Two years ago the Lancet, 2016, published powerful evidence that breastfeeding saves lives, improves health and cuts costs in every country worldwide. The publication was a landmark moment for all those working to support breastfeeding – we felt that this irrefutable evidence of breastfeeding’s importance would galvanise everyone from policy makers to the wider society to pull together and create a social movement that would put systems in place to support and enable mothers to breastfeed their babies.
But more than two years on it continues to be a brave person who advocates for breastfeeding. Yet again last week, following the release of the RCM statement on infant feeding, health professionals who advocate for and support mothers to breastfeed were being vilified. With headlines such as “End of Breastfeeding Tyranny,” and “It’s good riddance to breastfeeding bullies,” health professionals are left feeling that they should not support or discuss the value of breastfeeding, for fear of putting too much pressure on mothers. Any chance of having an inclusive, factual and non-judgemental conversation about breastfeeding is once again shut down. Instead of discussing how we can best support all families to achieve their infant feeding goals (mindful that 8 out of 10 mothers stop breastfeeding before they want to), conversations about feeding too quickly turn to individual judgement and blame, leaving health professionals and families feeling disillusioned and guilty.
The UK has some of the lowest breastfeeding rates in the world, and for many families breastfeeding is a highly emotive subject because generations have not breastfed, or tried to breastfeed and not succeeded. This is so much more than the need to increase ‘support’ for struggling mothers; we need to tackle a culture and society that unwittingly undermines breastfeeding at every level, while worrying that breastfeeding promotion may have gone too far. In reality, the pressure on mothers to bottle feed is enormous – when the baby breastfeeds too little or too much, when breastfeeding hurts, when there are worries about milk supply, when the baby wakes in the night, when mothers go out in public, when they go back to work or for a hundred other reasons the answer in the UK is always to bottle feed. Mothers are far too often left in a situation where they cannot breastfeed and their only choice is to bottle feed, whereas if they had been in a country with a breastfeeding culture they would have been enabled to overcome these challenges. Health professionals who are working to tackle this pressure and give mothers a real choice to breastfeed if they wish to do so do not deserve to be vilified, nor should they be expected to solve the problem of the UK’s low breastfeeding rates by themselves.
If we want to create an environment that facilitates change in our infant feeding culture, we need to change the conversation; moving away from blaming individual mothers and midwives and instead recognising this as a public health issue that needs action across healthcare, community and wider society settings. We all need to be compassionate and have conversations that are informed, kind, sensitive and empathetic. The Unicef UK Baby Friendly initiative calls on governments and society alike to motivate actions to start removing the barriers – social, cultural, economic, physical and practical – that currently make it difficult and sometimes impossible for women to breastfeed in the UK.
Success in breastfeeding is the collective responsibility of society; no one person can or should be responsible for this. So let’s start here and have honest and positive conversations about how we can all support babies, their mothers and their families.
Sue Ashmore, Programme Director, Unicef UK Baby Friendly Initiative