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Why Are the Breastfeeding Rates in Rural America So Low?

In 2011, moms across the country protested Target, staging “nurse-ins” and refusing to shop there after a breastfeeding mother was threatened with legal action for nursing in the women’s clothing section. I was a television reporter in my home state of West Virginia then and covered this story, admittedly and embarrassingly a little skeeved out. I was in my early twenties, and remember wondering why someone would want to breastfeed in public anyway.

Born and raised in Appalachia, I had no exposure to breastfeeding. I wasn’t breastfed, nor were any of my younger family members. There were a lot of babies in the church I went to growing up, but I don’t remember seeing a single mother nurse her child. It wasn’t until I moved away from the mountains of West Virginia that I realized breastfeeding was actually quite common.

Across the country, as many as 82 percent of mothers breastfeed their babies for some amount of time. In rural areas, the numbers are lower, with 68 percent of women starting out breastfeeding. In rural Appalachia, the dichotomy is at its most extreme, with only 57 percent of mothers even attempting to nurse.

Appalachia is comprised of thirteen states, many of which are some of the most economically depressed states in the country and rank near the bottom when it comes to both median household income and breastfeeding rates.

In West Virginia, for example, the median income is $43,000, and less than 35 percent of mothers are breastfeeding by the time their child hits the six month mark.

As someone from Appalachia, I’m as sick as every other Appalachian is of hearing how sad and depressed and poor my beloved home state is. I roll my eyes at lists that rank West Virginia at the bottom, yet again. But you can’t have a conversation about breastfeeding statistics without talking about income. They’re that tied together.

Dr. Susanna Kapourales is a pediatrician in Teays Valley, West Virginia, just a few minutes away from the state capital of Charleston. She grew up in the town of Williamson, where nearly half of the three thousand residents live below the poverty line.

“My mom was the only person in her community who breastfed at all,” Dr. Kapourales said. “She had no support whatsoever; she learned how to breastfeed by a book. She had absolutely no help in the area because nobody breastfed. But she knew that it was better for her babies.”

Kapourales’ mother moved to Williamson as an adult; and for many native West Virginian and other rural Appalachians, the aversion to breastfeeding is deep-rooted.

Though the American Academy of Pediatrics recommends breastfeeding until twelve months, Dr. Kaporales says that most of her patients nurse for about six months and switch to formula. “A lot of people will get to that six months and then either from work restraints with pumping or something else, they just find it easier to use formula.”

The Federal Family Medical Leave Act, which pertains to all fifty states, only applies to employers with at least fifty employees and doesn’t guarantee paid time off. In fact, the United States is still the only developed country that doesn’t offer paid leave for new mothers, something that could really aid in setting good breastfeeding practices into place.

Federal law does also require employers to provide “reasonable daily unpaid breaks” to pump, but the conditions or the culture aren’t always encouraging. If you have an office you can close the door to, it’s a little easier, but what if you work at Red Lobster? Where do you go to pump? For many mothers, pumping at work just isn’t an option.

“Most of the time, they are so exhausted when they get home and they don’t have enough support,” Dr. Kaporales said.

Of course, there are many other factors beside someone’s income that can deter mothers from breastfeeding -- lactation or latching issues, issues with the baby’s weight or even medication the mother needs to take. But perhaps the most profound reason moms don’t nurse, in my experience, is that the act of breastfeeding itself is at odds with cultural norms, leaving them without the support of their family and friends.

Dr. Kaporales said, “some families have been raised to think that it’s weird -- and then others, come hell or high water, do not want to give their babies formula. I see both, and I really think it has to do with their family.”

Cigarette smoking and drug use also play a big part in preventing mothers from breastfeeding.

In West Virginia specifically, 29 percent of residents admit to smoking regularly, and drug use is rampant. At the hospital system Dr. Kapourales works for alone, there are 2,900 births per year -- babies from Ohio, Kentucky and West Virginia. Of those tiny infants, one fifth were exposed to drugs in the womb, and 400 had to be medicated after birth to help combat withdrawal symptoms that leave them screaming and shaking uncontrollably.

