Is Breastfeeding in Trouble?

A Quiet Place Issue 144 - September/October 2007

by Peggy O'Mara

Seventeen years later, in 1974, when I breastfed my first child, the breastfeeding initiation rate in the US was at 32.2 percent. In the ten years from 1970 to 1980, however, the breastfeeding initiation rate had more than doubled, from 26.5 percent to 55.3 percent. The rate continued to climb into the 1980s, and reached a high of 61.9 percent in 1982. Those of us who were breastfeeding advocates at the time thought we had won the war.

Then, the impossible happened. The breastfeeding initiation rate began to drop, and continued to drop for 14 years. By 1990, the rate was 51.5 percent—10 percent lower than the high of 1982. What had happened?

It is no coincidence that Nestlé began advertising formula directly to consumers on television and in magazines in 1989, in violation of a long-standing, informal agreement among formula manufacturers and several national health organizations. Bristol-Myers, in partnership with Gerber, quickly followed suit.

These campaigns were a big success. Both Nestlé and Gerber increased market share by nearly 3 percent each in one year. It came as a surprise to us naive breastfeeding advocates of the 1980s that corporate profits could trump good health.

In the late 1980s and the 1990s, breastfeeding advocates became more sophisticated, forming professional organizations and joining international efforts to promote breastfeeding. In 1997, the breastfeeding initiation rate surpassed the 1982 high and reached 62.4 percent. The rate grew three percentage points from 1996 to 1997 alone. In 2002, the breastfeeding initiation rate in the US reached an all-time high of 70.1 percent. The bad news, however, is that in 2003 the rate dropped four percentage points, to 66 percent—the first drop in eight years, and only four points higher than the 1982 rate. Do these 2003 numbers signal another decline?

Even without a decline, these numbers tend to make it appear as if there is more breastfeeding going on than there actually is. The US Women, Infants, and Children program's definition of initiation is one breastfeeding in one day. A formula company, Abbott-Ross, publishes the only available numbers on breastfeeding initiation, and includes in its count mothers who have breastfed for just one month.

What this means is that the rate of breastfeeding initiation is not a measure of who is breastfeeding, but only of who has tried breastfeeding. It is a measure of mixed feeding, not of the exclusive breastfeeding that the American Academy of Pediatrics and the World Health Organization recommend for at least a child's first six months. The US rate of exclusive breastfeeding is not increasing. It has been at 46 percent for the last several years, and only 10 percent of US babies are still being exclusively breastfed at six months.

Most other countries are doing much more breastfeeding than we are in the US. I looked at 2003 Breastfeeding Statistics compiled by Carol Huotari of the LLL Center for Breastfeeding Information (www.laleche league.org/cbi/bfstats03.html). With 86 countries reporting, the US is among only seven countries with breastfeeding initiation rates lower than 85 percent. Seventy of the 86 countries have breastfeeding initiation rates of over 90 percent.

Certainly, US women are deterred from breastfeeding beyond a few weeks because our country offers no paid maternity leave, and because the six weeks of unpaid leave that we do get—if we can afford to take it—barely give us enough time to establish breastfeeding, much less figure out how to combine it with working. In addition, white-collar workers have greater access to lactation support in the workplace than do blue-collar workers. We need laws that protect every woman's right to breastfeed or pump in the workplace, and provide training for employers about breastfeeding's advantages. Numerous studies have shown that the many benefits include lower health care costs, less absenteeism, improved staff productivity, and lower employee turnover.

In addition to obstacles in the workplace, there can be no doubt that our country's soaring cesarean rate adversely affects breastfeeding, as it did in the 1980s. A 2005 study in Greece showed that cesarean section and information disseminated through the mass media have a negative impact on exclusive breastfeeding. (Fani Pechlivani, "Prevalence and Determinants of Exclusive Breastfeeding During Hospital Stay in the Area of Athens, Greece," Acta Paediatrica 94, no. 7 [2005]: 928-934.) In the US, mainstream media coverage of breastfeeding, particularly on ABC, is sensational, provocative, and undermines breastfeeding success. On July 15, 2007, Good Morning America aired a segment titled "Breast-Feeding Battle." The host quoted a study showing that the majority of Americans disapproved of breastfeeding in public when, in fact, ABC's own online poll, "Public Breastfeeding: Tacky or Tactful," shows that 75 percent of respondents find breastfeeding in public totally acceptable.