When the time came to wean my son, I cried. I'd breastfed him for 16 months — significantly longer than the average American mom — but I still mourned the fact that my baby was growing up, and that we would no longer have the sweet moments of connection that nursing allows.
Nursing wasn't easy, especially at first. My son's latch was imperfect, and in his early, sleepy days I didn't realize he was sucking ineffectively and slipping into jaundice. Getting back on track required a few days in the hospital, several appointments with a lactation consultant, and the support of my husband and family.
The week I went back to work, I began to get chronic, extremely painful clogged ducts. I struggled with oversupply and undersupply. I once had to lug 80 ounces of milk, after rigorous TSA testing, though the airport on return from a work trip. My life for those 16 months was segmented into neat three-hour blocks, at the beginning and end of which I always had something — baby or pump — attached to my breast.
Why I nursed as long as I did
The struggle was worth it, for a whole number of reasons. Nursing soothed my son, and he cuddled into me during his morning and night feeds. I didn't have to pack any food for him when we went on vacation. I knew exactly what he was getting each time he fed. My boy loved nursing, too — he would squeal with delight when he heard my bra clasps unclip. One of his earliest words was "nur-nur!"
But the most important reason I breastfed as long as I did was this: Breast milk is the best source of nutrition for a baby. I don't "believe" that it's best the way I might believe my son is calmed by wearing his amber teething necklace, or hope that it's best because I want to justify having my boob out in public every three hours.
I know that breast milk is best for babies because millions of dollars have been spent on research that over decades has concluded time and again that breast milk is the absolute best source of nutrition for babies. Yes, more research is needed to aid in our understanding of the mechanisms by which breastfeeding benefits both mother and child, but the research that's already been done has made clear that it does.
Despite this research, we're in the midst of a breastfeeding backlash. The past several years have brought a wave of skepticism about the benefits of nursing. In 2009, Hanna Rosin wrote "The Case Against Breastfeeding" for the Atlantic; a few years after that, a dad followed up with "A Father's Case Against Breastfeeding." Courtney Jung wrote a piece for Vox earlier this month calling breastfeeding overhyped; it echoed her essay in the New York Times last October that labeled nursing as oversold. These articles feature frustrated parents claiming that the research on breastfeeding is bad or that pressure to nurse has left formula-feeding parents feeling shamed and guilty.
This backlash misses a crucial point: that the public health push for breastfeeding is designed to eliminate health disparities between the rich and poor and create, at least in early infancy, a semblance of equality in health. Breastfeeding promotion is working and shouldn't be curbed because middle-class parents are tired of hearing it.
Breastfeeding promotion is crucial — in the developing world and the US
When I was a young, childless public health grad student, all of my maternal and child health classes imparted the fact that improving breastfeeding rates was vital to improving population-level health. In class I learned about the benefits to mothers and babies and simply couldn't understand why every mother didn't just breastfeed. It was simple! It was free! It was by far the healthiest option!
A few years out of school and now focusing on adolescent health, I have a toddler and breastfeeding experience of my own to reference. I know now that breastfeeding isn't as simple or free as I once thought. But my knowledge that it's the healthiest option has remained steady.
In a developing-world context, breastfeeding is absolutely vital. Babies who drink formula made with dirty water or who drink inferior or homemade formula that does not meet health standards suffer and die. These babies die of diarrheal diseases or malnutrition in disproportionate and striking numbers. If all babies in developing nations were exposed to optimal breastfeeding practices, 13 percent of children under 5 who die could be saved. Babies who aren't breastfed and survive are often impacted through stunting, kwashiorkor, or chronic infections and illness.
In an American context, mothers and babies have access to clean water (except when they don't, as the Flint, Michigan, water issue has shown us) and high-quality formula. Formula has been getting better and better as scientists work to create breast milk substitutes that look and act more like the real thing.
Breastfeeding promotion is working and shouldn't be curbed because middle-class parents are tired of hearing it
Here, breastfeeding advocacy is less about harm reduction and more about ensuring that the benefits of breastfeeding are offered to all. Your baby won't die from drinking formula, or be made stupid or sick. But if your baby does breastfeed, he or she has the opportunity to develop an enhanced immune system, has a greater likelihood of avoiding several chronic, debilitating illnesses, and is more likely to remain a healthy weight through infancy, toddlerhood, and childhood.
Mothers also reap significant benefits. Breastfeeding has been shown to reduce the risk of certain cancers. And the roughly 500 calories per day it takes to produce enough milk for an infant helps mothers return to their pre-pregnancy weight in a healthy and timely manner. When obesity is a issue that impacts low-income women in disproportionate numbers, shouldn't helping these moms return to a healthy weight be a priority?
The clear benefits to mothers and babies are why the America Academy of Pediatrics recommends breastfeeding exclusively until 6 months (which fewer than 19 percent of moms end up doing) and in complement to starter foods through at least 12 months. The World Health Organization recommends nursing for even longer and has conducted extensive research to back the claim that breastfeeding has health benefits through a child's second birthday.
What breastfeeding advocates missed: Nursing can be really, really hard
What the World Health Organization, the American Academy of Pediatrics, and many other organizations failed for too long to note, however, is how difficult breastfeeding can be. Yes, they showed the world how beneficial breastfeeding was, and, yes, they helped design policy to ease the transition back to work. But the messy, exhausted moments that change a mother's mind about breastfeeding? The bleeding nipples, the crying baby, and the paralyzing fear that the baby's not eating enough? The back-to-work struggle and the boyfriend who thinks breastfeeding is dirty?
