Do some women feel stigmatized if they are unable to breastfeed?

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“Breastfeeding benefits babies and mothers. It is one of the most effective measures that a mother can take to improve the health of her baby and herself,” Dr. Nancy Lee, deputy assistant secretary for Health and Women’s Health at the US Department of Health and Human Services, told Medical News Today.

Such a statement is unlikely to be a surprise for new or expectant mothers. In recent years, there have been an array of campaigns focused on increasing breastfeeding rates.

One in particular is happening as you read this: World Breastfeeding Week – a campaign launched by World Alliance for Breastfeeding Action (WABA), which takes place August 1st-7th every year.

This year’s campaign slogan is: “Breastfeeding: A Winning Goal for Life!”. According to WABA, the slogan aims to highlight how early, exclusive and continued breastfeeding can help achieve the Millennium Development Goals (MDGs) – a set of eight objectives set up in 1990 by governments and the United Nations to help tackle poverty and promote healthy and sustainable development.

And such campaigns seem to be working. In the US alone, 79% of newborn infants began to breastfeed in 2011, increasing from 71% in 2000.

Why is there such focus on breastfeeding?

Breastmilk is rich in nutrients and contains antibodies that can help protect the baby from infection and assist healthy growth.

Past research has suggested breastfeeding can reduce a child’s risk of sudden infant death syndrome (SIDS), obesity, asthma, diabetes and even cancer.

Earlier this year, MNT reported on a study published in the journal Applied and Environmental Microbiology, which claimed breastfeeding helps infants grow friendly gut bacteria. Another study published in JAMA Pediatrics suggested that continued breastfeeding could even improve a child’s intelligence later in life.

But it is not only good for infants. Research claims breastfeeding can also reduce a mother’s risk of certain types of breast cancer, ovarian cancer, type 2 diabetes and postpartum depression.

As a result of these potential benefits, the World Health Organization (WHO) recommend that women exclusively breastfeed their infants in the first 6 months of life, and solid foods should be introduced at 6 months to complement breastfeeding for up to 2 years or more.

In the US, the American Academy of Pediatrics support such recommendations but state that breastfeeding should continue until the child is at least 12 months of age.

Although the number of mothers initiating breastfeeding is on the rise, however, the rate of continued breastfeeding is lagging behind.

Are recommendations for continued breastfeeding achievable?

Healthy People 2020 – 10-year national objectives set by a diverse group of individuals and organizations in 2010 with the aim of improving the health of all Americans – aim to increase rates of breastfeeding at 6 months to 60.6% in the next 6 years, and rates of breastfeeding at 12 months to 34.1%.

But of infants born in the US in 2011, only 49% were breastfeeding at 6 months, reducing to 27% at 12 months. This poses the question: why are so few mothers engaging in continued breastfeeding?

A 2012 study published in the journal BMJ Open – which surveyed infant feeding experiences of new mothers and their partners – revealed many new and expectant mothers see global policies recommending exclusive breastfeeding for up to 6 months as “unrealistic” and “unachievable,” with some stating that the recommendations “set them up to fail.”

Essentially, mothers in this study felt they were not receiving the support they needed to continue breastfeeding. Some stated that health care workers appeared solely focused on ensuring mothers reach the minimum 6 months exclusive breastfeeding target, rather than focusing on what is best for both mother and baby.

The researchers wrote:

“By promoting 6 months exclusive breastfeeding, policy makers are encouraging idealistic expectations and goals in pregnancy, but health services are not providing the skilled help required to establish breastfeeding after birth.

This mismatch between idealism and realism is likely to be a mechanism behind the media stories of mothers feeling pressurized to breastfeed.”

Are women ‘stigmatized’ for not breastfeeding?

Of course, not all women find it easy to breastfeed. In a 2012 article published in The Independent, a 28-year-old mother explained:

“Breast might be best, but it’s by no means easy. It can hurt; it’s physically draining, and constant. It means leaking and chapped nipples, industrial bras, and if you’re going back to work, pumping in the loo at lunchtime to keep up your supply. It took a local support group and antibiotics (for mastitis) to get me through the first month.”

Some mothers are unable to breastfeed their infant. Estimates indicate that up to 5% of new mothers are unable to breastfeed for various reasons, such as medical illnesses that reduce their breastmilk supply.

Earlier this year, MNT reported on a controversial study claiming that the benefits of breastfeeding are “overstated,” and that it is no better than bottle-feeding for long-term health outcomes, such as obesity.

Lead author of this study Cynthia Colen, assistant professor of psychology at Ohio State University, claimed that recommendations of continued breastfeeding could stigmatize women who are unable to breastfeed their babies.

“We need to take a much more careful look at what happens past that first year of life and understand that breastfeeding might be very difficult, even untenable for certain groups of women,” she said. “Rather than placing the blame at their feet, let’s be more realistic about what breastfeeding does and doesn’t do.”

This is echoed in a recent study conducted by researchers from the University of California-San Francisco (UCSF), which claims that breastfeeding advice for women should rely on scientific evidence, not “social advocacy.”

Pediatricians ‘should not succumb to social advocacy’

As stated previously, breastfeeding is associated with numerous long-term health benefits. But leader of the UCSF study Dr. Valerie Flaherman notes that more recent research – such as the study led by Colen – suggests breastfeeding may not have as many benefits as originally thought.

She believes that some social organizations or campaigns, however, continue to emphasize certain studies that promote benefits of breastfeeding even when there is insufficient evidence to support them. She says they do this “because the studies advance social organizations’ goals or priorities.”

“There are real and very important health benefits that come from breastfeeding. However, some social advocacy organizations present breastfeeding as a panacea and can stigmatize mothers who choose not to breastfeed,” Dr. Flaherman says, stressing that pediatricians should not succumb to this.

“As pediatricians, we have a responsibility to educate parents with up-to-date information so each mother can make her own decision about how to feed her baby and then support her decision. Breastfeeding is very important, but it’s not an excuse to abandon our role as medical providers and slip into social advocacy.”

‘Every mother deserves information, guidance and support when deciding to breastfeed’

Overall, it seems increased efforts are being made to ensure women are given the support they need to make an individual decision about breastfeeding.

Dr. Nancy Lee, also director of the Office on Women’s Health (OWH) in the Office of the Secretary at the US Department of Health and Human Services, points out that the OWH have launched a campaign called “It’s Only Natural.”

This focuses on helping African-American Women and their families understand how breastfeeding benefits both mother and baby. The campaign also addresses mothers who are having difficulties breastfeeding.

The OWH have also launched an initiative called “Supporting Nursing Moms at Work: Employer Solutions,” which aims to help employers support mothers who are returning to work and wish to breastfeed.

Despite conflicting evidence surrounding the long-term health benefits of breastfeeding, there is no doubt that “breast is best” in terms of the nutrients it provides for the infant.

But as Dr. Lee told us:

“It’s important to remember that the decision to breastfeed is a personal one, and a mother should not be made to feel guilty if she cannot or chooses not to breastfeed. Women need the facts about breastfeeding. Every mother deserves information, guidance and support when making this decision.”

 

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