Barriers to Breastfeeding: Why U.S. Breastfeeding Rates Are so Low
Breastfeeding has many known health benefits to mom and baby alike. Breast milk provides the best nourishment for a child, fights against childhood diseases and childhood obesity, reduces healthcare costs, and is free and convenient. And American women want to breastfeed: about 75% initiate breastfeeding in the hospital. Despite this, rates of breastfeeding in the U.S. are astoundingly low, and women often do not get the support they need to breastfeed successfully.
U.S. Breastfeeding Rates
Rates of successful breastfeeding in the United States are low relative to other countries. In Rwanda, 88% of children are exclusively breastfed at 6 months, in China 76%, and in Sweden 37%. In the US, only 15% of children are exclusively breastfed at 6 months, despite World Health Organization’s (WHO) and American Academy of Pediatrics (AAP) recommendations to exclusively breastfeed for 6 months.
The U.S. Centers for Disease Control and Prevention’s (CDC) sets health goals for the US population every 10 years. Regarding breastfeeding, the CDC’s 2020 goal is to increase the percent of infants who are breastfed at 6 months to 60%. But, even in California, the state with the most baby-friendly hospital policies and highest rates of breastfeeding, only 25% of infants are breastfed exclusively through 6 months.
Why Are U.S. Breastfeeding Rates So Low?
Why is it, that in spite of the known benefits of breastfeeding, the desire of women to breastfeed, and the recommendations of health agencies, that rates of breastfeeding in the US are so abysmal?
- The Baby-Friendly Hospital Initiative
UNICEF's Baby-Friendly Hospital initiative was launched in 1991 to ensure that all hospitals support breastfeeding.
Lack of Support in Hospitals
The vast majority of US babies are born in hospitals. From the moment babies are born, hospitals are stacking the decks against women’s breastfeeding success. Too few staff are trained properly in lactation issues and staff attitudes can discourage breastfeeding. Hospitals also routinely engage in practices that decrease breastfeeding success, such as 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.
Worldwide, countries that have adopted “baby-friendly” hospital standards have seen dramatic increases in breastfeeding rates. In Cuba, for example, almost all hospitals are designated “baby-friendly” and breastfeeding rates have gone from 25 percent to 72 percent. In the US, only 4 percent of hospital have adopted these standards.
Aggressive Marketing by Infant Formula Companies
Formula companies, hoping to sell their products, market aggressively to pregnant women, sending coupons to expectant mothers, giving free samples and “starter” kits to hospitals to deliver to women, and sending 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, towards formula feeding.
Negative Societal Attitudes
Even as public health officials are pushing for increased rates of breastfeeding, women are reminded over and over again that breastfeeding is not 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 Delta flight because she refused to “cover up” while nursing is just one of many stories that demonstrate that breastfeeding in public is not universally acceptable. News stories of women being asked to cover up, move to a bathroom or otherwise private location, and being asked to leave stores or courtrooms, are all too common.
A side product of the negative societal attitudes towards breastfeeding is that nursing is not seen in our culture. Women who do nurse publicly often cover themselves or nurse in “private” places. By keeping it hidden, breastfeeding stays foreign, taboo, and stigmatized. Women 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 make clear that longer maternity leaves encourage higher rates of breastfeeding. Yet, the US joins only Liberia, Papua New Guinea, and Swaziland as one of only 4 countries that do not require paid maternity leave. The length of paid leave in European countries vary, but leaves of one year are not unusual, with some countries allowing for up to 4 years of maternity leave.
Inconvenience at Work
Recent law now requires employers to make some reasonable accommodations for nursing mothers, providing them time (though not necessarily paid) and a private space (not well defined) to pump at work. Despite this advance, women still have an uphill battle when considering pumping at work, facing uncomfortable conversations with their bosses and disapproving comments from co-workers. The inconvenience and social unacceptability is enough to convince many women to give up. The irony is that breastfed babies are healthier, so moms who provide breastmilk for their babies are less likely to miss work to take care of their sick children.
What It All Means for 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 to decrease the rates of US women who nurse successfully. Policies and practices in hospitals and attitudes and behaviors of families, friends, and communities shape a context in which women start and continue breastfeeding. To make meaningful changes in the numbers of women who breastfeed successfully, we must change that context to one that embraces and promotes breastfeeding and gives women and their babies the greatest chance possible of breastfeeding success.