Those were, for a long time, left out of the breastfeeding conversation beyond a cursory, "Yes, it will be hard, but it will be worth it."
It's this difficulty, and the fact that it remains unaddressed in many ways, that drives so many women to start supplementing with formula or to stop nursing altogether. The most frequently cited challenges associated with breastfeeding include pain, supply issues, work-related pumping issues, and lack of support.
These challenges, present for most women, are felt most acutely among low-income women who don't have access to lactation consultants, lengthy or flexible maternity leaves, nursing and pumping rooms at work, and partners who understand the benefits of breastfeeding.
Better policies are helping low-income women nurse, and nurse for longer
In recent years, breastfeeding advocacy and policy has shifted to address these concerns in ways that help low-income mothers come closer to having the same opportunity to give their children breast milk. Breastfeeding support is now built into the way women experience health care, and it's this support, so vital to low-income women, that so often annoys middle-class breastfeeding skeptics.
With President Obama's Affordable Care Act came legislation requiring insurance to pay the full cost of birth control — when pregnancy is planned, the mother is more likely to breastfeed, and when subsequent pregnancies are delayed, she's more likely to breastfeed for longer. When that woman does become pregnant, she has increasing odds of delivering her baby at a baby-friendly designated hospital, one that supports rooming in, provides access to a lactation consultant, and does not give formula without the mother's specific request.
When she heads home and back to work (which happens very quickly if she's a low-income woman), she likely now has access to lactation support through her baby's first year as well as an insurance-provided breast pump. She also, thanks to the ACA, is much more likely to have an employer that's mandated to provide reasonable pumping breaks until her baby's first birthday. The laws aren't perfect, and swaths of women are still left out, but they're far better than they used to be.
Prior to this legislation, women had less access to birth control and were more likely to give birth at a hospital that sent them home with cans upon cans of formula. Women had to pay out of pocket for their pump and then hope their employer let them use it. The women who had the income, resources, and social capital to pull all that off were far more likely to be middle- and high-income women. And those without? Their babies were left, in the first days and weeks and months of their life, without the opportunity to receive nutrient-rich breast milk.
Breastfeeding advocacy and policy helps low-income mothers get the same opportunity to give their children breast milk
Women who work outside the home and breastfeed largely use pumps to supply milk for their babies. With more than a third of women working full time outside the home in their babies' first year, and low-income women returning to work sooner than their middle- and high-income counterparts, frequent pumping has become a reality of modern motherhood.
In her piece, Jung equates pump companies with "big business" — but almost any industry whose primary driver is that humans need to eat is going to make big money. Pump companies, and government regulations that provide women access to pumps and pumping time, are designed to be equalizers — they allow low-income women the ability to provide breast milk (something far more middle-class babies are getting) for their babies even when they have to be away from them.
And if we want to talk about business that profits from the nutritional needs of babies, we must discuss formula companies. Yes, formula is necessary for babies who cannot receive breast milk because of their or their mother's individual circumstances. But formula companies target mothers at their most vulnerable and are very aware that lower-income women are far more vulnerable to breastfeeding challenges than middle- and high-income women.
Similac, one of the largest formula manufacturers in the US, focuses its ads on making breastfeeding versus formula look like just another inconsequential parenting choice, such as using a stroller versus wearing your baby. These ads reaffirm that anyone who dares say that breastfeeding is better than formula feeding is a jerk, someone who wants to prove she's better than others and who has no problem igniting mommy wars.
Yes, sometimes breastfeeding doesn't work – but that doesn't mean we should reject it
As pro-breastfeeding as I am, I recognize that there are often circumstances in which breastfeeding doesn't work or doesn't make sense for a mother and child. But just because something doesn't work for us, or for lots of people, doesn't mean that we should try to debunk its value.
I'm an educated woman, but from time to time I make decisions that are not in line with medical recommendation. The American Academy of Pediatrics recommends that babies ride in rear-facing car seats until they are 2 years old. When my son was only 20 months old, I made the decision to flip his seat to face forward. In much the way that a frustrated mother whose baby won't latch decides to switch to formula, I concluded that a mom distracted by a crying baby might do better overall if the child were facing frontward and calm.
The thing is, I don't get upset when I see car seat safety PSAs. I don't try to bend science and assert that it really doesn't matter which way a baby faces. I am grateful that the research has been done —and grateful when another mom points out that my son might be safer facing backward, because it means people are looking out for me and for my son.
For a middle-income woman who has had the time, education, and support to do ample research on infant feeding and care, it may be annoying to hear a nurse choose not to talk about formula or to hear lactation consultants impart the benefits of rooming in and breastfeeding.
But for a poor woman, or a younger woman or a less-educated woman, the hospital may be the first place she has had exposure to this information. In an attempt to justify a decision that needs no justification — it's your baby and your choice — breastfeeding skeptics unwittingly undermine years of public health work that was designed to level the playing field, not make well-to-do moms feel bad about themselves.
Julia Pelly has a master's degree in public health and works full time in the field of positive youth development. She is writing a memoir on pregnancy, motherhood, and sisterhood. She lives in Charlotte, North Carolina, with her husband and son.
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