Submission to the Sex Discrimination Commissioner

July 2002

Introduction

The Australian Breastfeeding Association (formerly Nursing Mothers' Association of Australia) is one of the largest self-help women's organisations in Australia.

Our vision is for Australia to achieve the World Health Organisation recommendation that babies are exclusively breastfed until six months of age, with continued breastfeeding following the introduction of other foods.

The Australian Breastfeeding Association supports the right of women to choose whether or not to enter the paid workforce after the birth of a baby. However, mothers must have real and supported choices. We support paid maternity leave in order to give women the optimal chance of establishing breastfeeding before a return to work.

The Association encourages the development of a broad range of public policy mechanisms that support the health and welfare of mothers and babies. As such, the Association is pleased to provide comment on Valuing Parenthood: Options for Paid Maternity Leave - Interim paper 2002.

Our submission is structured so as to address the relevant questions proposed in the Interim Paper. The Association does not comment on the specifics of the structure and funding of paid maternity leave. However, we believe that the options should be evaluated in terms of their contribution to the increase in duration of breastfeeding in Australia. Maternity leave provision and its funding should be such that it provides real choice to all women about staying at home with their baby for the important early months.

The Australian Breastfeeding Association: Services to Mothers and Babies

The Association through its volunteers provides a range of services to the Australian community including:

• A 7 day, 24 hour breastfeeding helpline. The Helpline provides women with information and support that they need to make informed choices about infant feeding and managing breastfeeding problems. Each year the Associations' trained volunteer counsellors receive around a quarter of a million counselling contacts per year.
• 1400 trained volunteer breastfeeding counsellors provide mother-to-mother support at the local level to new mothers, and those with concerns about infant feeding.
• Our 367 local groups regularly visit schools, preschools, and hospitals to educate the community about the importance of human milk and appropriate management of breastfeeding problems. We conduct approximately 90,000 community activities and events per year

We have also for many years focussed on meeting the needs of mothers in paid work. The Australian Breastfeeding Association:

• Introduced the inaugural Mother Friendly Workplace Awards in 1995
• Established the Breastfeeding and Work Working Group, which develops policy and resources in this area.
• Collaborated on a joint project with the Department of Industrial Relations, which culminated in the Work and Breastfeeding Guide distributed nationally by the Department.
• Provides resources including the Mother Friendly Workplace Information Sheet, Breastfeeding Women & Work booklet, Expressing & Storing Breastmilk booklet, The Carer's Guide to the breastfed baby, "We Can Work It Out" section in the National Newsletter, Essence, Working and Breastfeeding Guide (joint NMAA & DIR publication), Case studies
• Provides services including telephone and face-to-face counselling, talks to employers, seminars on breastfeeding and work, group discussions, breast pump hire, Lactation Resource Centre providing information and resources to health professionals

Breastfeeding and Employment

The Association is strongly supports the availability of paid maternity leave for all mothers for at least 12 - 16 weeks after birth. As breastmilk is recommended as babies' main food for the first year of life, the longer the paid leave, the better chance there is of establishing breastfeeding. A community commitment to paid maternity leave combined with workplace facilities and policies supportive of breastfeeding will help more mothers exclusively breastfeed for the 6 months or more as recommended by the World Health Organisation. Financial pressures and an unsupportive employer can take away a mother's choice to breastfeed. Our experience in counselling mothers through our Breastfeeding Helpline indicates that some mothers either do not initiate breastfeeding or only do so for a matter of weeks if they are returning to the paid workforce in the early months after the birth.

It takes most women up to 16 weeks to physically recover from the birth of their babies and to fully establish breastfeeding. The early weeks are also a period of transition and many women find them emotionally challenging.

The successful establishment of breastfeeding and the resultant well-documented emotional and physical health benefits is more likely to be achieved with the opportunity for unlimited contact between mother and baby in the early weeks.

Paid maternity leave promises direct improvements in the health and welfare of mothers and babies by providing the opportunity for this contact for women otherwise unable to afford it financially.

Objectives of Paid Maternity Leave

From the perspective of the Association, paid maternity leave acknowledges the work that all new mothers do in getting our new citizens off to a good start in life. With the rise in the women's paid labour force participation in the last two decades, it has become increasingly evident that the need to return to paid work is a barrier to breastfeeding for some women.

Paid maternity leave will remove some of the financial pressures created by a growing family. It will, therefore, be one of the many mechanisms required in our society to support an increase in the duration of breastfeeding.

Around nine in ten women initiate breastfeeding, but by 12 weeks this has fallen to 60%. By 6 months only approx four in ten mothers are still breastfeeding. Exclusive breastfeeding rates are even lower, with evidence from the ACT ¹ suggesting only one in ten babies are exclusively breastfed at around 6 months as recommended by the World Health Organisation.

