive.

It was mainly due to vanity, wealth or pressure from the husband's side during this era that small number of women would breast feed only a very limited time or refuse totally to breast feed and use e.g. wet nurse to feed the child.

Apart from industrialization having taken a leap, hospitalization of child birth and the increase of pediatrician practice brought the interest to develop a better alternative than the previously mentioned artificial feeding methods. One of the reasons behind was the concern for infant mortality. Around mid 1800 those concerns linked to invention of rubber nipple & baby bottle gave enough ground to start the research and hunt for a baby formula. From 1910 onwards the market for baby formula grew steadily.

A Boston study from 1911 showed that 20% of bottle fed babies died before reaching the age of one. Where as for breast fed children the rate was 3% in comparison.

During this time also milk stations were established for proving clean milk for urban consumption, milk pasteurization launched and other activities to reduce any risk of bacteria. At this time also the human milk banks, which are in use still today, were established. Places were mothers could go and bump their excess milk to help other mothers in the need of milk for their infants.

Parallel the development of baby formula was brought to new heights with the use of evaporated baby milk formulas from 1910 onwards.

As per the data I was able to gather online, by 1950 baby formula was the primary choice for infant feeding. So, in relatively short period of time, a drastic change took place: over 50% of the babies in US were now fed by commercialized baby formula. At the same time urbanization shifted yet another gear for women, moving them from homes and kitchens to public and work life. Leading to even further reduction of breast feeding. By 1970 only 25% women were breast feeding their babies, and of those only 20% continued beyond 6 months.

Meanwhile in Finland from early till mid 1900s the impacts of industrialization were still minor, majority of the population's income was still linked to farming and agriculture. Also the attempts to have all kinds of "home grown" baby formula had resulted to the formula fed babies risk of dying being 3 times higher than breastfed babies during early 1900s.
In 1936 our legendary pioneer of childrens' pediatrician, Arvo Ylppö, was big promoter of breastfeeding. He helped to bring mother milk centers to Finland for sick or prematurely born babies.
The first commercial baby formula entered the Finnish market only in 1956.

Industrialization and urbanization reached Finland during 1960s, including hospitals taking bigger role in child birth. Instead of giving birth in the sauna, women moved to give birth in hospitals. Industrialization had also the side effects to women and infant feeding following the schedules and rules of the changed society. Women entering work life and having insufficient break from work to care for the baby (from breast feeding perspective).

With those changes came the change to recommendation around the length and schedules of infant feeding. Instead of following the child's needs one tried to force the feeding to take place only 5-6 times a day. Which we know today, leads to very unpleasant (or even painful) experience to the mother and reduces the milk amount. Another recommendation at the time was to reduce the duration of breastfeeding. Where it had previously been 1-2 years, it was changed to 3 months. Lot of pressure and rules to the new mothers. Baby formula was still seen as a secondary option and aid in the panic of trying to comply with all the rules enforced to new mothers. As well as trying to keep the child fed with the reduced amounts of breast milk (which was mainly due to trying to comply with the limited feeding times).

What happened in Finland though during 1970s was exactly the opposite. Awareness had reached the population about the benefits of breastfeeding vs formula feeding. Unethical marketing of baby formula got consumers to boycott the products. Suddenly the direction was exactly the opposite than a decade before. Women started to demand to get "back to the roots", more natural birthing style and nursing & caring the babies by themselves in their room from birth onwards. This lead steadily to increasing the recommendation of the infant feeding time, which rose back to 1-2 years.

"Back to breast feeding" occurrence was seen in US during 1980s. Women were encouraged to go after more independence and self-fullfilment through better education. As well as going out to the market place, after the available jobs instead of housewifery. Yet importance of breast feeding was emphasized at the same. This lead to breast feeding reaching as a high as 52% by 1990. This was a major win also for La Leche League, which had since 1956 tried to raise the awareness of breast feeding and supported the mothers in learning the art of breast feeding.
Today the organization is international. Funny enough, they are active through the Nordic countries, except Finland. More about the history of La Leche League: LINK.

What was based on my findings, one major difference between the two countries, was that in US women breast feeding their children stayed as an encouragement. How the women were supposed to take care of it was left on their own devices and often times under lot of pressure as well. Not all women had either means to understand the concrete health benefits breastfeeding vs baby formula, nor the support available. Which has resulted partially to baby formula staying for many as primary choice and the general attitude has been that baby formula is normal.
When in 1800 wealth resulted to some women refusing from breast feeding, this has changed during the years to wealth (and proper employer support) enabling to breast feed. Lower income mothers are not standing on the same line, unfortunately.

