What MCH Policy Means to the Mother in Me

Immunizations, breastfeeding, childcare, contraception, child abuse, maternal death rates, infant mortality rates… there are so many topics that pique and enhance my interest that I often feel conflicted to reflect upon just one. While the following discourse may seem entirely fragmented and tangential, the floodgate of concern and simultaneous enlightenment that I have experienced as a mother among mothers encouraged this...

I sometimes hesitate to continue the discussion of vaccines, but it highlights an underlying issue that I want to address. If such a basic tenet of public health is currently met with trepidation and often times outright disdain, how do we as a society and a global health community effectively address other matters (in essence, move on to current issues) with the gusto and perseverance that created our public health foundation? All health programs hail immunizations as the “sine qua non of a personal preventive heath intervention” and our health policy echoes the sentiment. However, our fiscal policy and subsequent funding offers a muddier view. Our state government covers the cost of certain vaccinations uniformly while others are left to insurers, Medicaid, or patients. Perhaps, if the entire cost of administering immunizations was covered by our municipal and federal governments and a standard method of distribution was adopted, some of the controversy would diminish. I understand why parents are wary of ingredients in the vaccines, the number of vaccines, and over enthusiastic physicians. During an interview with Dr. XXX, he said some other physicians were reluctant to use combined vaccinations as they are able to charge an administration fee per injection. Such knowledge is discouraging to say the least. And yet, it seems that our healthcare system is on a proverbial slippery slope and the controversy over childhood immunizations are setting us apart even further and distracting us from the issues of lack of universal healthcare, disparities in access, an overly wrought healthcare system, an aging populous, a dependent global health community, etc.

At times policy has preceded the public outcry for social change. Although my examples relate to environmental policy change regarding Carter’s Corporate Average Fuel Economy mandates and Nixon’s National Maximum Speed Law of 55 MPH to save gasoline, they illustrate how policy can change our social norms. Transitioning thrugh present day, as our society currently stands, the structural and supportive mechanisms for adequate maternal and childcare are benign. My example relates to breastfeeding. I know of no working mother who continued to breastfeed if she returned to work outside the home prior to her child’s first birthday. The majority of working women do not have the financial means to spend a year at home. While the benefits to breastfeeding are readily acknowledged, the obstacles are so very numerous that they boggle the imagination. One must be emotionally, physically, financially, and familially encouraged and supported into such a “natural” decision. Our American society puts such a financial burden on the family to generate two incomes regardless of socio-economic stratus that the decision to breastfeed is one of several components of a healthy childhood that is routinely lost. Advances do continue to be made as legislation is catching up at an achingly slow pace- there is breastfeeding in public places, federal buildings, workplace mandates regarding time to express milk and or breastfeed, exemptions from jury duty- all on the state legislative level and to varying degrees. If I breastfed in 30 out of the 50 states I could be cited for indecent exposure because I am not expressly protected. That is entirely bizarre. Perhaps these other 30 states, like most countries in the world, take breastfeeding so for granted that legislation is moot. These states may believe that breastfeeding truly is the natural and more importantly the normal way to feed an infant. Or perhaps I am just wishful thinking. I am proud of the efforts that Hawai′i has made to make breastfeeding more acceptable. The following is for reference regarding Hawaii’s Statutes:
Hawaii Rev. Stat. § 367-3 (1999) requires the Hawaii Civil Rights Commission to collect, assemble, and publish data concerning instances of discrimination involving breastfeeding or expressing breast milk in the workplace. Prohibits employers to forbid an employee from expressing breast milk during any meal period or other break period. (HB 266)

Hawaii Rev. Stat. § 378-2 (1999) provides that it is unlawful discriminatory practice for any employer or labor organization to refuse to hire or employ, or to bar or discharge from employment, or withhold pay, demote, or penalize a lactating employee because an employee breastfeeds or expresses milk at the workplace. (HB 2774)

Hawaii Rev. Stat. § 489.21 and 489-22 provides that it is a discriminatory practice to deny, or attempt to deny, the full and equal enjoyment of the goods, services, facilities, privilege, advantages, and accommodations of a place of public accommodations to a woman because she is breast feeding a child.

Even Emily Post’s etiquette book states that breastfeeding is something to be done in private. While I acknowledge that she’s hardly the standard for maternal and childcare health, that is exactly why the book should probably never have touched upon the subject. It seems that the stigma relating to breastfeeding is perpetuated in our society with a saddening deliberation.

Several years ago there were public service announcements done on breastfeeding during the National Breastfeeding Awareness Campaign that were pulled from being aired due to the AAP protesting the negative message about not breastfeeding children. The Campaign fired back saying that was the point of the ads. They were nonetheless never shown amid the controversy and heavy involvement by lobbyists on behalf Johnson & Johnson and several formula companies. When I saw the 60 minutes expose on it, I was dismayed by both sides. The following question came to mind; how can we make a woman feel guilty about not breastfeeding while simultaneously not giving her the support to do so? I read a Time article on how women were bringing their babies to work and felt encouraged that although our legislative policy may be archaic, our business ethic was shifting towards a more enlightened and caring consensus. http://www.time.com/time/magazine/article/0,9171,1699879,00.html These are among the more privileged of our society and the social injustice of the breastfeeding of a child being a luxury is palpable.

I was genuinely blessed to have grown up in the developing world- in India, Somalia, Kenya, Bangladesh, and Thailand. However, it created a presumption that I held that declining health status was a direct result of poverty and ignorance. Being also privileged to live in Hawai′i for the past fifteen years, I realize that it is just not so. There are so many determinants to health, and even more numerous facets to maternal and childcare health specifically, that need to be addressed. Health is incredibly nuanced, as is the policy framework used to describe and maintain it. For example, even the term infant mortality can mean several things depending on geographic definitions and usage. I had once (quite naively) presumed that this universal indicator would have broad and systematic usage. It is indicative of how subtle differences in diction can alter policy outcomes and participation.