Several weeks ago I read this great post by amoment2think about reasons why women stop breastfeeding. It was a really good post. It was inspired by another thoughtful post over at PhD in Parenting. Now I will say here that I didn't really love the original post because I think it spent too much time formula bashing and the resulting comment stream had not so subtle overtones of "if only doctors/nurses/mothers were not so stupid as to fall for formula's tricks then we would all breastfeed because it is the only acceptable choice." I know this was not the intent of the author, she merely points out how formula prevalence may contribute to a complicated issue, but sadly whenever the words "breastfeeding" and "formula" appear in the same post, the storm of righteousness (on both sides) tends to appear. amoment2think explains the case against blaming big formula way better than I can, so read both of the posts, then head back for my bit of input...its cool, I will still be here.
Now, both of those posts address really great points, but I think they both miss two huge issues: mothers sense of self and having a lifestyle conducive to breastfeeding. I know why these don't get talked about a lot, but I really think it is important that they do get discussed. If we are all going to work hard towards understanding why women who start out wanting to breastfeed don't always do so in the long-term, and hopefully create a system where all women who want* to breastfeed are eventually able to, then we do have to take a long hard look at these items.
First up is mother's sense of self. Breastfeeding, especially in the long-term, means you are still essentially pregnant. You must serve, to some extent, at the beck and call of the child you are now supporting with your body and your body alone. This is hard for some women. We live in a society where, as women, everything about our bodies can be considered public domain so adding in that now you will spend upwards of 2 years being a 24 hour buffet for another person can be really difficult to stomach. If you have had a difficult pregnancy or delivery, this may feel like insult to injury. These feeling are normal and perfectly appropriate (with the standard disclaimer that if you feel completely overwhelmed by this emotion all the time get thee to a doctor for PPD help), but they can make it so tough to get through those weeks where all you do is nurse the baby. Not everyone can get over that. Some women who do breastfeed feel this way, and don't enjoy the activity, but manage to do it anyway. Some women enjoy the feeling of being special because they now play the largest role in their babies' lives, and the new sense of self fits them well. Some women just plain get off on the martyrdom of it all. However, some women cannot overcome this and the bad feelings associated with nursing may far outweigh the perceived benefits. This does not make these women bad people, it just means that nursing is not a good choice for them. We need to acknowledge that these feeling are real and acceptable. This may not be something we can fix, but it is certainly not something can just be ignored.**
Second, and perhaps far more important is the idea that not everyone leads a lifestyle where they can just drop everything and do whatever it takes to breastfeed. When I talk about this I am alluding to many factors, but most importantly I am alluding to socioeconomic status. This is often not discussed because it is rude and it is often not studied because socioeconomic status is notoriously hard to identify in a quantitative manner for analysis. Long story short, success with breastfeeding depends heavily on having the time to get it properly mastered and on the ability to keep supporting it long term. For women who work outside the home this means you need ample maternity leave and a job that allows the flexibility and support to pump. Workplace support and decent maternity leave is hard enough to get in nice salaried office jobs so you can bet your buns that women who work in hourly unskilled labor (the women who are most likely to need to go back to work as a matter of basic solvency) don't get enough time off postpartum or a place to pump during a shift. It is not that they are too stupid to chose breast milk, or that they lack dedication to raising their children, it just means that they may have to chose between nursing and paying bills.
Of course, things other than working outside the home can make it unrealistic breastfeed. Maybe you are home, but still a functional single parent and someone has to make sure the groceries get purchased and laundry gets done. Maybe you have older children and can't be limited in activity by nursing all day, or you have an older special needs child so other aspects of family development are more important. These are not women who are being selfish or who are unwilling to commit. These are women who need to make real choices about what is best for their family. Now tons of women overcome these challenges, but tons don't and we can't just pretend that these factors don't have a huge impact on long term breastfeeding rates. Again, I am not sure how we "fix" this, but writing these women off as "not trying hard enough" or "not willing to prioritize" is certainly not the answer.
I think that these factors may play a much larger role than anyone realizes and sadly, they are also the hardest hurdles to remedy. This kind of harkens back to my post about awareness campaigns. Maybe we need to spend less time touting the evils of formula, or the natural/easy/cheap/blissful aspects of breastfeeding and focus on social/political changes that really help families. Better maternity leave, more workplace support for pumping, pushing for research to improve the nutrition/safety of formula and more discussion of alternative/combination feeding choices (we need not be stuck in the only formula vs. exclusively breastfed from the tap dichotomy) might be the real answers to increasing the number of women who provide breast milk to their children for those "ideal" time frames.
*Wanting to breastfeed doesn't inherently equal being a better parent, but wanting to do so means you should be given every possible chance to make it happen. Women who know they do not want to breastfeed are still making a good choice, but they are no longer the target demographic for the sake of this discussion. They do not need to "saved" from their choice in any way. The hardest part about this whole discussion is separating the idea that we need to support women who chose to breastfeed from the idea that we should try and make everyone chose to breastfeed because "we" know it is better. We need to do more to adequately support, and respect, all choices on the spectrum.
**Personal anecdote: having nursed my first for her first month and then
exclusively formula fed my second, the first few months of having a baby
are demanding as hell and no matter what you chose, that baby owns you
and works you like a rented mule. I am not saying that formula is
the easy path to low maintenance parenting (nothing makes this easy, trust me), I am merely saying that if this
feeling of overwhelming loss of self is an issue, that bottle can
take the sting out of the situation and that can be a really good thing.