Where as in Finland, from the baby steps from 1917 the major breakthrough was during 1970. Having the Employment contract act including already 105 days of maternity leave, linked to maternity allowance for the same period of time.  Since then the development has only been positive resulting to additional nursing & parental leave, and later on to additional paternity leave. All these are protected leaves and as part of the legislation. Mothers and families have been given not only the encouragement to care for their child but also the legal support to do so. At the same removing the possible impact of education / income level / employer to that decision.

Where are we now?
In my view....if we could combine the best of both countries, world would be wonderful. Below is the summary based on my personal observation and gathering data available. About 70% of all mothers breast feed their child in US but only 49% continued to breast feed till 6 months and even less, 27% continued to feed till child was 12 months old.

Finland lies bit higher in the percentages, yet it has the lowest rank within the Nordics. Thus campaigns have been launched to change the trend. 92% of the new mothers have started breast feeding but for one reason or another the percentage decreases from there. Leading to children at the age of 4 months 68% being breast fed,  23% fully breast fed (without partial solid food of formula to support). At the age of one year only 1/3 of the children were still breast fed.

Let us start with the view of legislative support perspective:
As of the 2014 report by the International Labor Organization, two countries where parental leave is not a legal right is Papua New Guinea and US. Apart from that there are only 3 countries in the world, where paid maternity leave is not supported in an organized way. Yes, the two already mentioned countries make to that list too on top of Suriname.

In US the lack of legislative maternity/parental and nursing leave means for many families either no paid leave or paid leave, which is max 6 weeks.
In past years more noise has been made about US being the only civilized country without a proper maternity & nursing leave, protecting the mother's employment. Some companies have responded but each in their own way. The maximum paid leave in majority of companies with "great benefits" is 3 months. Netflix recently made a bold move to offer women in total 26 weeks of paid maternity leave (combination of medical and parental leave). Netflix made a good opening but until parental leaves are standardized legal right, many hesitate to take them. It is not in all companies that those leaves equal to protected leave. Not to mention the space for social pressure.

The lack of standardized approach to support possibility to nurse the baby or lack of legal rights in this matter puts many mothers to be responsible alone for the decision, whether to start breast feeding at all and if yes, what to do after you go back to work? For the lower income families staying away from work as short as possible and using formula is lesser "evil" than taking extended leave and then trying to pump during the lunch break at work. Since pumping during work hours may be seen negatively.

In the bigger organizations, who also care for their public image, one can have access to a luxurious "pumping room". Where mothers can go pump the excess milk and store it in the fridge. Obama care has also brought the breast bump to the reach of all mothers. Which is another positive step to the right direction.

Meanwhile in Finland, mothers enjoy as legal right the paid maternity leave 105 days, after which they or the father can take parenting leave of 158 days. On top of that a parent (mother or father) of a child under 3 years can stay home on an unpaid leave to take care of the child, i.e. care taking leave. On top of this the father has possibility to take 9 weeks of paternity leave. For the parts, which are unpaid by employer, the social security allowances kick in. The allowances are only partial compared to the fully paid leaves, but give still support to take the time off from work to care for the child.

So, I would throw into "my dream solution basket" the Finnish legal rights and Obama care. Just because I think it is a great idea to allow mothers to have a proper breast bump, regardless whether they stay home caring for the child or return to the office. On top of that I would include the Finnish Baby Box availability to all mothers.

What about the social attitude?
The generation X and Y are now the ones giving birth. The history snapshot helps to understand the somewhat different starting point to the generations in both countries towards breast feeding and baby formula.

In Finland breast feeding is considered by majority still the primary choice. The current generations of mothers were mainly breast fed as a child.
It is also considered as natural as ....going to sauna naked or eating. You will see more motbers breast feeding in public and no reactions are present. Cause breast feeding is not linked to sexuality, it is commonly understood to be the lifeline of an infant. I think also thanks to the Finnish sauna culture there is less fuss about seeing a breast in baby's mouth, as all of us have seen our mothers naked.

During the 1970s breast feeding was taken to a different level and women were proud of it, not hiding it. Thus everyone has seen for a long while already mothers breast feeding a baby.
So, the level of social acceptance is higher and level of shame is lower. Good amount of mothers do not feel the need today to use any kind of blanket covering while breast feeding.

An example from my observations: a mother can ride in a public transport vehicle (metro, subway, bus, etc.) and breast feed the child openly without any reaction from anyone. If the child is not done with eating by the time the stop for getting off arrives, the mother continues feeding while exiting and people around normally offer to help to get the baby stroller etc. carried out. Because everyone understands how important it is for the baby to be fed.

