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Barriers to Breastfeeding: Why U.S. Rates Are So Low

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I am a writer, mom of two young children, and public health professional with over 15 years' experience.

Despite the known benefits of breastfeeding, many parents begin using formula when their babies are just a few months old.

Despite the known benefits of breastfeeding, many parents begin using formula when their babies are just a few months old.

How Many Mothers Breastfeed in the U.S.?

Breastfeeding has many known health benefits for mothers and babies alike. Breast milk provides the best nourishment for a child, fights against childhood diseases and obesity, reduces healthcare costs, and is free and convenient.

American women want to breastfeed—in 2017, about 84 percent initiated breastfeeding in the hospital, per the Centers for Disease Control and Prevention (CDC). Despite this, long-term rates of breastfeeding in the U.S. are astoundingly low, and women often do not get the support they need to do so successfully.

Breastfeeding Rates in the U.S.

Rates of successfully breastfeeding in the U.S. are low relative to other countries. In countries considered to be less developed, the rates at six months were considerably higher. In Rwanda, the rate was 86.9 percent, in Burundi 82.3 percent, and Sri Lanka 82 percent, according to UNICEF.

In the U.S., only 25.6 percent of children are exclusively breastfed at six months, according to the CDC's 2017 Breastfeeding Report Card. This is despite recommendations from the World Health Organization (WHO), American Academy of Pediatrics (AAP), and the CDC itself to exclusively breastfeed for six months.

The CDC sets health goals for the population every 10 years. Regarding breastfeeding, their goal was to increase the percentage of infants who are still breastfed at six months to 60 percent by 2020. But even in California, the state with the highest number of baby-friendly hospitals (95 percent) and one of the highest rates of breastfeeding, only 28.2 percent of infants are breastfed exclusively through the six month mark. Baby-friendly is a term coined by a UNICEF initiative, which I'll explain in just a bit!

Why Are Rates So Low?

Why is it that despite the known benefits of breastfeeding, the desire of women to breastfeed, and the recommendations of health agencies, rates of breastfeeding in the U.S. are so abysmal?

Here are the reasons we'll look at:

  • Lack of support in hospitals
  • Marketing by infant formula companies
  • Negative social attitudes
  • Short maternity leave
  • Inconvenient for work

Lack of Support in Hospitals

The vast majority of births in the U.S. are in hospitals. From the moment babies are born, hospitals stack the cards against women for breastfeeding success. Too few staff are adequately trained in lactation issues, and their attitudes can discourage the practice.

Hospitals also routinely engage in practices that decrease breastfeeding success. Distributing formula and bottles, taking the baby away from the mother rather than allowing for immediate bonding time after birth, and encouraging moms to have babies sleep in the nursery rather than "rooming in" with the mother are all factors that decrease a woman's likelihood of breastfeeding.

To support and increase the number of facilities around the world encouraging breastfeeding, UNICEF launched the Baby-Friendly Hospital Initiative around the world.

Countries adopting "baby-friendly" hospital standards have seen breastfeeding rates increase dramatically. As of 2016 in Cuba, all hospitals are designated baby-friendly, and the rates of women breastfeeding when leaving the hospital were nearly 100 percent. However, even in Cuba, the rates fell to only 41 percent at the six-month mark.

In 2019, in the U.S., only 28 percent of births happened in hospitals designated as baby-friendly. This does mark an improvement—in 2007 it was less than 3 percent.

Aggressive Marketing by Infant Formula Companies

Formula companies, in an attempt to sell their products, aggressively market to pregnant women. They send coupons to expectant mothers, give free samples and “starter” kits to hospitals to deliver to women, and send samples to mothers at their homes.

While these practices may seem innocuous, they further contribute to an environment that pushes women’s decisions away from breastfeeding and towards formula feeding.

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Negative Societal Attitudes

Even as public health officials push for increased breastfeeding rates, women are repeatedly reminded that it isn't widely accepted in our society. Even among supportive groups of women, plans to breastfeed exclusively or beyond one year are often questioned or frowned upon. Women breastfeeding publicly can face stares, smirks, or inappropriate comments.

The 2006 story of a woman being ejected from a flight because she refused to "cover up" while nursing is just one of many stories that demonstrate how breastfeeding in public is not universally acceptable. Stories of women being asked to cover up, move to a bathroom or otherwise private location, or leave stores or courtrooms to nurse are all too common.

