Every time I see Madeline* in clinic I am reminded of how many stereotypes she has broken.
She is the 2-year old daughter of a young, low-income, African American couple. She was breastfed for 18 months.
Her mother admits she fell into breastfeeding by chance, with no plans initially of even wanting to or trying to breastfeed. While in the hospital, she was offered the opportunity and the support to try to breastfeed, so she gave it a chance.
Now, two years later, she is thrilled about the experience.
World Breastfeeding Week is celebrated every year from August 1-7. Many health-care providers, public-health workers, and communities at large use this time to raise awareness and create engagement around the importance of breastfeeding and providing breastmilk to babies.
The American Academy of Pediatrics, along with multiple other health organizations, reminds us that exclusive breastfeeding is recommended for the first six months of an infant’s life. Yet in the United States, only 1 in 4 mothers and babies achieve this goal. For African American infants like Madeline*, only 1 in 7 achieve this goal.
The reasons for this suboptimal statistic are complex and multifaceted. My daily pediatric clinic could easily be a highlight reel of these reasons:
I don’t get any paid leave, and I have to go back to work in six weeks.
I was worried I didn’t make enough milk for my baby so I decided to supplement with formula.
Nobody in my family ever breastfed; I don’t want to do it.
I had an emergency C-section and had trouble breastfeeding after that.
I am a single mom and have two other kids, I don’t have time to breastfeed.
Madeline’s story is unusual not only in that she started to breastfeed at birth, but also in that she kept it up for so long. Her mom and dad would tell me stories of their family members, curious and questioning, shocked even, about Madeline’s continued desire to breastfeed. At 2 years old she has barely been sick and is thriving.
The best evidence points to the protective benefits of breastfeeding against respiratory and gastrointestinal illness, asthma, SIDS, among many others. In 2016 the prestigious medical journal Lancet published a report calculating that over 800,000 children worldwide could be saved every year with optimal breastfeeding rates.
Madeline’s mom has also helped herself as well. Researchers at UNC-Chapel Hill and at Harvard Medical School calculate that the deaths of over 2,600 women (from heart attacks, breast cancer, diabetes) could be prevented every year if we had optimal breastfeeding rates in the United States.
Efforts to improve breastfeeding rates makes business sense as well, saving over $3 billion per year in costs associated with illness and deaths.
The CDC tells us that 1 in 5 children in the U.S are never ever breastfed. We learned less than a month ago that the U.S delegation at the World Health Assembly in Geneva did not support language in a resolution that called on governments to “protect, promote, and support breastfeeding.” Last week, it finally became legal to breastfeed in public in all 50 states.
I am always struck by the notion that somehow recommending something healthy and lifesaving is a hot topic. Many of my patients don’t get in five servings of fruits and vegetables a day, yet we still talk about it. Usually laughing and brainstorming, but without guilt. Nobody says broccoli is not all it’s cracked up to be.
Without a doubt, breastfeeding can be hard, challenging, and stressful for many families. For some parents it is possible to breastfeed but not desired. For other parents, sadly, it is desperately desired but not possible. The efforts to empower, educate, and support families to achieve their breastfeeding goals is never meant to shame, blame or isolate families that do not breastfeed, whatever the reason.
Supporting breastfeeding is not a zero sum game. We can still fight and demand better support for our breastfeeding families without isolating those that do not.
*Name has been changed to protect the identity of this patient.
Dr. Gabriela Maradiaga Panayotti is an assistant professor of pediatrics at Duke Children’s Hospital. She is a member of the Academy of Breastfeeding Medicine and of the Section on Breastfeeding for the American Academy of Pediatrics.