Breastfeeding: Benefits and Barriers no one talks about
According to the International Journal for Equity in Health, “In Canada, 91% of all mothers initiate breastfeeding, but 40–50% stop by 6 months and only 34% breastfeed exclusively for 6 months, with lower rates among socially and/or economically vulnerable women.” (1) This is important to recognize because it’s not just about knowing the benefits to breastfeeding , it’s also recognizing that there are real barriers to breastfeeding that are unrelated to mom and baby directly, and more related to financial or social barriers, and a lack of support.
But before we get there, let’s talk about the benefits of breastfeeding.
Benefits to mother and baby
We all know that breastfeeding brings massive benefits to baby and mother, so let’s go over those first.
breast milk contains all the nutrients an infant needs (2)
it’s easily digested and efficiently used (2)
helps baby’s immature immune system (2)
increased oxytocin, the love hormone
According to an article by the World Health Organization, “Breast milk contains all the nutrients that an infant needs in the first 6 months of life, including fat, carbohydrates, proteins, vitamins, minerals and water. It is easily digested and efficiently used. Breast milk also contains bioactive factors that augment the infant's immature immune system, providing protection against infection, and other factors that help digestion and absorption of nutrients.” (2)
Fantastic, right?! In addition to all that, oxytocin, aka the love hormone, increases with breastfeeding or pumping.
According to an article in the Drugs and Lactation Database, “Oxytocin is an essential lactation hormone released during breastfeeding that causes milk ejection and appears to have calming effect on the mother.” (3)
Which exhausted mom doesn’t need more calm in that postpartum period? I know I did! 🙋🏽♀️
Not only can oxytocin improve mood, it can improve bonding, connection and responsiveness to baby. According to a systematic review in the International Journal of Nursing Science, “Oxytocin levels significantly increased in infants, mothers and fathers during skin-to-skin contact and parents with higher oxytocin levels exhibited more synchrony and responsiveness in their infant interactions.” (4)
However, it’s hard to know whether oxytocin is just from breastfeeding or chestfeeding, or whether it’s the snuggling and skin-to-skin time. The same article shows that Kangaroo Care, when the infant is in a diaper and placed directly skin-to-skin on a parent’s chest, reduces stress and anxiety in parents. (4)
Cancer Research UK lists breastfeeding as a way to decrease risk of breast cancer (5).
There are numerous reasons why breastfeeding is amazing (how cool is it that our bodies can do that?!) but let’s also be honest. There are numerous reasons breastfeeding (BFing) is hard, challenging and painful. There are many reasons why BFing doesn’t work for everyone.
Breastfeeding or chestfeeding is not for everyone
We need to consider is that many people have complex relationships with their breasts, for example, folks who are non-binary or transgender, survivors of sexual assault or trauma, folks with a history of cancer, and so much more. We cannot expect every mother to breastfeed or to want to breastfeed. Of course, we know that there are benefits to baby, but prioritizing a mother’s health and well-being is also important. When a mother feels safe, supported and secure, there are direct benefits to a baby.
Barriers to breastfeeding
Difficulty accessing support from lactation consultants and doctors
When breastfeeding is challenging (like it is for MANY people), it can actually put more strain on the mother-baby relationship, and worsen mood disorders. A mother may crave so badly to breastfeed, but may have inverted nipples, undersupply, oversupply, or a poor latch, that can leave her feeling extremely disappointed in her body.
A mother may seek help from lactation consultants only to find careless practitioners gaslighting a mother’s pain by saying “the latch looks good. It’s fine, you just have to keep going.” Or worse, a mother may have sought help and then was told that her nipples weren’t designed to breastfeed. Navigating breast shields, nipple creams and Silverette cups, a mother may have no idea where to get help. Many moms may need to see multiple lactation consultants and doctors before they get the help they need, but not everyone has access to these supports or the finances to accommodate this.
Breastfeeding sexualized
There is very little I can say about this, except: gross! Why does everything come down to how men see us and our bodies? Breasts have a massive function beyond sex-appeal. Breastfeeding - the word breast is in the word itself! In Canada, you are allowed to breastfeed openly, but in actual practice, there is a lot of stigma around it. Mothers are seen as flaunting their breasts when all they’re trying to do is feed their babies. Restaurants will ask mothers to go to a separate room to avoid making the other patrons feel uncomfortable. What in the actual f**k?! The problem is this attitude also prevails amongst women themselves. I’ve heard women grossed out about breastfeeding, afraid it will make their boobs look weird (note, it’s not breastfeeding that makes your breasts sags - it’s the pregnancy and lax hormones that do), or be nervous about people seeing their breasts. I myself felt the pressure to cover up when breastfeeding outdoors or at weddings. Imagine eating your lunch with a cloth over your head. That’s what we do to our babies when we try to cover up. It’s disrespectful and inappropriate to ask mothers to cover up.
Barriers for Black mothers and racialized people of colour
According to an article by the CDC, “Rates of breastfeeding duration and exclusivity, calculated for all infants regardless of whether they had initiated breastfeeding, are lower among Black infants than among white infants.”(6) I share that knowing full well that the world is more than just Black and white bodies, but for the purposes of this Blog post, here’s what I have to share.