A side product of the negative societal attitudes towards breastfeeding is that nursing is not seen in our culture. By keeping it hidden, breastfeeding stays foreign, taboo, and stigmatized. Most people in the U.S. do not see it as a normal or natural part of parenting and don't see models of breastfeeding moms in their daily lives.

Short Maternity Leave

Studies show that allowing mothers more time for maternity leave encourages higher breastfeeding rates. Yet, the U.S. is one of only a few other countries that don't federally require paid maternity leave (the others being the Marshall Islands, Micronesia, Nauru, Palau, Papua New Guinea, and Tonga). It's left to private employers to implement.

In the U.S., some areas have implemented paid maternity leave for mothers, including California, Hawaii, New Jersey, New York, Rhode Island, and Puerto Rico. The Family and Medical Leave Act (FMLA) does provide a total of 12 unpaid weeks. But still, this only applies to companies with 50 or more employees and makes having a newborn much more of a financial risk.

The period of paid leave in European countries varies. Up to one year is not unusual, with some countries allowing up to four.

Inconvenience at Work

Recent laws now require employers to make reasonable accommodations for nursing mothers, providing them time (though not necessarily paid time) and a private space (not well defined) to pump at work.

Despite this, women still have an uphill battle when navigating pumping at work, facing uncomfortable conversations with their bosses and disapproving comments from co-workers. The CDC reported in 2018 that only 49 percent of employers provided onsite lactation spaces or programs.

The inconvenience and social unacceptability are enough to convince many women to give up, despite studies proving the health benefits of breastfeeding.

What Is the Future of Breastfeeding in the U.S.?

Women today face many challenges when it comes to breastfeeding. Even the most committed moms may find themselves unable to nurse due to lack of milk supply, pain when nursing, or a child who simply can not latch on.

Yet, the numbers demonstrate that other factors are at work in decreasing the rates of U.S. women who nurse successfully. Policies and practices in hospitals, attitudes and behavior of families, friends, and communities, and issues in the workplace all shape the context in which women start (and decide whether to continue) breastfeeding.

To make meaningful changes in the numbers of women who breastfeed successfully, we must alter our national mindset to one that embraces and promotes the practice. We must give women and their babies the highest possible chance of breastfeeding success.

Sources

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

Comments

LauraGT (author) from MA on March 26, 2013:

Thanks for your comment exphoebe. It makes me sad that breastfeeding is still seen as something that needs to be kept separate. It's especially interesting in that in a church setting, a holy setting, something so natural as feeding one's child would be seen as at all related to pornography! I think if some of these folks saw breastfeeding in public they would be disappointed by the lack of breast exposure!!

exphoebe on March 19, 2013:

What a great hub! You are so right on pointing out the many reasons women tend to bottle feed instead of nursing their babies. I have nursed all of my children I believe that is the reason my children are usually healthy and have a strong bond with me.

I live in Utah and just recently read an article where breastfeeding in a church became an issue. I never ran into much opposition myself but definitely have felt alienated while breastfeeding. Some LDS churches have specific rooms for nursing mothers and when you have a newborn you will spend most of church time in there. Socially you are cast out during the breastfeeding month. LDS claim the open breastfeeding creates a porn problem. Ridiculous!

LauraGT (author) from MA on September 27, 2012:

KCap: Thanks for sharing your story and perspective. I completely agree that a lot of the problem is in our societal norms around breastfeeding. I think in some parts of the country it has become completely fine to breastfeed in public. But, I'm still distraught by how many young mothers feel that they can't breastfeed in front of others, even other mothers, and feel that they need to cover themselves up or go to another room. Well, one breastfeeding mother at a time...

Kelly Capozzi on September 26, 2012:

This is a really good hub. I am very passionate on the subject and wrote a similar hub after there was so much controversy over that photo of women breastfeeding in uniform.

I received a tremendous amount of support from the nurses in the hospital when I had my son. My situation was little different than most because my son was premature so I had to pump rather than nurse but it was strongly encouraged and supported by all. I think that the main reason that the rates are so low in the U.S. is because of the way it is viewed in the public. It makes people uncomfortable and it really shouldn't. What will make people more comfortable with it is to be exposed to it more and starting at a young age. Before I had my son, I might have seen a handful of women in my life nurse their babies. If children are taught from a young age that this is how mommies feed their babies and they are exposed to it then it will be"normal" to them as they grow up. Americans just need to get over their stigma about breasts and stop sexualizing them. Just my 2 cents

LauraGT (author) from MA on May 07, 2012:

kkflowers: Thanks for sharing. I'm glad it has worked out for you! Yes, it is horrible that women have to choose between their careers and their children, especially on something as basic as breastfeeding.

