*This post is adapted from one I wrote in June 2012.

Everywhere we turn, there is an abundance of information about the value of breastfeeding. Breastfeeding saves lives and money, promotes good brain development and even helps mitigate the affects of tragedy or disaster, to name a few recently cited reasons why new moms should breastfeed. The assumption is since breastfeeding is best for baby, it should be The Choice for every new mom. That’s not the case, however, as this post will discuss. I love that breastfeeding is such a popular topic (I wish another public health issue- intimate partner violence – received as much attention and support!) but saying “breast is best” ignores and marginalizes the experiences of mothers who cannot breastfeed.

Research tells us that there are no end to the benefits a baby receives when she is breastfed but what we don’t hear discussed as often, and which should be given at least as much attention, are the challenges that new moms face in breastfeeding. New moms encounter two kinds of challenges as they tackle breastfeeding for the first time: “general” ones (making sure baby has a good latch; dealing with an over-supply/under supply of milk; how to express efficiently, etc.) and “individualized” ones that are more complex and less talked about (the privilege of breastfeeding; negotiating the task of breastfeeding when you work outside of home; emotional and physical triggers involved with breastfeeding). Often the “general” challenges, while they can be emotional, are a result of a physical issue and can be an easier fix, with informed hands-on help. Hands-on help can come from a number of resources including the family’s post-partum doula, a CLC/CLEC or IBCLC, a pediatrician, or any number of internet resources (such as this great video on maximizing production). For my purposes in this post, I’m going to leave “general” challenges aside and concentrate on the “individualized” challenges behind why saying “breast is best” is problematic. The focus will be on the US as that is my experience.

As a new or expecting mom, the assumption is that you will do what is best for your baby and choose to breastfeed. For many moms that means making the commitment to breastfeed during their maternity leave, if they meet certain criteria. Some moms also choose to breastfeed for six months, i.e. until baby is ready for solids (although the age indicator is arbitrary and one should go by baby’s signs of readiness instead.). Other moms have the goal of one year. One year is the time recommended by the AAP although the WHO recommends two years. Obviously behind any good intention lay many complicated issues, an important one of which is privilege.

Being in a position to exclusively breastfeed your child for any amount of time is a place of privilege. Note: for my purposes here I am defining “exclusively breastfeeding” as feeding baby only breastmilk, either pumped milk or milk directly from mom. Exclusively breastfeeding often takes substantial early effort to ensure success and while it becomes more effortless, maintaining an exclusively breastfed baby takes a considerable amount of time on the part of the mother. Let’s look at both of those parts a little more closely:

Breastfeeding may be the “most natural thing in the world” but it’s not easy. Getting it right (pain-free for you and meeting the needs of baby) is learned. Remember the “general” challenges (good latch, etc.) that I discussed above? They may be “general” but these are often reasons why moms decide not to breastfeed.
Time. Newborn babies should be fed 10-12 timeswithin a 24 hour period. And even after the first two weeks, baby still needs to eat 8-12 times within 24 hours. Even now at 13 months, Elisabeth nurses generally every 3-5 hours, although not as often overnight. That’s a lot of time that mom spends feeding a baby!

Given these two factors of time and effort, obviously then there will be some women do not have the luxury of choosing breastfeeding. Which new moms then will be disproportionately challenged more than other moms? Answer: poor women for three main reasons-

Poor women are more likely to be employed part-time at low wage jobs (fast food staff, gas station attendants, etc.) which do not really support a breastfeeding mom, either because their maternity leave was short or non-existent or that the infrastructure of the job is such that 20-30 minute breaks to pump milk isn’t possible* even if employers are required by law to support a breastfeeding mom;
These moms are also less likely to get the support that they need to fix those early “general” challenges because of: costs associated with that help; logistics involved with getting the help (transportation, finding the help, etc.); a lack of knowledge that such help exists and which laws and resources protect their rights as a mom;
Finally, poor women are also more likely to have more than one child that they care for, either full or part time.

Poor women, then, are hit with a triple whammy of obstacles that often exist even before their baby is even born. And these are the obvious obstacles. Perhaps you can think of other obstacles such as culture and family history, an unsupportive or even abusive partner, an unhealthy body image and/or a history that includes mental health issues.

Consider the life story of a newly separated woman, Maria, for example. Maria breastfeeding is not a choice because:

Circumstances: Maria’s baby was born early, started on formula at the hospital and the lactation consultant at the hospital didn’t visit Maria until the 2nd day of their stay;
Resources: Maria works 45 minutes from her home and she doesn’t have the time to pump as often as she’d need to or the extra money for a pump and its accessories;
Family: Maria’s sister watches the baby while she’s at work, raised her children on formula and thinks formula feeding is easier.

Breastfeeding, then, is clearly a privilege that not every woman has. And this is the first of three reasons why I believe we need to stop saying “breast is best”. When we make this assumption, we ignore the life story of the mother and in doing so marginalize and isolate her at a time when she is most vulnerable. This belief is the core reason why I started Outside The Mom Box: all too often our society disregards the needs of the mother as soon as she birthes her baby. Moms’ lives counts too…just as much as baby’s.

Until we have sufficient social systems (from milk sharing programs to lactation rooms in places of work) in place to fully support moms who want to breastfeed but cannot for whatever reason, then we have no right telling women that “breast is best”…and thus shaming moms who don’t, by “choice” or otherwise, breastfeed their baby. Doing so is like telling a domestic violence survivor that she should leave her abusive partner but not provide her with the resources she needs: transportation, a place to go, food to eat or money for her cell phone.

Who am I then, and indeed, who is society, to tell Maria and others that “breast is best”?

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