By Rita Brhel, API Leader, Editor of Attached Family magazine, API’s Publications Coordinator

For so many women, breastfeeding was the turning point for our journey into Attachment Parenting. And one organization that many of us have to thank for our introduction to both breastfeeding and Attachment Parenting—even in the case of API’s cofounders Lysa Parker and Barbara Nicholson, coauthors of Attached at the Heart—is La Leche League (LLL) International.

Jeanne Stolzer, PhD, Professor of Child and Adolescent Development at the University of Nebraska in Kearney, USA, whose research is known worldwide as an intelligent challenge to the current Western medical model that seeks to pathologize normal human behaviors including breastfeeding, shares her beginnings in LLL.

“Most people think that because of the research I do, I was raised in a granola-eating, breastfeeding, bare-footed family,” Stolzer said. “Nothing could be farther from the truth. The first breastfeeding baby I ever saw was when I was 18 years old, and I was mortified. Five years later, I saw a woman with a PhD breastfeeding a 3-year-old, and my immediate response was, ‘What is wrong with her?’”

Some years later, Stolzer herself was expecting a baby when a friend encouraged her to attend a LLL meeting: “I was very reluctant, but I went,” she said. As fate would have it, “I instantly felt like I was with kindred spirits.”

LLL led Stolzer to begin educating herself about breastfeeding. As she remembers: “I was reading and reading all this stuff and was getting madder and madder: Why didn’t my mother know this? Why didn’t my friends know this? And, gosh darn it, why didn’t my doctor know this?”

Where Did the Mammal in Us Go?

“For 99.9% of our time on this earth, we have been hunters or gatherers, and we have been practicing esoteric mammalian parenting,” said Stolzer, meaning non-medicalized births, breastfeeding and staying in close proximity to our babies. “Look at what, in just 100 years, we’ve done: We’re supposed to be the top mammal on the planet, but we’ve managed to completely erase the mammalism in our lives.”

Conception, pregnancy, birth and breastfeeding are intricately linked together as one continuous process to give each baby the best start in life, Stolzer explains: “Most people see these as separate. They’re not. If you mess with one, you risk throwing off the whole connection.”

While there are a very small number of females in every mammal species unable to get pregnant, the United States has the highest infertility rate in the world among humans. But is there any  wonder when we stop to look at what Western cultures are doing to the birthing and breastfeeding functions of this process? Stolzer finds it comical that most mothers won’t touch a cigarette or a caffeinated drink while they’re pregnant—which is commendable—but then have no problem in going to a hospital and having powerful narcotics mainlined into their arm during labor and birth. In the United States, 38% of women are getting Cesarean sections when, naturally, only 1 to 3% of births might actually require medical intervention.

Then mothers and their newborn babies are, more often than not, separated immediately after birth. If a mother is able to give birth vaginally, she is flooded with hormones, but by separating the mother from her baby, that hormone flow is interrupted. As if the breastfeeding relationship isn’t challenged enough by separation, then it has to overcome the ordeal of a hormonally-deficient mother and a drug-affected baby: “It takes 138 muscles alone in the jaw to nurse, and if you’re drugged, they won’t work,” Stolzer said.

The truth is, most Western physicians are not educated in breastfeeding. To be so, they must go on to continuing education because medical schools don’t teach lactation.

“I think women do the very, very best they can with the information they have at the time,” Stolzer said. “Breastfeeding decreases all forms of hospitalization, death and prescription drug use. That’s amazing, but how many women who are formula-feeding know this?”

Introduction of Formula Feeding

Formula was developed with the mechanization of the dairy industry and is derived from whey, a byproduct of processing cow milk.

In 1910, only 2 to 13% of mothers formula-fed. After World War I, that statistic jumped to 65 to 70%, and the impression was that only the poor and the immigrants had to “resort” to breastfeeding. Formula feeding had become a status symbol of wealth, and physicians were supporting that formula feeding was superior to breastfeeding. The lesson learned here, says Stolzer, is to question your societal trends: “Formulas are manufactured by pharmaceutical companies. Look at who’s funding every study: If it’s a pharmaceutical company, don’t even read it—it’s propaganda.”

In reality, human milk is far better than any substitute milk. Human milk changes with each child, depending on the needs of that particular child during a particular time of the day, during a particular age of that child. Human milk—and breastfeeding, for that matter—quite simply, can’t be duplicated.

“Pumped milk is infinitely better than formula,” Stolzer said. “However, it would be a scientific fallacy to say that pumped milk is the same as milk from the human breast,” because of how breast milk changes throughout the day, not to mention that feeding by a bottle misses the intricacy of the relationship aspects of breastfeeding.”

