AAP_amning

Om orimliga förutsättningar för amning

I USA rekommenderas numer amning i två år. Detta trots att väldigt få mammor ens har möjlighet att amma de första sex månaderna, på grund av brist på betald föräldraledighet. AAP offentliggjorde den radikala ändringen (från 1 år till 2 år) mitt i förra sommarens ersättningskris.

Så sent som förra sommaren (’22) skärpte amerikanska motsvarigheten till vår folkhälsomyndighet, American Academy of Pediatrics (AAP), rekommendationen kring amning för sina invånare. Från att tidigare ha rekommenderat amning i ett år eller längre, rekommenderas numer två år eller längre. Detta trots att det visar sig ligga långt ifrån verkligheten och nuläget, och också mycket långt ifrån vad de flesta mammor i USA har möjlighet till, även om viljan att amma så länge skulle finnas. När de nya rekommendationerna tillkännagavs skrevs det om i de flesta nyhetskanalerna, se till exempel NY TIMES eller USA Today.

Precis som många andra länder följer USA världshälsoorganisationens (WHO) råd kring amning, som innebär att man rekommenderar uteslutande amning de första sex månaderna. Därefter rekommenderar WHO fortsatt amning i två år eller längre, som komplement till riktig mat, vilket är mer ovanligt att länder antagit som statlig rekommendation. Men från förra året, 2022, står alltså USA alltså bakom denna rekommendation. AAP hävdar att det har indikerats att så lång tids amning kan ha hälsofördelar för den ammande mamman, i form av minskad risk för förhöjt blodtryck, diabetes, bröst- och äggstockscancer.*

AAP’s policys för amning framhålls grunda sig i samma resonemang som WHO för; att amning visat sig minska risken för infektionssjukdomar för spädbarnet under tiden det helammas, såsom luftvägsinfektioner, öroninfektioner och diarrésjukdomar. AAP omnämner också sambandet mellan amning och minskad risk för fetma.**

*OBS: Det är oklart om sambanden har med själva amningen att göra eller om det kan vara andra faktorer som orsakat skillnaderna mellan de observerade grupperna.
**OBS: Man nämner inte hur vanligt/ovanligt det är med dessa infektionssjukdomar eller att orsakssambandet med fetma inte kunnat fastställas.

Ett hån?

Argumentationen från AAP är svepskäl, menar vissa, då man gjorde ändringen i amningsrekommendationen mitt i den kris som uppstod i landet till följd av brist på modersmjölksersättning förra året. Rekommendationen har också fått kritik eftersom den ligger så oerhört långt ifrån verkligheten.

USA har ju nämligen fortfarande en av de kortaste och minst generösa föräldraledigheterna i västvärlden. Många amerikanska föräldrar tvingas återvända till arbetet mycket snabbt efter att ha fått barn på grund av bristen på betald föräldraledighet och svårigheter att hantera ekonomiska förluster, eller förlora jobbet. Att ens upprätthålla amning de första sex månaderna kan vara svårt, eller ofta omöjligt, även för de mammor som rent fysiskt kan och vill. Rekommenderas man att amma i två års tid måste det ju finnas något så när rimliga förutsättningar för det, annars kan det ju bli svårt att ta rekommendationen på allvar, menar allmänhet och kritiker. AAP har tidigare och i samband med den ändrade rekommendationen framhållit vikten av ökat stöd, såsom betald föräldraledighet, för att fler mammor ska kunna amma. Trots detta, uppfattas rekommendationen som ett hån av många.

amning Unna Baby

Ändringen i den statliga rekommendationen kring amning har rört upp känslor och en debatt kring de orimliga krav som ställs på mödrar och förutsättningarna för att bilda familj i USA. Ämnet har också kastat nytt ljus på frågan om amning som ett ”gratis” alternativ.

Allison S. Gabriel – professor i organisationspsykologi uttalar sig i HuffPost: ”Then there’s the fact that this new guidance came in the midst of the ongoing formula shortage that’s been rife with shameful messaging about how women should “just breastfeed” because “breastfeeding is free” — as if those are viable solutions to the problem.

En debattör i The Times, Jessica Grose, problematiserar ytterligare: ”Adding insult to injury: the guidelines were released days after the Supreme Court overturned Roe v. Wade, “when millions of American women are alarmed about restrictions on their reproductive and physical autonomy” — a move that “struck many as clueless and even callous.”

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