| 摘要: | 1980年代，世界衛生組織開始強調母乳的重要性、使用配方奶粉的風險，並呼籲會員國訂立哺乳政策。1992年台灣跟隨國際潮流，由衛生署擬定母乳哺育推廣計畫，在多數婦女都在醫院生產的背景下，衛生政策透過考核壓力，迫使產科機構轉型為母嬰親善醫院，由醫護人員臨床協助婦女哺乳。此後關於臨床哺乳的文獻逐漸累積，歸結出婦女因個人意願而不願哺乳。隨著民間母乳支持團體成員、若干兒科醫師的持續發聲，援引系統知識指陳產科照護流程制度性地箝制了婦女的哺乳能力，宣稱婦女哺乳與否並非個人意願的問題，將哺乳議題指向醫療制度面的討論。不過該類團體仍停留在小眾推廣的階段，沒有產生廣大的影響力。本研究透過參與觀察、訪談以及文獻探討，進一步理解民間母乳支持團體對產科制度的批判，以及團體擴張無效的原因。 研究發現，1960年代台灣滿月的嬰兒幾乎以母乳哺餵，隨著產婦集中醫院生產、廠商免費提供配方奶粉給醫院、醫院採用配方奶粉集中瓶餵新生兒，形塑穩固的瓶餵行為與論述，母乳哺育率逐年下降。 1992年後產科機構面臨政策壓力而改革，但是人事成本控制、分科照護設計、醫護人員缺乏職前哺乳教育、哺乳與醫療未形成整體觀，故不易產生制度性的變革。此外，醫護人員容易視哺乳為醫療問題，忽略出院產婦需要社會支持，未能與母乳支持團體建立對等的合作關係。 母乳支持團體因為提供系統知識，增加婦女反思常民養育觀、抵抗產科規訓的能量，使婦女藉由知識重新肯定哺乳行為、堅持哺乳。不過團體缺乏由下而上改變產科制度設計的企圖，僅能協助哺乳意願較強、主動求助的婦女，以小眾模式推廣。我們歸結出，產科機構未預設婦女必然哺餵母乳的情況下，廣設母乳支持團體對提升母乳哺育率的效果十分有限。
In 1980s, World Health Organization (WHO) begins to emphasize the importance of breastfeeding and the risk of infant formula, and to call upon the member states to conclude the breastfeeding promotion policy. Taiwan followed the international trend in 1992. The health policy has been drafted by National Health Administration. With women concentrating to labor in hospital, the hygiene policy forces the hospital of obstetrical department to make the transition for the baby-friendly hospital in order to help women to nurse clinically. Since 1992, relative discussing has been accumulated gradually. The main opinion that will be nursed or not is put in woman's personal will. As the folk breastfeeding support peer groups and some pediatricians’ lasting sound, they quote systematic knowledge and mean the way that obstetrical department take care of mothers and babies is improper And then declare that it is not a question of the personal will whether women nurse or not, the prenatal procedure of obstetrical department will disable women’s nursing ability gradually. They shift the issues of breastfeeding from a personal approach to an institutional approach. But such groups’ influence is still small. In the research, we try to understand more clearly what the folk breastfeeding support peer groups criticize obstetrical department for the improper way to take care of mothers and babies, and the hindrance of the groups’ expanding. According to our research, most one-month babies in 1960s were breast-fed. As woman concentrated to labor in hospital, manufacturers of infant formula offered their production to hospital for free, and the babies in hospital were bottle-fed together, mould the firm bottle-feeding behavior and discourse. The breastfeeding rate dropped year by year. The obstetrical department faced the policy pressure and reformed after 1992, but personnel cost control, the caring design of separating mothers and babies, the training of medical personnel lack of breastfeeding programs, breastfeeding and medical treatment being thought as two different parts, it is difficult to produce the institutional change. In addition, the medical personnel is apt to regard nursing as the medical question, neglect women’s need of the social support, so as to fail to establish reciprocity cooperation with the breastfeeding support peer groups. The breastfeeding support peer groups offer systematic knowledge to women, increase their ability to introspect the view of the local way rearing children and the rule of obstetrical department, make women insist on nursing again with knowledge. But the groups lack the attempt changing the system design of obstetrical department from bottom to top, can only help women with strong will and asking for help voluntarily. We sum up, the hospital of obstetrical department has not preserved under the situation that women must breast-feed, establishing in a wide range of breastfeeding support peer groups to be very limited to the result which improves the breastfeeding rate. |