In hope to raise the breastfeeding rates across the country, hospitals have adopted a certification system that list them as “baby friendly.” At “baby friendly” hospitals, breastfeeding is encouraged by giving the newborn to the mother right away, foregoing nurseries by leaving the newborn with the mother the entire stay, and providing lactation support before discharge. West Virginia has just one such hospital.

That kind of support, Dr. Kapourales said, is crucial in educating, encouraging and sustaining breastfeeding. It should probably even start during pregnancy.

“In the community, if people don’t have enough support, they get discouraged with it and quit,” she said. “Those first three weeks are hard, and people feel helpless and like they can’t get through it. And if you don’t have that support system to do it, it’s hard.”

But breastfeeding rates won’t rise in these rural areas, Dr. Kapourales said, until breastfeeding is normalized. And the only way to normalize breastfeeding is to do it. In public. All the time. At the grocery store, at your older kids’ soccer practice -- even at Target.

Photography by Belle Savransky for Well Rounded.

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One of the hardest areas to declutter can be your children's toy closet. Does that beeping, singing firetruck spark joy for you? Well no, in fact, it might be the most frustrating toy, but then again, having an occupied, entertained child sparks more joy than all of your household items combined.

So do more toys really mean a more engaged child? Studies say no. Having fewer toys leads to a more ordered home and encourages your child to develop creativity, concentration and a sense of responsibility for taking care of their belongings. But how do you go about reducing the number of toys your child has when there are so many "must haves" on the market? Perhaps more importantly, how do you ensure you don't bring any more toys that will be quickly forgotten into your home?

The secret: Look for toys that are open-ended, toys that will last for years, toys that encourage creativity, and toys that benefit development.

Here are some of our favorite Montessori-inspired toys.

Open-ended construction


Toys that are open-ended, rather than have just one use, empower your child to be an active participant in their own play. An example of an open-ended toy is a set of blocks, while a more limited use toy might be a talking toy robot. Blocks are only fun if your child applies their own creative thinking skills to make them fun, while the robot is a much more passive type of entertainment.

Open-ended toys also tend to keep children's interest for much longer, as they grow with your child—as their skills develop, they can build increasingly complex structures and scenarios.

There are so many beautiful sets of blocks available, but here are a few good choices.

1. Wooden Blocks

2. Duplo Lego

3. Magnatiles

Pretend play


Beginning in early toddlerhood, many children begin to incorporate pretend play into their repertoire. They do this all on their own, without the aid of toys, turning mud into pies and sticks into hammers.

Still, these toys will encourage their budding imaginations and also allow them to process things they experience in their own lives through role-playing and pretend play.

4. Doll

5. Farm

6. People figures

7. Train set

Music


Music provides a great deal of joy to most children, and can also aid in brain development.

Providing regular opportunities for your young child to both create and listen to music will encourage him to develop an appreciation for music, an understanding of rhythm, and an outlet for creative expression.

8. Musical instrument set

9. Simple music player with headphones

Movement


Giving young children opportunities for movement is so important, both for their gross motor development and for giving them a daily outlet for their boundless energy. Children who spend plenty of time running around generally sleep better and are often better able to concentrate on quieter activities like reading.

Encouraging plenty of unstructured time outside is the best way to ensure your child gets enough daily movement. These toys though can help your child develop muscle coordination and strength, while also providing plenty of fun.

10. Balance bike

11. Pedal bike

12. Climbing structure

13. Wagon

14. Balls

Puzzles


Puzzles are wonderful toys for helping children develop spatial understanding, problem-solving skills, resilience and new vocabulary. Bonus, they also provide a quiet activity that can engage even young children for an extended period of time!

15. Peg puzzles

16. Jigsawpuzzles

17. Layered puzzles

Games



Games encourage your child to develop social skills such as taking turns and winning and losing gracefully.

