Women’s Health Today

Kaitlin Lewis

Breastfeeding has been identified as a public health concern both nationally and globally. Organizations such as the World Health Organization (WHO, 2003) and the American Academy of Pediatrics (AAP, 2012) have policy statements that uphold breastfeeding as the normal and optimal method of infant and young child feeding. In the United States, the Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) have specified target rates for breastfeeding initiation, exclusivity, and duration in the Healthy People goals for 2020.

While 76.9% of new mothers in the United States initiate breastfeeding, only 43.5% are breastfeeding at all at 6 months. These mothers may be mixed-feeding with breastmilk substitutes or offering solids. At 12 months, only 25.5% of mothers are breastfeeding at all (CDC, 2012). These figures are well below the Healthy People 2020 targets of 81.9% of babies initiating breastfeeding, 60.6% of babies still breastfeeding at 6 months, and 34.1% of babies breastfeeding at all at 12 months of age (Healthy People 2020). In an effort to increase breastfeeding rates, many organizations and individuals have created and disseminated messages that may be characterized as breastfeeding advocacy, promotion, or support.

Healthy People 2020 targets

0 MONTHS 76.9% → 81.9%

6 MONTHS 43.5% → 60.6%

12 MONTHS 25.5% → 34.1%

Promoting breastfeeding sensitively

For the mother who cannot produce a full milk supply for her baby, these messages can be hard to hear. She may feel insulted and judged because she was not able to breastfeed exclusively despite her intent and desire to do so. Exclusive breastfeeding is physiologically impossible for women with insufficient glandular tissure (IGT), no matter how hard they try or how committed to breastfeeding they might be. This dichotomy between wanting what she has been taught is best for her baby and what she is actually able to do can be very difficult for a mother with IGT to accept.

Messages from well-meaning health care providers that not managing to breastfeed “isn’t the end of the world” or “isn’t a big deal” may sound like patronizing lies, when spoken by the same people who have told the mother throughout her pregnancy that she should consider breastfeeding exclusively. The promotion of breastfeeding (organized or random) that permeates the “mommy blogosphere” and social media platforms might be felt as a personal attack. When a mother wanted to breastfeed, to give her precious baby the very best of everything, those messages that advocate breastfeeding, when they practically criminalize artificial infant feeding, do not help her. They might even contribute to her growing sense of anger, guilt, or shame that she’s experiencing, as this mother describes.

While the sentiment behind breastfeeding campaigns is meant to stimulate an increase in breastfeeding, it is important to acknowledge that some women cannot bring in a full milk supply. For these women, the campaigns can feel like an attack, adding insult to injury. It is crucial that the creators of these campaigns are aware of this phenomenon and show sensitivity and compassion to mothers who have low to no supply, so as not to inadvertently add to their sense of failure or grief.

Being unable to sustain my child, and feeling that my body was broken was devastating for me. No one had ever told me that a failure to produce milk was even possible unless someone gave up. I was judged, guilted and made to feel like I was ignorant and lazy by friends, family, and medical professionals and it was not until I found the information buried deep beneath the sea of ‘all women can breastfeed’ as long as they try hard enough that I began to heal.

Excerpt from Finding Sufficiency: Breastfeeding with Insufficient Glandular Tissue by Diana Cassar-Uhl, MPH, IBCLC.

Photo with title by Belle Verdiglione