In US the majority of people are not there yet. Feeling of embarrassment and being socially isolated shadows still breast feeding. In some cases expectations are there for the mother to go behind closed doors to breast feed, even within the family or relatives. Breast feeding is linked to sexuality for some reason, instead of seeing it as the crucial lifeline for the baby. Thus it has been considered to be shameful and inappropriate to breast feed, unless behind closed doors. In some areas of the country one has been able to move from behind the closed doors or using public restrooms to covering the baby with a blanket (which is not always preferred by the baby, especially in a hot climate).
Lately more and more media attention has been made by celebrity mothers and their urge to breast feed in public. Laws have been also passed in many states to allow mothers to breast feed in public.
All this is seen positive by many women but it will require more acceptance from the mainstream to get the attitude adjustment. As it seems based on the community discussions, mothers are on it :) They are out and about, they are feeding, in increasing numbers and their husbands are supporting them :)

Meanwhile in Finland...I have noticed the high independence level of Finnish women is showing few new rising trends. Mothers wanting to make their own decisions, which in some cases decrease the dependency between the child and the mother but lead to more freedom of the mother. Formula is seen as  some level of ease as well, the mother not being only food source to the baby.

Yet, it seems that majority of people consider still breast feeding the primary choice and baby formula being the aid, when the first mentioned fails. Which may be a rising trend for the current generations, cause we have grown in a more ready made world compared to our mothers and grand-mothers. The tolerance towards the time span to make things work is shorter and perhaps expectations "mother nature" taking care of it all are causing part of the pain. As the reality is...one needs to learn it and prepare for breast feeding prior giving birth. It also takes a lot of time during the first months. The patience to wait till one starts feeding solid food to the child seems to have decreased lately. Rush and feeling the need to have freedom / independency is slowly creeping to the relationship between the mother and infant.

Lot of "mental beating" is done by the mothers themselves while going through the battle. Often feeling alone in all this. The pressure set by the society is also still there. In many families two previous generations of women were driven by urge to breast feed.

What I am aware of, less marketing is done currently in Finland vs US about the research results between the two approaches. Were as in US it is made more clear in all kind of marketing material, which starts flooding the mail box as soon as one has recorded to be an expectant mother, that there are studies which show link between baby formula feeding and obesity and/or diabetes.

What is also a great plus in US is the organized lactation consultant support. As an example my health insurance covers 6 sessions with a lactation consultant. The role of this person is to help the mother to learn immediately after the child is born the right techniques and support in learning the art of breast feeding. In Houston such resources are available as part of the hospital staff at many birthing hospitals.
One has understood here longer ago that as much as we want it to work like magic taken care by mother nature...well, it does not unless you learn it. Education material is available by so many sources & media to understand the ins and the outs of breastfeeding prior to giving birth. Which helps to set the expectations right and reduce the mental stress (which impacts in a negative way to the whole).

So, to "my dream solution basket" I would take the Finnish social acceptance of breast feeding, whether in public or with the family & relatives. Taking off the unnecessary pressure from the fresh mother (they have enough other pressure to deal with).
If one would look around and pay attention, in comparison one gets to see more breast exposure in advertisements, commercials, beach and movies. Or in a Finnish sauna :)
The little slice of skin that one may see while a mother breast feeds the child (when the baby is covering most of the breast with his/her mouth) is not much to get upset about or if so, then men should not walk around without t-shirt. Cause they are really showing it all, aren't they? :) The very same body part, the only difference is that theirs aren't full of milk.

At the same I would add to "my dream solution basket" the social acceptance to allow the mother to choose which ever feeding form they decide for, whether breast feeding or baby formula. But allow them to have US way easy access to objective research results of educating themselves properly. This leads to them making an educated decision.
As a side bonus I would add more efforts in giving the mothers a standard access to professional lactation consultants and variety of material about breast feeding, starting prior to giving birth and continuing after they are home. This regardless of their income level or insurance type. This way they are not left on their own to try out breast feeding. This would increase the amount of women getting off to a good start and having a positive experience, instead of being left alone to figure it out. That often leads to pain, fear, panic and at the end in many cases; changing to baby formula.

I hope that an organization like La Leche League would be established in Finland too. Again not to leave the mothers alone with the attempts of trying to get the hang of the art of breast feeding. La Leche League appears to be a very active organization, present where the mothers are. Organizing breast feeding meet ups and other events, on top of providing material and support in various forms.

It has been really interesting to realize that simple thing like this has had a very different history in different countries. Thus one cannot take it for granted to understand why and how things work, unless one goes back to the roots.

I have tried to bring the various aspects in but am welcoming comments and stories of your own experience, if you want to share some. 
Thanks in any case for your interest to even read the result of my curious mind journey.

For those interested in more:
Once you start browsing through the colorful history of infant feeding...you will be awed!
Below some of best information sources from all the data I went through:
LINK to Wikipedia's snapshot of breastfeeding,
LINK to history of infant feeding (providing broader view)
LINK to history of infant feeding in US
LINK to breastfeeding history in Finland (in Finnish)
LINK to Barriers to breastfeeding in US
LINK to CNN article "Why we are still so squeamish about breast feeding?"