Human milk is a dose-responsive, specific variable, meaning the response is specific to the dose: the more that a baby is breastfed and the longer a baby is breastfed, the more benefits that breast milk affords to the child and the mother. Research that began in the 1920s clearly shows that breastfeeding reduces the risk of myriad physical and mental health conditions for both baby and mother, through protective antibodies and enzymes, and through the oxytocin and prolactin “love” hormones secreted with each breastfeeding interaction.

“Choosing not to breastfeed brings a halt to oxytocin and prolactin. This brings on the grief response in mammals,” Stolzer said. “That’s why we have [high] postpartum depression rates in this country. Because the body believes that we’re grieving.”

In addition, it’s important to note the differences between cows and humans on an animal level. While both are mammals, humans and cows are not nearly the same. There are two types of mammals on the earth, in terms of how they care for their young:

• Caching—i.e., cows. These mammals give birth to young who are, soon after birth, able to walk, regulate their own temperature and be left alone for periods of time while the mother forages for food. Feedings are meant to be spaced to allow this, and therefore, the milk produced is high-protein and high-fat.
• Carrying—i.e., humans. These mammals give birth to young who are unable to walk, regulate their own temperature or stay quiet for long periods of time alone, and therefore must be kept in close physical proximity to the mother. Feedings are meant to be continuous and on demand, and the milk produced is low-protein and low-fat.

Quite simply, cow or soy milk formula cannot be as good as human milk for human babies: “It makes sense: We have such a different brain than a cow, and a soybean doesn’t even have a brain,” Stolzer laughed.

All kidding aside, human mothers treat their babies like those of caching mammals. This is evident not only in formula sales—a $1 trillion industry—but also in the boom in sales of helmets meant to reshape the heads of babies whose heads are flattened on one side because the baby spends more time lying down than being held.

Another important argument against formula feeding is the increasing rate of food allergies in Western cultures, Stolzer said: “The number-one allergen in human populations is dairy products. The number-one ingredient in formula is dairy. Of course we’re doing this.”

Extended Breastfeeding is Best

According to World Health Organization recommendations, babies must be breastfed for at least two years to obtain optimal benefits. Developmentally, human children are designed to breastfeed well over two years of age. For example, permanent molar eruption doesn’t occur until the child is 5 to 7 years old. In another example, Stolzer shares: A child’s sucking needs last for three to seven years—evidenced by prolonged thumb-sucking, pacifier use and hair-sucking in older children.

The average breastfeeding weaning age worldwide is three to four years. In the United States, weaning typically happens at only six weeks, the time when women return to work outside the home. The breastfeeding research available clearly shows that if all women in the United States breastfed exclusively for just six months, the nation would save $3.6 billion a year, mostly in health care costs and time spent paying parents for sick time to stay home to care for their children. If they breastfed exclusively for one year, the savings would climb to $7 billion a year.

“Five thousand to 6,000 years ago, mothers were breastfeeding their children until about 7 years old. They were ensuring the survival of the human species,” Stolzer said. “Not only is the human brain not done growing until the child is 5 to 7 years old, but the human immune system is not fully developed for five to seven years.”

Breast milk naturally has more antibodies available for the older child, because babies are designed to always be with their mothers. That’s why breastfed babies in child care centers still get sick: The antibodies in their mother’s breast milk are designed to ward off family germs, not germs from the whole community. The antibody load naturally increases as the child becomes more mobile, Stolzer explains.

It’s time that Western cultures quit playing it safe when it comes to educating women about breastfeeding, Stolzer says. The benefits of breastfeeding are consistently dependent not only on the frequency and intensity of each nursing session but also on the duration.

Worth the Work

One of the concerns of Attachment Parenting is the physical work involved in the early years, especially the first few months, when the baby’s natural sleeping and feeding schedule is so contrary to the parents’ pre-baby schedules and to what the parents want to return to because of what Western culture promotes as “normal.” But Stolzer encourages parents to stick with it.

“I know it feels really intense right now—and it is really intense right now—but in the time between birth and death, this really intense time is very small,” she said. “Attachment Parenting does not ensure that babies won’t cry or make choices that will hurt you or make you so mad you could flip,” she added. “But if you lay that foundation with Attachment Parenting, that path [of loving interaction] will always be there for them to find again.”