Many games for young children also have educational benefits such as building memory or practicing counting.

18. Memory game

19. Bingo

20. Simple board game

Taking the plunge and reducing your children's toy collection can be scary. If you're uncertain whether your child will miss a certain toy, try putting it away in a closet for a month to see if they notice. Take some time to observe your child with their reduced toy collection and notice how their play changes.

Once you commit to fewer toys, you'll find you can truly be intentional with what you provide your child and can also choose higher quality toys when you're only purchasing a few. There will also be far fewer little objects strewn around the house to trip over, which is a huge bonus!

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For so many parents, finding and funding childcare is a constant struggle. How would your life change if you didn't have to worry about finding and paying for quality childcare? Would you go back to work? Work more hours? Or just take the four figures you'd save each month and pay off your student loans faster?

These hypothetical scenarios have been playing in the minds of many American parents this week as presidential hopeful Senator Elizabeth Warren unveiled her plan for free or affordable "high-quality child care and early education for every child in America."

Universal childcare will be a cornerstone of Warren's campaign for 2020. It's a lofty goal, and one many parents can get behind, but is it doable?

Supporters note it's been done in other countries for decades. In Finland, for example, every child has had access to free universal day care since the early 1990s. Sweden, too, has been building its universal childcare system for decades.

Critics of Warren's plan worry about the price tag and potential for ballooning bureaucracy, and some are concerned that subsidizing childcare could actually make it more expensive for those who have a government-funded spot, as it could result in fewer private childcare providers.

But subsidized childcare had lowered prices in other places. In Sweden, parents pay less than $140 USD to send children to preschool. In Finland, the cost per child varies by municipality, household income and family size. A parent on the lower end of the income spectrum might pay as little as the equivalent of $30 USD, and the maximum fee is about $330 a month.

But Finland's population is on par with Minnesota's. Sweden is comparable to Michigan.

So could the Nordic model scale to serve the hundreds of millions of families in America?

As Eeva Penttila, speaking as the head of international relations for Helsinki, Finland's education department once told The Globe and Mail, "you can't take one element out and transfer it to your own country. Education is the result of culture, history and the society of a nation."

Right now America spends less on early childhood education than most other developed countries (only Turkey, Latvia, and Croatia spend less), but that wasn't always the case. This nation does have a history of investing in childcare, if we look back far enough.

Back in World War II, when women needed to step into the workforce as men fought overseas, America invested in a network of childcare to the tune of $1 billion (adjusted to today's money) and served hundreds of thousands of families in almost every state through center-based care. Parents paid between $0.50 and $0.75 per child per day (the equivalent of about $10 in today's money).

So America does have a historical and cultural precedent, not to mention a current model of universal preschool that is working, right now, in the nation's capital. In D.C. In Washington, D.C., 90% of 4-year-olds attend a full-day preschool program for free, according to the Center for American Progress. Seventy percent of 3-year-old are going too, and the program has increased the city's maternal workforce participation rate by more than 10%.

It won't happen overnight

While some American parents might be daydreaming of a life without a four-figure day care bill in 2020, the road to true universal childcare for all children in America would be a long one. Peter Moss, a researcher at the University of London's Institute of Education, previously told The Globe and Mail it took Sweden "many years to get it right."

Indeed, the 1990s saw long wait lists at Swedish day cares, but the growing pains of the '90s paved the way for the enviable system Swedes enjoy today.

According to Moss, governments in other countries look at the Nordic model and "tend to say, 'We can't do that.' But what they really mean is 'We can't suddenly do that.' In other countries, they just don't get to grips with what needs doing and actually plot a course."

Maybe America's starting point is found in its history books, or in the modern day preschools of the nation's capital, or in the conversations happening between now and 2020. It doesn't have to be Warren's plan, but America does need a plan for safer, more affordable childcare.

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It's so unfortunate that in the working world there are still those who believe mothers are more distracted and less productive than people without children.

