News

Breastfeeding: The Healthy Important Option - Speech to the 'Hot Milk' Conference by Chair of AMA Public Health Committee, Dr John Gullotta

Good morning, ladies and gentlemen, mums, children & babies.

I would like to thank the organisers for the invitation to speak at this important Conference in this important week - World Breastfeeding Week.

My thanks to the President of the Australian Breastfeeding Association (ABA), Margaret Grove, and the Board.

I would like to acknowledge the Founding Mothers of the Nursing Mothers Association of Australia with us today.

I would like to also acknowledge the traditional owners of this land the Wurundjeri People.

It is an honour for the AMA to be able to share its view with you on the major health issue of breastfeeding.

I am a GP and am well acquainted with the health concerns my patients have around breastfeeding.

I am not a mum but I was breastfed, and I am so busy with AMA work that I am not a dad … yet!

But, more importantly, I am in a position to educate and share my knowledge of the benefits of breastfeeding - for mother and child.

Breastfeeding is a normal practice and it is very important!

On behalf of the AMA, though, I have a confession to make.

As arguably Australia's leading health advocacy organisation, we are a bit light on as regards a formal policy position on breastfeeding.

We have a brief mention in our policy book - but it is, quite literally, a motherhood statement.

Let me read it to you.

Doctors should encourage the establishment and maintenance of breastfeeding.

The AMA supports breastfeeding because of its beneficial effects on an infant's nutritional, immunological and psychological development and because of the bonding promoted between mother and child.

Doctors have a role in ensuring that all pregnant women and their partners receive sufficient information to enable them to make an informed decision on the way to feed their infant.

Any mother experiencing difficulty in breastfeeding should, if the mother's doctor does not have the necessary expertise, be offered referral to practitioners or agencies with special expertise.

Doctors and all other health care professions should be responsive to the concerns and needs of those mothers who, for a variety of reasons do not breastfeed and ensure they are supported in their decision and are not, in any way, discriminated against.

It is a statement full of good intent, but not far-reaching enough for the contemporary environment.

I can tell you today that an updated and expanded AMA policy is on its way.

As the new Chair of the AMA Public Health Committee, I promise you that 100 per cent - and also that we will produce it together with the ABA.

As doctors, we know that breastfeeding is good for the health of mothers and infants.

But, sadly, the broader population has not adopted breastfeeding in the modern age as enthusiastically as other nations or, indeed, previous generations.

Breastfeeding rates in Australia are poor.

As a community we have to get those rates much higher.

Doctors are part of the solution, but we need to do more.

I believe we can do a better job at supporting women, families, and the community to achieve better breastfeeding rates.

So I attend this Conference today not to preach, but to learn.

The medical profession can gain plenty by taking on board the collective wisdom in this room today.

As we heard last night, there is over 500 years of collective experience and wisdom in this room today.

If we are to educate mothers and partners about the health benefits of breastfeeding, we are going to have to give them the facts and plenty of evidence.

While many would like to breastfeed their children, and do so for as long as possible, the fact is that modern society and family pressures provide disincentives.

We have to accentuate the positives.

Evidence

The health evidence is all there.

When I say benefits, I mean improved health outcomes for mother and infant.

The National Health and Medical Research Council says the health benefits of breastfeeding for infants and their mothers include:

  • reduced incidence and duration of diarrhoeal disease
  • protection against respiratory infection
  • reduced prevalence of asthma
  • reduced occurrence of otitis media and recurrent otitis media
  • possible protection against neonatal necrotising enterocolitis, bacteraemia, meningitis, botulism and urinary tract infection
  • possible reduced risk of auto-immune disease, such as type 1 diabetes and inflammatory bowel disease
  • reduced risk of developing cow's milk allergy
  • possible reduced risk of adiposity later in childhood
  • improved visual acuity and psychomotor development, which may be caused by polyunsaturated fatty acids in the milk
  • higher IQ scores, which may by the result of factors present in the milk of breast stimulation
  • and reduced malocclusion as a result of better jaw development

Without explaining all those big words, I'm saying that breastfeeding is good for the baby - in both the short and the long term.