There are numerous barriers for Black mothers, Indigenous mothers and other racialized mothers to breastfeed. Lower income is touted to be the reason, prompting mothers to return to work earlier and leaving them unable to breastfeed. Lack of education is another reason often given.
But how about the impact of slavery and wet-nursing? Mekha McGuire writes: “In the context of reproductive justice and the history of our communities in this country, the answer is non-extractable from the Transatlantic Slave Trade and the practice of slave breeding in the Americas. This Black Breastfeeding Week, like many others in the past, meets the crucible forged by white supremacy, medical racism, and heteropatriarchal state violence against the bodies of Black mothers and their children.”(7)
Black women were forced to be wet-nurses for white babies, while leaving their own babies to perish. The sheer violence and inter-general impact of this trauma needs to be discussed. It’s too easy to blame low income and lack of education - because the onus is then put on the lower income and uneducated people. We need to discuss the real systemic barriers and the violent history of oppression and enslavement in order to understand why many Black mothers may not want to breastfeed. And Black mothers should never be shamed for the decision not to breastfeed.
Importance of representation
There is a complete lack of representation in posters, educational materials and amongst healthcare workers. Breastfeeding is a very intimate act, and a mother needs to feel safe and supported while seeking support from doctors or lactation consults. Racism is prevalent across the healthcare system and many racialized folks may not feel safe seeking support from a predominantly white medical team. Even Black celebrities like Beyoncé and Serena Williams received shockingly poor treatment during birth and postpartum, and there is a general mistrust of the medical system when it has worked against Black, Indigenous and people of colour for so long.
This is the problem in having all the “normative” data based on white bodies. Whiteness has been marked “the norm” and it is not. We need to see Brown and Black bodies represented. As a Brown woman myself, I have never seen a poster of someone who looks like me in any breastfeeding brochure, or pregnancy or postpartum educational materials. This is a huge problem. According to Wikipedia, 5% of the Canadian population is of Indian origin (from the country India). South Asians make up ~20% of the Toronto population. So why don’t I say at least 20% of posters representing Brown bodies? The reality is there is minimal effort on the part of healthcare workers, hospitals and organizations to truly change material and make their teachings more inclusive. I know I’m doing my part to change that and it makes me so happy to see more and more melanated professionals taking up space.
Abysmal maternity/parental leave and workplace standards
In addition to all this, in our backwards society, moms are often forced to go back to work within weeks of having a baby. I feel very fortunate to live in Canada, where we have up to 18 months of maternity leave, and some people can get some income replacement through Employment Insurance (EI). However, by and large, with the cost of living and pressure on parents to work earlier and earlier, it can impact a mother’s ability or desire to breastfeed. Breastfeeding can be completely unrealistic to sustain in the workplace and pumping can be a massive challenge. While in theory, mothers should be given a private place to pump, we know that in practice, this doesn’t always happen. There is a stigma if a mother takes time away during work to go pump, and I hear from my clients that new mothers are seen as less valuable members of a workplace.
So when we talk about breastfeeding and the benefits, we also need to talk about the barriers. A mother may know all the benefits but if she has so many cards stacked against her, she may not be able to breastfeed the way she planned. This is not a failure on the mother’s part, this is a failure on a systemic level. We are all part of the system that devalues mothers and forces them back to work and “normal” live within weeks of having a baby.
Breastfeeding isn’t easy or free. It is a sacrifice.
Obviously breastfeeding is convenient in the sense that you your breasts are portable so you can take them out with you and baby wherever you are. However, it takes time, resources, energy and attention. It is a sacrifice on the mother’s part, and we need to recognize and honour that. A mother is limited in how long she can be away from her baby, without pumping or having space to hand express. If a mother chooses to feed formula, pump or use a combination of feeding techniques, it is completely her choice.
Mothers should not be shamed or judged for how they choose to feed their babies.
Resources:
I share my own experience and challenges breastfeeding both my kids, including blocked ducts, oversupply and fast let-down. Check out my Blog: Breastfeeding is hard: oversupply, fast let-down, and how I lasted 40 months.
Need help with blocked ducts? Check out my Blog: Tips for blocked ducts.
References:
Francis et al. (2021). Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study. International Journal for Equity in Health. Read article here.
Breast-milk composition. SESSION 2: The physiological basis of breastfeeding.(2009). Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. World Health Organization. Read article here.
Bethesda (MD). Drugs and Lactation Database: Oxytocin. National Library of Medicine (US). Dec 20, 2021. Read article here.
Scatliffe et al. Oxytocin and early parent-infant interactions: A systematic review. Int J Nurs Sci. 2019 Oct 10; 6(4): 445–453. Read article here.
Cancer Research UK. Protective factors against developing breast cancer. Read article here.
Beauregard et al. Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015. Weekly / August 30, 2019 / 68(34);745–748. Read article here.
Mekha McGuire. (2018). Black Breastfeeding after a History of Trauma. August 30, 2018. Read article here.
