Is it Harder to Breastfeed Now? Systemic Barriers in a Modern World.

by katie black

Despite bubbly magazines and upbeat blogs telling you breastfeeding is one of the most joyful experiences you can have, any mom can tell you that it’s not a simple decision (if you get a choice at all!), or an easy feat. It takes a lot of time, effort, and support. If a mom chooses to breastfeed she’s in for a lot of work, and if she can’t or doesn’t want to she might face mom-shaming or guilt.

The sad reality is a lot of moms know about the benefits of breastfeeding, want and intend to breastfeed, but then bump into obstacles along the way, the majority of which are completely out of their control. A lot of these barriers are systemic, and sometimes even intentional.

In 2023 the medical journal The Lancet published a three part series on the challenges modern women face with breastfeeding to see what needs to change and how.

The researchers point to what they see as the top barriers that are interconnected and systemic:

Gender inequality
Cultural influences
Healthcare inadequacies
Formula company practices

Gender inequality at work and home

It’s no secret that despite the majority of women in the U.S. having jobs, most of which are full time, they’re still doing the majority of child care, domestic chores, and other “care work.” Care work is things like looking after babies and children, those with disabilities, the elderly, or those who are sick. And tasks like cleaning, cooking, and collecting water also fall under care work.

Data from 67 countries shows women do 76% of all unpaid care work, which is three times more than the unpaid care work men do.

The economic value of unpaid care work is huge. But since the rules of measuring GDP don’t count production and exchange that isn’t monetised, it’s economically underestimated. This shapes how people value things like breastfeeding, so policies and resources to support it are not exactly a priority for governments and corporations.

New moms’ careers often take a hit after giving birth as well, even after returning to work. This is because of things like taking breaks to pump milk, or dedicating more time to child care. For example, moms are far more likely than dads to take time off when their kid gets sick.

Currently the U.S. doesn’t have a federal mandate on paid maternity leave, and there’s no national breastfeeding protection law either. So most moms don’t get a choice on whether to return to work or not if their financial situation relies on it. It’s no surprise that North America has the lowest exclusive breastfeeding rate in the world.

The researchers emphasized that giving women the choice to breastfeed benefits everyone and the way our country’s economic performance is measured should change so women's unpaid work and the value of breastfeeding are factored into policy making.

Cultural influences and traditions

Breastfeeding is socially and culturally influenced. If friends or family have breastfed, they can share their experience and give support and encouragement from a place of understanding.

Moms living in a culture that discourages breastfeeding, or has traditions that can harm the experience have a higher chance of stopping breastfeeding early, or not starting in the first place.

For example, if a culture sees breasts as purely sexual, (this is a big problem in the West), women may feel too embarrassed or self conscious to breastfeed, or have less support from their partner or peers.

Across the world, there are different traditions like throwing colostrum away since it’s thought the milk isn’t ready yet, or giving newborns different drinks such as water or tea before breast milk. This practice is strongly associated with worse starts to breastfeeding and how long a mom breastfeeds for.

In the U.S., Black women face unique systemic barriers, and have the lowest breastfeeding rates. This is partly because of slavery in America when enslaved women were used as wet nurses for white children while their own babies went hungry, or weren’t able to breastfeed at all. The effects of this became generational. Many Black moms don’t have relatives that breastfed, so they might not get the support or knowledge they need to even see it as an option.

There’s also discrimination within healthcare.

Healthcare practices

Black families are less likely to get education and support on lactation by health services, and are more likely to be given baby formula at the hospital.

And as for the current programs and education on breastfeeding, a lot of it is white centric and there’s a lack of diversity among lactation consultants.

Among other shortcomings in healthcare: data from 32 countries shows less than half of women giving birth get breastfeeding counseling and just 10% of births occur in facilities accredited by the Baby-friendly Hospital Initiative (BFHI).

