By Sheena Sommers, MA
The recent controversies generated by depictions of Attachment Parenting in the Western media and elsewhere have revealed a fairly astounding degree of misinformation about infant and child development. Most especially, the media’s fetishist focus on “extreme breastfeeding” has revealed the tremendously wide chasm that exists between official medical recommendations about breastfeeding and the actual reality and perception of the practice on the ground.
Discussions generated by overly sexualized and highly sensationalized depictions of breastfeeding have often helped only to bolster a set of beliefs about the practice that are as dangerous as they are inaccurate. Though breastfeeding is touted by almost every recognized medical body as being one of the best things a mother can do to ensure the health and well-being of her child, the fact remains that very few infants are exclusively breastfed during their first six months of life and even fewer still are breastfed beyond their first year as official medical guidelines recommend.
Breastfeeding older babies, sometimes referred to by advocates as full-term breastfeeding, means different things to different people. Though some feel that nursing an infant past one year should be considered full term, others define it as breastfeeding a child past the age of two. Perhaps more important than any specific age reference is instead a commitment to continue breastfeeding until a child initiates the weaning process.
While beliefs and approaches to breastfeeding have certainly varied widely through time and place, the current level of societal discomfort breastfeeding engenders is without doubt an anomaly. What has since our earliest days been central to our very survival as a species has, more recently, been made to seem—by some of the more vocal critics at least—as an unnatural, immoral and even perverse practice when engaged in beyond the first year of an infant’s life. Thus, mothers who breastfeed their toddlers and very young children have been called everything from odd and eccentric to sexually perverse and even abusive.
What may therefore come as a shock to many in the West today is that from an historic and cross-cultural perspective, breastfeeding older babies and very young children is the norm. As Cornell University (USA) anthropologist Meredith Small, PhD, surmises in her groundbreaking work Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, the “hominid blueprint of the way babies were fed for 99% of human history indicates breast milk as the primary or sole food until two years of age or so, and nursing commonly continuing for several more years.”
Breastfeeding children until the age of three or four years has been the norm throughout much of human history and remains so in various parts of the world today. Even as late as 1800, an infant born in the United States could expect to be nursed for somewhere between two to four years.
What happened over the last 200 years to have so dramatically altered breastfeeding patterns is too complicated a history to review here. It is needless to say, however, that despite no shortage of scientific and medical evidence to support much longer-term breastfeeding, this has not been enough to sway popular practice or belief in any large measure. In the United States, Canada and elsewhere, breastfeeding beyond a year—or two for the more progressive types—raises eyebrows and even ire amongst some otherwise seemingly rational people. As discussed further below, though breastfeeding rates are on the rise, the increases are small, and breastfeeding older babies is still a far cry from the cultural norm in the West.
Not only does the historical and anthropological evidence suggest that weaning before age two is unusual, but from a purely biological perspective, nursing a child through the toddler years is not in the least bit abnormal. In fact, the typical age for child-led weaning from a physiological standpoint has been estimated to fall within the broad range of two and a half to seven years of age.
As Katherine A. Dettwyler, PhD, an anthropology professor at the University of Delaware (USA), has demonstrated, this large spectrum is based upon an analysis of various biological and physiological factors derived from comparisons to other mammals of similar size. When looking at the relationship between gestation times and weaning for instance, human babies are geared to wean somewhere around four and a half years of age. Other relevant mammalian comparisons also support a much longer breastfeeding duration, including:
- the eruption of the first permanent molars—5.5 to 6 years
- adult body weight—4 to 7 years
- adult body size—2.8 to 3.7 years.
Even the most conservative estimate, derived from an analysis of human birth weights, would suggest natural weaning occurs between 25 and 32 months of age.
The health benefits of breastfeeding are, of course, much more widely acknowledged. Not only do breastfed babies suffer fewer childhood illnesses and recover faster when ill, but the benefits continue to accrue throughout their adult lives. In every scientific study comparing breastfed babies and formula-fed babies, the breastfed babies have been shown to have a lower risk of disease and to score higher on cognitive functioning.
