We don't talk about not wanting to Breastfeed
Some people are unable to establish or maintain breastfeeding because they don't have the capacity to overcome challenges. It might be due to existing mental health issues, lack of social support, relationship problems, financial barriers or lack of motivation. These mothers might describe themselves as not being able to breastfeed, however this is not really accurate. The problems they experienced could be resolved and are overcome all the time. But these individuals were not in a position to do so.
Not everyone wants to breastfeed. Some have life experiences which mean breastfeeding isn't a good choice for them. Some just don't like the idea. They could breastfeed but they choose not to.
It's important that we talk about these people when we talk about population breastfeeding rates. Sometimes data might give the impression that a great many people are physically unable to breastfeed exclusively for six months or to continue to breastfeed for at least 2 years. If a study shows just 29% of babies were exclusively breastfed for 6 months, you might think that 71% were unable to do so. However, a percentage of these parents have chosen not to breastfeed or intentionally introduced formula and/or started solids before the recommended age.
Your Baby, Your Body, Your Choice. But.
By not talking about the discreet difference between can’t breastfeed and won't breastfeed, we maintain the myth that a great number of mothers physically cannot breastfeed. This leads to a lack of confidence among pregnant women who worry they will fall into this group.
More honesty from individuals and more support from society would give an accurate picture of breastfeeding experiences. Not being able to overcome supply issues because you had zero support from your partner and family to do so is not the same as not establishing milk production due to a thyroid disorder.
Mothers say they need better support to breastfeed. But many are unable to describe exactly what that support would look like. Emotional support? Practical support? Medical support? Community support?
When your own mother is constantly pressuring you to give your baby formula and stop breastfeeding them every time they cry, what is the cause of your low supply? You might describe yourself as not making enough milk but, really, you were bullied into bottle feeding instead.
There is a lot of anger in women who see breastfeeding promotion as an attack on their own choices or circumstances. When we explain that the majority of women can breastfeed and physical inability is very low, they are triggered because their own experiences were so overwhelming. If most problems can be overcome, why couldn't you overcome them?
“Insurmountable problems” is a broad definition for why many babies are not fully or partly breastfed. “Perceived Insufficient Milk Supply” is the most common reason women stop breastfeeding. They don't actually lack milk, they lack confidence in their milk. Unrealistic expectations of the feeding, sleeping and crying behaviour of babies in the early months need to be addressed well before babies are born. It is not enough to educate parents though, we need to undo generations of false beliefs on a community wide basis.
If humans were steadily losing the ability to breastfeed babies on a global level, we would see similar data from all countries. However, this is not the case and it is not just differences in culture or socio-economic circumstances. Indeed, women in some affluent countries are more likely to formula feed than women in some poorer nations. There is privilege in being able to choose to use formula when you know you have the water, heat, literacy and facilities to safely and correctly prepare it for your baby. The irony is that public health initiatives focus on teaching vulnerable people the risks of not breastfeeding while affluent women are taught the benefits of breastfeeding.
Affluence allows the privilege of safer formula feeding, through literacy, access to clean water, energy to heat it and income to afford to use it correctly.
One of the most common reasons women give for initiating formula feeding from birth is their experience of trying to breastfeed previous babies. While this is often a motivator for mothers to be better prepared and resourced for breastfeeding success second time around, it is not so for everyone. Some people weren't highly motivated in the first instance. But others have unresolved trauma from their experiences and cannot face a similar outcome. These parents should be offered counselling and given support to understand what went wrong and why, regardless of their intentions.
Most people can physically breastfeed. Not all are supported to do so. And a small minority don't want to.
Premature introduction of solids
The recommended age to introduce solids is six months. When breastfed babies are prematurely given cereals, purees and other foods they are no longer considered exclusively breastfed and this can skew breastfeeding data. Mothers might be surprised to find their babies are classified alongside those who are fully formula fed but the fault is in the language used in data collection. You can see it is this example from the Australian Bureau of Statistics in 2017/18:
29% of children aged 6 months to 3 years were exclusively breast fed to 6 months.
48% of children aged 6 months to 3 years were introduced to solids at 6 months or later.
Public health initiatives to improve breastfeeding rates, especially exclusive breastfeeding for six months is not judgement of individual circumstances or choices. Globally, we need to do better. Nationally, we need to do better. Individually, we need to do more to support others - as well as make informed decisions we are comfortable with.
