In ancient times, nursing a baby was a simple act of feeding. Nursing had no artificial competitors, was not laden with agendas and was not a topic of social, health of medical debate. It certainly was not a test of endurance or standard for good mothering. The same can be said of some places today.
But in the West in recent years, the issue of attitudes toward nursing has attained fascinating prominence, whether in research or interdisciplinary debate. A comprehensive survey recently published by the Health Ministry, entitled “National Health and Nutrition Survey from Birth to Age 2," provides an interesting peek into the way nursing is perceived — or more specifically, how society’s perception of it is reflected in the women who do the actual nursing — and apparently health is not the only consideration that determines whether or not mothers nurse.
The survey was conducted by the National Disease Control Center and the Health Ministry’s Nutrition Department between 2009 and 2012. More than 2,000 mothers participated (about half Jewish and half Arab) from before their babies were born until they reached 2 years of age.
The first question in the survey, “Do you plan to nurse?” got an affirmative response from 90.7 percent of the women immediately after they gave birth. Only 7.7 percent said they did not intend to nurse, while 1.5 percent said they had not decided. A small percentage of those who said that they did not plan to nurse said it was by their own choice, while the rest said it was for other reasons, such as the difficulty of nursing, problems producing milk or medical issues.
The women also indicated they were determined to nurse over the long term: 25.4 percent said they intended to nurse for three to six months, and 29.4 percent said they planned to nurse for six months to a year. Only 8.4 percent said that they planned to nurse for one to three months.
An essential act
Generally speaking, the contribution of nursing to the baby’s health and bond with the mother is not in doubt. Mother’s milk has the upper hand over baby formula, particularly during the first several months of the baby’s life. But everything beyond that is up for debate.
“The Health Ministry recommends nursing exclusively until 6 months of age, and then combined nursing until at least 1 year. The World Health Organization recommends nursing until 2 years of age,” says Haya Gutmann, coordinator of nursing at Clalit Health Services. “Mother’s milk is the most appropriate for the baby’s development, just like cow’s milk is appropriate for the calf, which has to stand on its own feet just an hour after being born. Babies receive not only antibodies for all kinds of illnesses, but the composition of the milk they receive changes all the time. For example, the composition of mother’s milk at the beginning of nursing is different from what it is at the end. It also changes between morning and evening, and it changes as the baby develops.”
One of the most significant factors in the success of nursing is the experience of nursing for the first time after birth. “It is a process that we put effort into even before the birth and do a great deal so that it will work,” says Professor Nechama Linder, director of the neonatology unit at Beilinson Hospital. “The first thing we do right after the birth is allow all the babies who are feeling well to nurse.”
Who has the time?
Professor Dahlia Moore, dean of the College of Management’s School of Behavioral Sciences, says, “There is social pressure to nurse. There is a kind of mobilization of medical people and policymakers who see the fact that so many women go out to their jobs and careers as a threat to motherhood, and they start emphasizing the importance of the mother’s bond with the baby. What I find odd is that they ignore the fathers completely and do not allow them to create a place in their children’s lives.”
Still, she adds, “I don’t think that the percentage of nursing women in Israel is very high, which also applies to the whole Western world. The reason is that most women aren’t suited to nursing. They go out to work, they want to live for themselves as well, and not just for their children. Nursing binds the woman. I think that even if there is an advantage for the baby, if the mother is nursing and unhappy about it, if she is giving in to pressure, what she will be giving to the child is not the warmth of nursing, but a kind of tension or pressure or hostility. In situations like that, a bottle is better.”
From a social standpoint, women seem to be expected to commit to nursing their babies even before they give birth to them. But according to the survey, there is a large gap between that commitment and following through. Two months after giving birth, 75 percent of women were still nursing. Six months after giving birth, the number fell to 55 percent. And a year after giving birth, it fell to 29 percent. Only a small hard core of 2.4 percent nursed for two years or more.
“It seems that not many women enjoy it. For some, it’s not natural or comfortable, so there are lactation consultants. If it were instinctive, it wouldn’t have to be taught,” says Moore. “It’s apparently something that is very sociocultural, a kind of fashion that goes in and out of style and now is a bit weak, so today there is pressure to bring it back. Also, nursing doesn’t allow the husband to be a partner in raising the child, and today’s husbands want to be partners.”
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