Fresno celebrates breastfeeding while the U.S. debates the merits of infant formula

Fresno County has reached a milestone in breastfeeding, nearly matching the average in California, but advocates say a lot more mothers would choose to breastfeed if they had help and support.

And those same advocates wonder if they can count on the federal government to support breastfeeding after reports that the Trump administration this spring tried to weaken a World Health Organization breastfeeding resolution because it called for limits on the promotion of infant formula.

“Will that impact us on the work we’ve been doing to improve breastfeeding rates? I think we’d be naive not to look at that,” said Rose Mary Rahn, maternal, child and adolescent health director at the Fresno County Department of Public Health.

President Trump has sharply contested the New York Times report that his administration is anti-breastfeeding, tweeting this month that the U.S. strongly supports breastfeeding but doesn’t believe women should be denied access to formula. “Many women need this option because of malnutrition and poverty,” he wrote.

Fresno County supervisors have voiced their support for breastfeeding, proclaiming August as breastfeeding awareness month. And hundreds of parents carrying babies and pushing strollers are expected to converge at Woodward Park on Saturday for a breastfeeding awareness walk and to participate in the worldwide “Big Latch-On,” when babies are breastfed all at a specified time.

The county has reason to celebrate. At latest count, Fresno County had 69 percent of mothers exclusively breastfeeding newborns, just slightly below the California average of 69.6 percent. The rates are based on 2016 data, the latest available.

Fresno County’s rate is a significant improvement from the 60.9 percent who breastfed in 2015, according to a report by the WIC Association and UC Davis Human Lactation Center. And among 49 counties with enough births to compare, Fresno County in 2016 ranked 31st in California for exclusive in-hospital breastfeeding, considered a crucial marker to a mother’s breastfeeding success. In 2015, Fresno County ranked 39th for exclusive breastfeeding.

Fresno County has the highest exclusive breastfeeding rate in the central San Joaquin Valley in 2016. Kings County had 64.8 percent of its mothers exclusively breastfeeding, Madera County had 65.4 percent, Merced 61.3 percent and Tulare 53.8 percent, according to the California Department of Public Health.

But in all counties, breastfeeding rates vary across ethnic groups.

In Fresno County, for example, 80.8 percent of white mothers exclusively breastfed infants in 2016, but only 52.8 percent of Asian American mothers, 59 percent of Native American, 63.2 percent of African American and 69.5 percent of Hispanic mothers breastfed, according to the California Department of Public Health.

Fresno County and others are looking at the disparities. Some are taking steps already to promote breastfeeding. Hospitals such as Kaweah Delta Medical Center in Visalia have free Spanish breastfeeding classes. And Madera County has applied for a state grant that would help pay for county programs addressing breastfeeding and other health disparities in specific populations in the city of Madera.

Six months is the goal

It’s not clear how many mothers continue to breastfeed once they leave the hospital, but the consensus among breastfeeding experts is a steep drop occurs across all groups.

The goal is to keep mothers breastfeeding for at least six months. Research shows that babies who are fed only breast milk for the first six months have fewer illnesses, including ear and respiratory infections. And there are health benefits for the mothers, too, including a lower risk of breast and ovarian cancer.

And for the poverty-riddled Valley, breastfeeding is economical: It’s estimated that the cost of infant formula can be up to $150 a month.

New mothers in California are luckier than most. Mothers can get up to six weeks disability and family leave at partial pay. And beginning this January, all private employers with 20 or more workers must provide eligible employees with up to 12 weeks of unpaid job-protected parental leave to bond with a new child within one year of birth, adoption, or foster care placement.

But many mothers still face barriers to breastfeeding, including the necessity of returning to work, which for some may mean within two weeks after delivery. And many mothers return to workplaces that are not breastfeeding-friendly, even though California says employers must provide a clean place for mothers to pump breast milk.

Support hit and miss

Anne Lake, a leader at the La Leche League of Fresno, said support for breastfeeding women in the community is “hit and miss, and that’s the biggest problem.” La Leche is a nonprofit organization that provides support to breastfeeding mothers.