LauraGT (author) from MA on May 07, 2012:

Lovesleftovers: Thanks for reading and sharing your experience. It's amazing how the support of even one person can make a big difference. Imagine if all women were supporting by not just the individuals the individuals in their daily lives but also the institutions that usher them into mother hood!

LauraGT (author) from MA on May 07, 2012:

Kelleyward: Thanks for your comments. I agree that getting support is such an important factor in breastfeeding success. Where our society fails, women can hopefully make up the difference by setting up supports for themselves and for each other!

LauraGT (author) from MA on May 07, 2012:

Pamela N Red and Kschimmel: Thanks for commenting. I agree that we have a very mixed up view of women's breasts and that they are too often sexualized. It's sad that women feeding their children is layered with this.

Kimberly Schimmel from North Carolina, USA on May 05, 2012:

Pamela is right on. A woman breastfeeding while covered up is considered shocking, while a Victoria's Secret fashion show doesn't raise an eyebrow. I nursed 5 of my 6 and could have nursed all if I hadn't been too proud to ask for help with my first baby.

kkflowers on May 05, 2012:

I find it a little shameful that our government doesn't extend disability benefits to a more reasonable time (at least 3 months!) In a way, I was lucky that I was laid off before the baby came so I didn't have to go back to work and I could collect unemployment after disability. My heart goes out to all the moms that have to stop breastfeeding and go back to work as well as the one's that manage to pump and continue while working!

I also had a very rough start to breastfeeding and tearfully thought I wasn't going to be able to continue. We made it through, thanks to the free visits to the lactation consultants at our hospital and my perseverance and now at 5 months, still going strong! Maybe I will share my experiences on a hub one day to help others with similar situations... :)

Thanks for the hub!

lovesleftovers from Texas on May 05, 2012:

Thanks so much for this article! It’s an extremely important subject and you’re helping to get the word out that breastfeeding is best for both babies and moms. A recent study showed that breastfeeding moms lost their baby weight faster and more naturally. And, like you mentioned, it’s free. Estimates show that the amount of money saved on formula is equal to the purchase price of a new kitchen appliance. I breastfed all three of my children and I remember that it was difficult with my first son. I was fortunate enough to have a patient and knowledgeable nurse to show me properly, but that was quite a few years ago. Incidentally, all my children were bottle fed once their teeth came in (ouch), but by then they had received the necessary nutrients and antibodies that babies need. Thanks again for sharing this wonderful, informative article!

kelleyward on May 05, 2012:

Thanks for sharing this useful hub. I'm gonna to link this to my new hub I wrote on how to wean a breastfed baby. I nursed all three of my boys for 1 year each and it was a wonderful experience. I can't imagine not having this experience as a new mom. I think many moms don't receive the support they need to continue breastfeeding and therefore give up or never start in the first place. Thanks for sharing this! Take care, Kelley

Pamela N Red from Oklahoma on May 05, 2012:

America have sexualized breasts and forgotten their purpose. Women wear revealing clothes to show them off to men and get implants increasing this problem.

Breasts are for babies, not men, until America changes this attitude these statistics will continue.

LauraGT (author) from MA on April 06, 2012:

Lord de cross: Thanks for reading and commenting. That's right, only 15% exclusively breastfeed at 6 months, a far cry from the Healthy People 2020 goals. Hopefully, there can be a shift in practices and attitudes that will help move this more in a positive direction!

Joseph De Cross from New York on April 06, 2012:

Staggering! Only 15% do breastfeed their babies. And we see why we get coupons for formulas and free packages.

Thanks for the insighful hub!

LORD

LauraGT (author) from MA on April 02, 2012:

Thanks for your comment, TXmom. It is very interesting. I personally think other cultures don't have such a mixed up view of breastfeeding. They see it more, so it's not as strange and is just more widely accepted, which I think makes it easier for moms all around. Also, since it's more the norm, women have more support.

TXmom on April 02, 2012:

Wow, I had no idea rates were so much lower here than in the rest of the world. Makes you think!

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