Breastfed babies have a much lower risk of dying from Sudden Infant Death Syndrome (SIDS) than do their non-breastfed counterparts; the formula-fed infants being, in fact, twice as likely to die from SIDS. According to “The Surgeon General’s Call to Action to Support Breastfeeding 2011,” formula-fed infants are also at a higher risk of common childhood infections, including gastrointestinal problems and ear infections, with the risk of the latter being a whopping 100% higher than in their breastfed counterparts.
The same report goes on to say that babies who are exclusively breastfed during the first four months of life have a 250% lower risk of being hospitalized for lower respiratory tract disease and a lower risk of respiratory infections. Breastfed babies also have a lower risk of developing leukemia. Formula feeding, as opposed to breastfeeding, is furthermore associated with an increased risk of some of the most serious chronic diseases of our time, including type 2 diabetes, childhood obesity and asthma.
While the early months are by far the most important with regard to the benefits of breastfeeding, research has shown that the health benefits of breast milk are cumulative. Thus, babies breastfed for 18 to 24 months do better than those breastfed for only the first six months, though as mentioned, the early months are certainly the most crucial.
While as of yet no large scale studies have been published on the specific health benefits of breastfeeding past two years of age, as Dettwyler and others have convincingly argued, there is little reason to believe the rewards cease immediately upon a child’s second birthday. Research has conclusively shown that the specific qualities of breast milk change over time in order to meet the nutritional needs of children as they grow. As such, there is evidence to suggest that breastfeeding beyond two years continues to offer important health benefits. As one of the foremost experts on the subject, Jack Newman, MD, at the International Breastfeeding Centre in Toronto, Ontario, Canada, argues, “Breastmilk still contains immunologic factors that help protect the child even if he is two or older.”
Mothers benefit enormously from the breastfeeding relationship too. For instance, it has been shown that the longer a woman spends breastfeeding, the lower her risk of ever developing breast cancer. Likewise, women who have never breastfed have a 27% higher risk of developing ovarian cancer compared to women who have breastfed for some period of time. Studies have also shown that breastfeeding for longer can maximize these protective effects. Overall, the report by the U.S. Surgeon General cited above concludes that “exclusive breastfeeding and longer durations of breastfeeding are associated with better maternal health outcomes.”
The “Breastfeeding Report Card—United States, 2012,” published by the U.S. Centers for Disease Control and Prevention (CDC), found that while national breastfeeding rates are on the rise, there is still a very long way to go in terms of meeting guidelines set out by almost every recognized medical body or health association across the globe.
While current recommendations as set by the World Health Organization (WHO) and echoed by many other organizations suggest that breastfeeding be continued for two years or longer if mutually desired by mother and child, the majority of infants in the United States are weaned by six months of age. Thus, although 76.9% of women in the United States initiate breastfeeding at birth, just under half of these women are nursing at six months and only a quarter of them are still breastfeeding at one-year postpartum.
WHO guidelines likewise stress the importance of exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding means giving the baby nothing but breast milk during this time. Again, despite the slew of data on the vital importance of following these recommendations, according to the U.S. National Immunization Survey (latest data for 2008), only 14.6% of babies are exclusively breastfed at six months.
As surmised by the Surgeon General’s 2011 Call to Action, although “many mothers in the United States want to breastfeed, and most try … within only three months after giving birth, more than two-thirds of breastfeeding mothers have already begun using formula.” This statistic is hardly surprising when one considers that in a study co-funded by the CDC and the U.S. Food and Drug Administration, it was found that almost half of breastfed newborns were being supplemented with formula while still in the hospital.
From a purely economic vantage point, these findings are extremely important. In fact, a study published in the April 2010 issue of the journal Pediatrics examined the costs (adjusted to 2007 dollars) associated with various illnesses including SIDS, hospitalization for lower respiratory tract infection in infancy, atopic dermatitis, childhood leukemia, childhood obesity, childhood asthma and type 1 diabetes, and found that if “90% of U.S. families followed guidelines to breastfeed exclusively for six months,” the direct and indirect savings of medical expenses would equal some $13 billion annually.
Challenges and Barriers
As evidenced above, it is quite clear that the widely available wealth of information concerning the array of physical, physiological, social, emotional, cognitive and even fiscal benefits breastfeeding provides has not been enough to alter public practice on a large scale. Thus, though the medical evidence is unambiguous and educational campaigns to shore up support for breastfeeding are now common, very few families seem to be able to actually put these recommendations into practice.