Research proves that just isn't true—working moms are actually more engaged than working dads and fathers and equally committed—and plenty of working mothers will say that parenthood has actually made them more productive.

Ayesha Curry counts herself among those moms who become more efficient at work after becoming parents. The entrepreneurial mom of three seems unstoppable when it comes to expanding her career, which she launched as a lifestyle blog back when the oldest of her three children was still a baby.

"You don't realize how much you can get done in a day until you become a parent and you're like, 'what was I doing with my time before'?" she recently old Cheddar's Nora Ali.

Now less than seven years later she's built her own empire as a mom, not in spite of being one.


Now a New York Times best-selling cookbook author and restaurateur, Curry has also got her own brand, Homemade, and you can find her products bearing her name in places like Target and JC Penny. She's been promoting a partnership with GoDaddy and she's an ambassador for the Honest Company, too.

Curry says motherhood taught her how to multitask and manage her time.

"I have three children, so I've had to grow four invisible arms," she explains. "I've definitely learned efficiency through being a parent. It's helped me in my business tenfold."

As a celebrity, Curry's life experience is kind of unique, but her experience of becoming better at work because of motherhood isn't, according to experts.

Career coach Eileen Chadnick previously told Motherly that motherhood is an asset in the workplace, in part because it trains women to be both empathetic and assertive at the same time, a combo that makes for great leaders. "There are incredibly nice, compassionate women who are very strong and know how to take a stand," Chadmick said. "And they're trusted and admired by others even if they need to say 'no' to their employees."

That's something Curry agrees with. Because it's her name on that frying pan, cookbook or bedspread, she doesn't shy away from saying 'no' when she doesn't like something. "I'm really good about being forceful and putting my foot down," she explains.

It's easier to put your foot down when you've already grown four invisible arms. That's the balancing act of motherhood, and it's what makes this mama so good at business.

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It may seem like there are more recalls than ever these days, but that's actually a good thing for parents. It means fewer potentially dangerous products are making it to our dinner tables and medicine cabinets.

According to food safety experts, the spike in recall notices for everything from broccoli to baby toys in recent years suggests companies are doing a better job of self-reporting, and we're actually safer than we were in the days when recalls were rare.

"It reflects a food industry that takes contamination and foodborne illnesses seriously. Increasingly companies are willing to recall their products rather than expose customers to potential harm," Dr. William Hallman, professor and chair of Rutgers Department of Human Ecology, said in an interview with Food Drive."So more companies are taking a cautionary approach."

Here are the recalls parents need to know about this month:

Dollar General Baby Gripe Water

The FDA issued a recall notice for "DC Baby Gripe Water herbal supplement with organic ginger and fennel extracts" after the company received one report of a one-week old baby who had difficulty swallowing the product, and there were three other complaints "attributed to the undissolved citrus flavonoid."

The FDA says "the product should not be considered hazardous but could result in difficulty when swallowing the product for sensitive individuals."

Basically, it's not harmful if swallowed but the undissolved flavonoid makes it a choking hazard.

The gripe water was sold at Dollar General stores in four ounce bottles with the UPC code 8 5495400246 3.

Nature's Path Envirokidz gluten free cereals

If you've got a kiddo with celiac disease you're probably familiar with the EnviroKidz kine of gluten free cereals sold at Trader Joe's and other grocery stores. Unfortunately, Nature's Path, the maker of the cereals, is recalling more than 400,000 boxes of Envirokidz cereals in the U.S. and Canada due to potential gluten contamination.

Choco Chimp, Gorilla Munch and Jungle Munch are all impacted. The best before dates are: 08/01/2019, 08/24/2019, 08/27/2019, and 09/21/2019. The UPC codes are: 0 58449 86002 0, 0 5844987023 4, 0 5844987027 2, 0 5844987024 1 and 0 5844987028 9.

If you can handle gluten they are safe, but Nature's Path says "people who have a wheat allergy, celiac disease or sensitivity to gluten and wheat should not consume the cereals."

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