As nursing students with a passion for public health and health promotion, we were incredibly fortunate to work with Sheway during our public health promotion clinical placement at Vancouver Community College. Sheway is a Pregnancy Outreach Program located in the Downtown Eastside of Vancouver (DTES) that provides health and social service supports to pregnant women and women with infants under eighteen months who are dealing with drug and alcohol issues. Our experience at Sheway was incredibly humbling as we gained significant insight into the deeper issues affecting the health of this community and these vulnerable families.
Our main goal while at Sheway was to explore how mothers were choosing their method of feeding their babies. To begin, we grounded our exploration around one fact and question: “Vulnerable women experience barriers to feeding their babies whether breastfeeding or formula feeding. How can we support all women to feed their babies in the way that is best for them?“
We spent nine weeks with women in the drop-in area having casual conversations and encouraging them to share as much information as they could. We offered our hearts and ears to the moms sharing their stories and our arms to the babies whom we were delighted to hold. Each week we learned something new that helped us better understand the complexity of this issue. We discovered that many families in the DTES are faced with an overwhelming lack of basic resources – things that most British Columbians take for granted. For these vulnerable families, their ability to meet basic needs largely determines their choice of how to feed their babies.
We also learned that the ‘choice’ for these moms to either breastfeed or formula feed their babies is shaped strongly by the social determinants of health:
1 — Food Security remains one of the top challenges for mothers of low socioeconomic status. Despite our first world standards in Canada, many on the DTES do not have a balanced and nutritious diet that makes it possible to produce breastmilk and some do not have any help in trying to manage the feeding schedule. Others have no reliable support and education to help troubleshoot challenges, including how to prepare a new formula when they switch brands (a common occurrence when formula is received through donations).
We were concerned by the heavily marketed perspective that ‘Breast is Best’. The current popular ideology of programs such as the Baby Friendly Hospital Initiative (BFHI) exclusively promotes breastfeeding. But there is nothing “baby friendly” about letting an infant starve. If we want to have a healthy happy baby, we need to support mothers first and recognize that anything that is dubbed “baby friendly” should take into account the needs of the baby first.
2 — Finances are another key consideration for mothers when choosing how to feed their babies. For example, we learned that formula is only covered through the Ministry if the baby has a medical condition that prevents them from receiving breast milk, or if the mother has communicable diseases that pose a health concern to the baby. Other mothers are unable to access maternity leave or struggle to afford expensive resources such as breast pumps, formula, bottles, nipples and other supplies to maintain feeding.
Many women struggle to put food on the table for their family and often end up starving themselves to pay for expensive lactose-free formula. When we asked one mother if she wanted us to get her a serving of the hot meal provided by the drop-in, she replied that she was too sick from the expired SPAM that she had eaten the night before. Families require nutritious food in order to thrive.
3 — Housing in Vancouver is a challenge, but more so for those who are living in subsidized housing. In many cases only mothers and children are allowed to reside in a unit, which excludes partners and greatly limits their ability to participate in the family. some mothers confirmed that they were choosing to formula feed over breastfeeding, as they simply did not have the luxury of partner support to look after their other children while they attended to the focused demands of breastfeeding.
4 — Past experiences of trauma and its relationship to womens’ bodies and breastfeeding also impact their decision for choice of feeding. How do they handle the disapproval and stigma that they encounter? How might issues undermine their confidence in making choices for their babies? Do they have ‘choice’ given that they don’t have all the supplies, resources, supports and education that they need to make a choice for their own autonomy?
Taking all of this into consideration, we had to ask, ‘Are we doing enough for families?’ The answer is simply no. We need to advocate for the policy changes required to enable adequate housing, better financial support, and food security. How these mothers choose to feed their babies is not simply their wish but is completely dependant on their ability to survive. And that is heavily determined by our social, political and economic systems.
The mothers that we met are some of the most resilient and dedicated parents out there, but they need our support. While our experience at Sheway is over, we know that many mothers will continue to struggle given the limitations at hand. As new nurses, we have been motivated to continue to work towards ensuring vulnerable populations have equitable access to needed resources. All British Columbians should be aware of these issues, and should demand proper funding for formula, food, and housing. If ‘children are our future’, we have a responsibility to take care of them and support the mothers who foster that future.
Thank you Sheway for sharing with us, for inspiring our nursing practice and for directing us to apply our new knowledge.
ABOUT SHAUNA MC GOLDRICK and VIKTORIJA GLAMBINSKAITE
Shauna Mc Goldrick has been working in community on the DTES and in Spinal Cord Rehab while she has been completing her BScN at Vancouver Community College. She is the mother of two beautiful daughters who have kept her focused and inspired along the way. She is passionate about advocating for the health of marginalized populations; her recent nursing placement at She’way brought together two important themes: ‘motherhood’ and ‘equity’. As a future RN, she hopes to continue to assist families in achieving optimal health, by addressing the systemic problems that continue to undermine their social determinants of health.
Viktorija Glambinskaite is a first generation immigrant who came to Canada with her family 13 years ago. She has always been passionate about caring for people and knew from an early age that she wanted to pursue a career in the health sector. Immigrating made this dream a reality because of the many opportunities available in Canada. She is passionate about women’s health and has worked at the BC Women’s Health Centre and in various clinics, including Oak Tree and a fertility clinic. Viktorija has worked in mental health and addictions for more than four years at the Heartwood Centre for Women. She has been a practicing LPN for five years and is currently in the process of completing her BSN.