Why might this be? As revealed by a 2005 U.S. National Survey conducted by the nonprofit Families at Work Institute, more than 60% of mothers of infants and young children work outside the home. U.S. law requires only 12 weeks unpaid maternity leave be afforded to new mothers and this only for companies with 50 employees or more. A report by the National Partnership for Women and Families found that almost two-thirds of women are left without access to employer-provided short-term disability benefits, while nine out of 10 members of the workforce are unable to draw upon employer-provided paid leave to care for a new infant.
Another study published in the February 2012 issue of the journal American Sociological Review revealed that those women who breastfeed their infants beyond six months see a steeper decline in their earnings than those working women who use formula or wean their babies earlier. As Phyllis Rippeyoung, one of the study’s researchers suggested, the results of the study demonstrate that “at least as work is organized right now in the U.S., there does seem to be an incompatibility between breastfeeding for a long duration and working for many women.”
This is, of course, not to say that women who work outside the home do not, or cannot, practice longer-term breastfeeding. However, as only about a third of even the largest companies in the United States provide women with a secure area to express breast milk, doing so can often require an extremely high level of ingenuity and commitment.
Studies like those above highlight a reality too often ignored in breastfeeding campaigns: breastfeeding is both time and labor intensive. Without adequate economic, political, practical and community support for breastfeeding—spanning from the institution of much better maternity leave policies to more family-friendly workplace arrangements—many mothers will continue to face a variety of obstacles that make conforming to ideal breastfeeding practices extremely challenging at best.
Though these barriers certainly require redress if exclusive and full-term breastfeeding is to become more common, providing better maternity leave by itself may not necessarily translate into major improvements. If one looks at the Canadian situation in which maternity leave policies are a good deal better, the numbers are almost as dismal. At three months postpartum, less than half of Canadian mothers are exclusively breastfeeding, and by six months, only 14% are offering nothing but breast milk. At 12 months, about a quarter of Canadian infants are receiving some breast milk, a number only marginally better than the U.S. figures.
It seems, therefore, that something else must also be afoot. As Small and others have pointed out, underpinning these very real structural barriers to breastfeeding is a belief system that is fundamentally at odds with the biological imperatives of infant and child development. In a culture in which independence and autonomy are so highly prized that infants as young as a few months are expected to self-soothe, parents are all too frequently made to feel conflicted about responding to the cues of their infants.
This rather peculiar state of affairs has unfortunately also led to the abandonment of a host of practices that have historically been integral to exclusive and full-term breastfeeding. Regrettably, many of the practices that have traditionally helped to ensure the success of the breastfeeding relationship have become marginalized and, in some cases, even vilified in the West.
The practice of cosleeping—which had been the norm throughout most of human history and continues to be in much of the world today—though never fully eradicated, was until very recently effectively forced underground by a campaign of misinformation. Practices such as cosleeping, babywearing and comfort nursing (soothing baby with the breast instead of a breast substitute such as a pacifier or bottle), to name just a few, support breastfeeding by allowing for unrestricted access to the breast. Unrestricted access encourages a mother’s milk production and ensures a healthy feedback loop. Unrestricted access is, however, precisely that which is so often lacking today.
In sum, the abandonment of practices that support breastfeeding necessarily hampers the effect of even the most progressive policy initiatives on the ground. Simply declaring the importance and sanctity of the breastfeeding relationship, however vociferously, will have very little effect in a society that in actual fact values, and even incentivizes, mother-infant separation from an early age. Unfortunately, we live in a time in which mainstream culture sanctions by both word and deed an approach to parenting that is totally out of sync with the needs of our children. As such, the hyperbolic reactions generated by images of older babies breastfeeding and the dire state of actual breastfeeding practices are together merely twin symbols of the very widespread misunderstanding of the attachment relationship and of infant development more generally.
The fact remains that while educational initiatives and institutional changes may help to increase breastfeeding initiation among new mothers, without a fairly dramatic re-evaluation of our current beliefs, practices, values and priorities surrounding infant and child care at large, exclusive and full-term breastfeeding will continue to be a practice of only a minority.