Women may not know how to get help or be able to get help at the time it’s needed, such as during the night, said Dr. Aimee Abu-Shamsieh, a Fresno pediatrician and member of the UCSF Fresno faculty. “There is patchy support,” she said. “But there’s not one hotline that everyone can call or one breastfeeding clinic.”

And the infant formula industry knows new mothers are vulnerable, said Felicia Esqueda-Rodriguez, a lactation consultant at Kaiser Permanente Fresno and member of the Fresno County Babies First Breastfeeding Task Force.

Coupons for free infant formula — and even containers of formula — “magically appear” at the homes of pregnant women a few weeks before their delivery dates, Esqueda-Rodriguez said. And three weeks after birth, when babies experience a growth spurt, more freebies show up. “They know when to do it, they’re not stupid.”

The $70 billion infant formula industry is in “panic mode” since hospitals in Fresno County and across the country have stopped giving new mothers formula to take home with their newborns, Esqueda-Rodriguez said. “The cash wagon of giving free formula to the hospitals and the hospitals giving the formula to patients is gone.”

Abu-Shamsieh said it’s difficult to resist a free packet of formula when it’s the middle of the night and you can’t ask a question and you have a crying, hungry baby. “People underestimate the vulnerability of the new mother and at the same time I think people vastly underestimate the power of the formula companies and just their marketing.”

Lake said she is disturbed and distressed at the Trump administration’s reported insistence that a global breastfeeding resolution include wording that mothers should have access to formula when they need it.

The government’s reported opposition to the World Health Organization resolution either was not well thought-out or it’s “in support of the formula industry and dairy industry and baby food industries without having any regard for child health,” said Abu-Shamsieh. Women in the United States are not being forced to breastfeed, she said. “We advocate for the health of the baby and educate moms so they can make an informed decision.”

No one is trying to make a mother feel bad if she chooses to feed her baby formula, she said. “But the bottom line is moms in the U.S. are not meeting their breastfeeding goals. They often had plans to continue breastfeeding but again, because of lack of access to help in a timely manner or their need to go back to work, they weren’t able to meet those goals.”

And the biggest barrier to breastfeeding on the national level is the lack of parental leave, Abu-Shamsieh said.

Time off to breastfeed

President Trump proposed guaranteeing six weeks of paid maternity leave during his campaign, and this month. Ivanka Trump, the first daughter who is also a White House adviser, has expressed optimism for support for it in Congress.

But for breastfeeding to become widely accepted it will take a “culture shift, a paradigm shift” in the United States, said Cathryn Herrin, a lactation consultant at Saint Agnes Medical Center in northeast Fresno. “We have to create it as a cultural norm and support those women who make that their choice.”

In January, Saint Agnes became the first hospital in the county to achieve designation as a Baby Friendly hospital for its support of breastfeeding. Saint Agnes is one of only 95 hospitals in California to earn the global recognition. Hospitals that are Baby Friendly have high rates of breastfeeding, according to WIC and UC Davis. By 2025 all maternity hospitals in California must be Baby Friendly or have similar policies.

“The goal is as a woman comes into this hospital, she leaves feeling very accomplished as a mother and feels confident she has the information she needs to make the best choice for her baby,” Herrin said.

Sara Sherwood, 33, of Fresno, got help from lactation consultants at Saint Agnes while in the hospital for the birth of her son, Everett, and after she brought him home two months ago. A first-time mother, Sherwood said within a day or two at home, Everett appeared not to be eating properly and the experts discovered the reason — her son’s tongue was tethered to the bottom of his mouth. He had surgery to correct the problem, and she pumped breast milk to bottle feed her son until his tongue healed.

Everett had to re-learn how to breastfeed and the consultants helped Sherwood resume breastfeeding.

“I can say without question I was determined I was going to breastfeed him,” Sherwood said. “But without them (lactation consultants at Saint Agnes), he would be on formula.”

This story was originally published July 28, 2018 at 4:26 PM.