By Patricia Mackie, MS, LPC, API Professionals Coordinator

Public breastfeeding can infuriate us, scare us, make us feel ashamed or empower us. For one Chicago mom, it empowered her to take action and create an organization that would focus on advocating for breastfeeding at a larger level in her city (located in Illinois, USA). She wanted not only to help raise awareness of the benefits of breastfeeding but to ensure that mothers feel comfortable feeding wherever and whenever their babies are hungry.

Breastfeed, Chicago! is making changes for Chicago, one mom at a time, through a very talented board of directors that help to put together the group’s advocacy campaigns. I sat down with Katrina Pavlik, the founder of Breastfeed, Chicago!, to find out more about the organization and advice she has for others who want to advocate for breastfeeding in public. We met on a brisk day on the southwest side of Chicago and sat down over some hot coffee to chat about breastfeeding.

PATRICIA: Tell us how Breastfeed, Chicago! came to be.

KATRINA: In 2011, I created a closed Facebook group to invite people to start a conversation about breastfeeding in Chicago. Within six hours, it had grown to 400 people. (As of this writing, the group boasts a membership of 2,287 members, and more people are added daily.)

I saw a need for a community that could discuss how to make Chicago more breastfeeding friendly. From the Facebook group, we expanded and added the Breastfeed, Chicago! blog and resource list.

I wanted to see moms having more of a voice in writing policies.

PATRICIA: Chicago and the surrounding suburbs boast a high number of La Leche League (LLL) and Breastfeeding USA groups. What is different about Breastfeed, Chicago!?

KATRINA: LLL and Breastfeeding USA are so important. They provide breastfeeding support, which is critical for new moms just getting started.

Our organization is about advocacy and policy. We are working to change the view of breastfeeding. We are working on raising awareness, educating the public and advocating for policy changes.

PATRICIA: Tell us about the advocacy efforts Breastfeed, Chicago! is working on.

KATRINA: One of the big projects we are working on is a letter-writing campaign. One of our board members drafted a letter that we send out to businesses. It basically goes over Illinois breastfeeding laws and gives some information about working with breastfeeding moms. We ask that the information be posted in the employees’ space, such as a break room, so all of the employees from the top down are receiving this information. The letter is also available on the Breastfeed, Chicago! resource list so that parents can print it out and send it to any business that they feel would benefit from this information.

We also are working on a sticker campaign. We have printed up Breastfeed, Chicago! window decals that businesses can place on their doors or windows that indicate that this is a breastfeeding-friendly business.

We really want this to be mom-driven, so we have these travelling baby cafes in the summer. We meet in different areas around the city, and moms can get together, have a cup of coffee and chat. It’s an opportunity for us to brainstorm ideas that will help make Chicago more breastfeeding friendly. We take the stickers with us and moms can take a stack and hand them out at their favorite businesses, restaurants, et cetera.

The blog also has an advocacy tool kit that can be downloaded. It includes information on your rights as a breastfeeding mom in public and at work. It has tips for advocating for yourself and your child, questions to ask your pediatrician, tips to make breastfeeding in public more comfortable. It also includes a letter that you can send to your birthing hospital to express your gratitude or disappointment with their approach to breastfeeding. And it includes the window sticker and a letter that accompanies the window stickers, explaining the sticker campaign.

PATRICIA: I noticed you didn’t mention nurse-ins.

KATRINA: Breastfeed, Chicago! has never implemented a nurse-in. We want to circumvent the nurse-in. We want to normalize breastfeeding and implement interventions that will make this normal. Nurse-ins are a tertiary intervention. We are looking at what can we do before that.

When thinking about a nurse-in, there are a few factors we want to think about. One thing I always try to think about is the mom-to-be, the woman who hasn’t had her first baby yet. What message does a nurse-in send to her? [That] this is so abnormal people have to stage protests in order to do it. We want her to get the message: “This is what all my friends are doing. I see it. It’s normal.”

Nurse-ins also serve to embarrass the individuals involved. Similar to the way we raise our children, we don’t want to punish and embarrass people into change. We want to teach them and educate them into changing their behavior.

PATRICIA: What advice would you have for parents in other cities who would like to take on a venture like Breastfeed, Chicago!?

KATRINA: Use social media. Moms are online all day everyday. Moms will come together and build community. Once that community it built, moms will start to share their needs. Make sure you are listening, and when a mom brings up a need, step back and contemplate and ask yourself, how do we make this better for all moms?

Make sure you reach out to your local breastfeeding professionals. Make them feel important, and ask them to be a part of what you are doing.

And be aware that things move slowly.

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.

The Science

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.”

Breastfeeding Rates

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.