The study highlighted three related reasons for why these shortcomings are so common:

Biomedical focused practices

Globally only 12% of healthcare budgets are spent on services that prevent health issues, while 70% are spent on treating them. This not only leads to breastfeeding support and counseling not getting enough resources, but also to the over-medicalisation and overuse of interventions like C-sections. High rates of cesarean sections and separating newborns from moms disrupts lactation and harms the start of breastfeeding. Moms who have C-sections also need a lot of time and support to recover, which affects their physical and mental health, and ability to breastfeed. Overuse of C-sections needs to be addressed.

Plus, health professionals often don’t have the skills, knowledge, and experience to support women and families. It’s common for doctors to not have the right education and training on breastfeeding and infant nutrition.

The researchers found that breastfeeding improves when health systems are women-centered, culturally sensitive, and midwife-led, actively empowering women and letting skilled, knowledgeable, and experienced peers support women during pregnancy, childbirth, and postpartum.

Formula company involvement

The formula industry's influence in healthcare, especially in pediatric nutrition, is huge. Companies offer incentives to healthcare workers, fund research, set infant nutrition guidelines, sponsor events and education, and donate products and equipment to hospitals. This creates conflicts of interest and gives the industry a better reputation among healthcare workers and policymakers. This is possible partly because of the BFHI not being fully enforced. Studies show that BFHI is more effective when used at the health system level, rather than just individual facilities.

The industry's being so involved in healthcare is part of a larger trend of corporations taking part in public services, particularly since the 1990s. This trend of profit-seeking at any cost leads to overmedicalization and promoting solutions that aren’t patient-focused.

Underfunded public services

There’s not enough funding for public services, like healthcare, which means breastfeeding doesn’t get enough support, especially in vulnerable populations. Economic factors and politics are a reason for this underfunding. Conflicts, economic downturns, and disasters make the situation worse. The lack of investment in preventive healthcare is also a huge problem.

Governments often see healthcare spending as a burden rather than an investment, missing out on the economic and social benefits of things like breastfeeding support. The WHO suggests that dealing with tax avoidance and evasion could generate a lot of public revenue without destabilizing economies. Currently, over $1 trillion is lost annually to such practices, disproportionately affecting lower-income countries. The researchers emphasized that there needs to be better regulation of the financial sector to make sure it serves societal needs.

Infant formula lobbying and marketing

The study also pointed to the influence of the global infant formula industry, made of trade associations and covert lobbying front groups that hurt measures set to protect breastfeeding. Despite public commitments to breastfeeding, major corporations often outsource lobbying which goes against the claims they make on corporate social responsibility.

Formula marketing also preys on parents’ desire for their children's health and well-being by suggesting that formula will solve common and normal infant issues. Labels and advertisements frequently promise relief from fussiness, flatulence, and crying, with some even claiming to enhance brain development within 24 hours. But there's no evidence behind these claims.

At a 2017 Vitafoods trade event, industry leaders admitted that the appeal of infant formula lies in giving solutions and peace of mind to sleep deprived, stressed out parents, rather than in the product's ingredients or innovation.

Another point the study adds, companies make out formula to be an empowering tool for women instead of pointing out that the lack of job security and maternity protection takes away the choice to breastfeed or not in the first place.

Conclusion

While the series can’t possibly cover every barrier a mom might face when it comes to making informed decisions about her infant’s nutrition, there are definitely some key systemic issues, and individuals and their families should never be blamed for them.

Addressing gender inequalities, recognizing the economic value of breastfeeding and unpaid work, and keeping corporations accountable are all a must. The study concludes that governments should view investments in breastfeeding protection, promotion, and support as beneficial to society, the economy, and the environment.

If you want more support on your own breastfeeding journey, join the free support group the Lactation Lounge filled with moms who have been where you’ve been and get it. And if you’re curious or concerned about the quality and nutrition of your breast milk, you can actually have it tested to get a food label unique to you along with some dietary tweaks you can make to boost your milk and make it even better.