THE D.C. Council will hold hearings next week on a bill to require city hospitals to promote breast feeding in maternity wards. The Infant Formula Action Coalition, which led the drive against use of formula in developing countries, has been pushing the measure as a way to reduce the city's high rate of infant mortality. Hospitals and many doctors believe the legislation would have no effect on infant mortality and may interfere with desirable medical practices.
In a country such as the United States, which has adequate water supply and refrigeration, the use of infant formula has not been shown to be a cause of infant mortality. True, almost all doctors agree that, under proper circumstances, breast feeding offers physical and emotional advantages to both mother and child. Experts are quick to note, however, that the required circumstances--a healthy, full-term baby and an emotionally and physically prepared mother--are not always present. In fact, the high rates of infant mortality in the District occur precisely because those circumstances are often absent at birth.
Many District babies are born prematurely or at full term with a low birth weight. Contributing factors include poor prenatal care, inadequate spacing of children, the extreme youthfulness or poor health of the mother, or her use of cigarettes, drugs or alcohol. Breast feeding can do nothing to remedy these problems--premature babies, in fact, require vitamin and protein supplements.
It is, however, clearly a good idea to ensure that all mothers, not just those who are well educated, are fully informed of the potential advantages of breast feeding well before their babies are born. The low rates of breast feeding at some inner-city hospitals suggest that adequate information isn't being supplied and that hospital routine tends to promote formula-feeding.
The legislation being proposed, however, goes far beyond the desirable measure of educating potential mothers and health practitioners in the advantages of breast feeding. It would establish a set of legally enforceable "rights" of the mother to such things as full information by persons trained to advise on the process of breast feeding and 24-hour access to infants, preferably starting right after delivery.
Pediatric societies have endorsed these practices whenever they are medically and institutionally feasible. But with so many other clearly more pressing health problems to be dealt with, it doesn't seem wise to enshrine such procedures in a legal code, where they may create only a burst of litigation and require expensive changes in hospital design and organization, with little effect on infant mortality.
Council Member Charlene Drew Jarvis, the measure's primary sponsor, has made it clear she is not wedded to any of the bill's provisions. But she hopes it will foster discussion of the larger question of ways to reduce infant mortality. That, anyway, would be a useful outcome. Enactment of the bill would not be.