Breastfeeding also has benefits for mum, including:

  • decreased risks for some cancers, such as breast and ovarian
  • decreased risk of osteoporosis
  • promotion of maternal recovery from childbirth
  • and creation of a supportive environment for mother and child bonding

You cannot underestimate the importance of that last point - the bonding between mother and child.

So how long does the breastfeeding experience last?

The most recent national data on breastfeeding rates from the 1995 National Nutrition Survey tells us that 81 per cent of infants were breastfed on hospital discharge.

However, this dropped to 57 per cent for infants exclusively breastfed to three months. That's a big drop.

But the figure the falls even more dramatically - down to 18 per cent achieving exclusive breastfeeding to six months. That's a huge drop.

With that low figure, our challenge is clear and confronting.

The National Health and Medical Research Council has set a goal of 80 per cent exclusively breastfed to six months.

Australia has a fair way to go to reach optimum breastfeeding levels and the health benefits associated with that target.

We must also be aware of other factors that may influence a woman's ability or capacity to continue breastfeeding.

Things like education, housing, occupation, work, income, and social environment impact either positively or negatively on their decision.

A woman who is disadvantaged in these areas may have greater difficulty in maintaining breastfeeding and will need greater support.

The Role of Doctors

So, where do we come into the equation?

All doctors, but GPs in particular, are well placed to provide support and advice on breastfeeding for women and their families.

Even GPs like me - male, single and with no children yet.

Doctors care for women before, during, and after their pregnancies.

We also care for their babies and their children, throughout the life cycle.

We can provide direct support and advice, and we can refer women to specialised support services such as ABA ones, if they are required.

And the AMA will be doing all it can to help doctors perform this important role.

The Way Ahead

As I said earlier, we are updating our breastfeeding policy and promoting it to governments, the medical profession, and the community.

Along with other groups, including yours, the AMA made a submission to the House of Representatives Inquiry into the benefits of breastfeeding.

Other submissions and the Inquiry's final report will inform our new policy.

But improving rates of initiation and duration of breastfeeding will require a multifaceted, whole of community approach.

We must look at issues such as the marketing of breast milk substitutes, breast milk banks, workplace provisions and other initiatives that will increase breastfeeding rates.

We must look, too, at initiatives that encourage breastfeeding.

Things like:

  • the partner's preference for breastfeeding and the partner's occupation
  • decisions made by the mother about breastfeeding pre-pregnancy
  • the maternal grandmother's preference for breastfeeding

And we must address the reasons that mothers give for ceasing breastfeeding:

  • the mother's perceived insufficient milk supply - this is where the doctors can be extremely helpful, as insufficient milk supply we know is fairly rare
  • lack of appropriate advice and support when difficulties arise - again, doctors can help here
  • and early discharge from hospital before hospital staff have had sufficient time to help establish breastfeeding

This last point is an increasing trend.

Many mothers are being discharged within 24 to 48 hours of delivery, when breastfeeding may not have been fully established.

Workplaces and work practices are other influences on breastfeeding.

Things like maternity leave provisions, flexible employment practices, lactation breaks, private rooms, and access to refrigeration and breastfeeding resources can all affect decisions.

Returning to work is a common reason for termination of breastfeeding.

With 72 per cent of women of childbearing age in the workforce, there is obviously a need to increase support for those women trying to combine work and breastfeeding.

Improved maternity leave provisions are also helpful.

I have to say that the Australian Breastfeeding Association is a strong and influential advocate for its cause.

Its lobbying to improve workplaces is excellent, as is all your work in promoting the benefits of breastfeeding.

It has been an immense pleasure for me to be here today to add in a small way to your efforts.

Be in no doubt that I and the AMA will do all in our power to promote the benefits of breastfeeding and lift Australia's breastfeeding rates.

After all, we're doctors, and we're here to help our patients.

Breastfeeding is normal and it has been normal for centuries AND it IS important!

It gives me great pleasure to declare the Australian Breastfeeding Association's "Hot Milk" 2007 National Conference officially open.

I wish you all well over the next few days of your conference and in all its deliberations.

Thank you.

Media Contacts

Federal 

 02 6270 5478
 0427 209 753
 media@ama.com.au

Follow the AMA

 @ama_media
 @amapresident
‌ @AustralianMedicalAssociation