The public health benefits of breastfeeding are well known. Artificial formula feeding substantially increases the risk of gastrointestinal illness, respiratory illness and infection, eczema, and necrotizing enterocolitis, with increasing scientific evidence of its links with chronic or serious illnesses or conditions such as childhood diabetes, urinary tract infection, certain types of cancers, diseases of the digestive system such as coeliac disease and Crohn's disease, liver disease and cot death. Breastfeeding is known to promote cognitive development and higher IQ, central nervous system development and visual acuity, and speech and jaw development. Breastfeeding also helps protect mothers against breast cancer and other cancers of the reproductive organs, and osteoporosis. ²

Women wean their babies prematurely for a wide variety of reasons. However, we know from calls to our Helpline that some women lose motivation to persist with breastfeeding if they are returning to paid work.

The vast majority of female workers are within small to medium sized workplaces and in industries without access to employer funded maternity leave. The Association believes that it is especially important for governments to ensure that paid maternity leave is not just for relatively privileged categories of workers. It is especially a concern that mothers in lower socio-economic groups are significantly less likely to breastfeed beyond the early weeks. ³

Mechanisms that provide more choice to women about when and whether they will return to the paid workforce are likely to have a positive impact on the duration of breastfeeding. Often formalised and Government initiated requirements and regulatory structures are needed for change to happen in workplace provisions. The Government needs to ensure that its policies of supporting and promoting breastfeeding are not undermined by incompatible workforce policies and pressures.

We are concerned that breastfeeding rates have plateaued in Australia in the last decade or so, despite the increasing and clear evidence of significant health risks to both mothers and babies of early weaning.

The first 12-14 weeks are critical in establishing breastfeeding, and we believe that ensuring adequate financial support for all mothers during the first months of a baby's life should be the priority for policy in this area. It should not be limited to those currently in employment or to women with supportive employers.

Costs and Benefits of Paid Maternity Leave

Lack of opportunity to establish successful breastfeeding increases ill health among mothers and babies. Treating such preventable illnesses through Medicare payments, the Pharmaceutical Benefits Scheme and the public hospital system has been shown by research⁴ to represent a major public and community health cost. Simply increasing the rate and duration of breastfeeding in Australia from 60% to 80% at three months has the potential to save over $11.5 million per year in Government health expenditure for just on 4 illnesses.⁵

Further, it has been shown that breastfed infants and children do not suffer as much illness as formula fed infants and children. Increased rates of breastfeeding lead to reduced cost to employers from employees absent to care for sick children.⁶ Mother's health also benefits from the opportunity to breastfeed beyond the early weeks. ⁷

In addition, individual households spend over $105.5 million on buying formula. Increasing the duration of breastfeeding will have an immediate and positively impact on the weekly family budget.

The countries, such as Norway, who have paid maternity leave at a level that provides greater choice to women and families about returning to the paid workforce have higher rates and duration of breastfeeding than we do in Australia. For example, Norway has nearly universal breastfeeding among babies up to 3 months old.

Extending the time a mother can be with her baby through the provision of adequate financial support should be seen as an investment in the physical and psychological health of families, and a recognition of women's unpaid as well as paid work. It will also contribute to reduced public health costs and family expenses.

Conclusion

Women return to work after the birth of their baby for diverse reasons including financial need and investment in a career. Many feel they must choose between breastfeeding and returning to work. Women need to see community and institutional support for breastfeeding and working to feel that this is an option. It is inequitable that only women with significant influence or those who have forward-thinking employers should have the optimal chance of establishing breastfeeding before a return to work.

The Australian Breastfeeding Association supports paid leave because of its potential to help mothers establish breastfeeding before return to work. A scheme which extends eligibility to all or most mothers, which targets assistance on the early months after birth, and which gives priority to mothers unlikely to have supportive employers is most likely to support breastfeeding. Such a scheme would be an important investment in the health and welfare of Australian mothers and babies, and their families, and would acknowledge the paid and unpaid work that mothers do including breastfeeding.

1. The survey is described in Thompson, J.F., et al., Early discharge and postnatal depression: a prospective cohort study. The Medical Journal of Australia, 2000. 172(11, 5 June).
2. We can provide references on request.
3. Donath, S. and L.H. Amir, Rates of breastfeeding in Australia by State and socio-economic status: Evidence from the 1995 National Health Survey. J Paediatr. Child Health, 2000. 36: p. 164-168.
4. We can provide references on request.
5. Drane, D., Breastfeeding and formula feeding: a preliminary economic analysis. Breastfeeding Review, 1997. 5(1, May): p. 7-16.
6. Cohen, R., M.B. Mrtek, and R.G. Mrtek, The impact of two corporate lactation programs on the incidence and duration of breastfeeding by employed mothers. American Journal of Health Promotion, 1994. 8(6): p. 436-441. Cohen, R., M.B. Mrtek, and R.G. Mrtek, Comparison of maternal absenteeism and infant illness rates among breastfeeding and formula feeding women in two corporations. American Journal of Health Promotion, 1995. 10(2): p. 148-53.
7. We can provide references on request.