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Barriers to Breastfeeding: Why US Breastfeeding Rates Are So Low

Updated on May 17, 2012
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Breastfeeding has many known health benefits to mom and baby alike. Breast milk provides the best nourishment for a child, fights against childhood diseases and childhood obesity, reduces healthcare costs, and is free and convenient. And, American women want to breastfeed: about 75% initiate breastfeeding in the hospital. Despite this, rates of breastfeeding in the US are astoundingly low, and women often do not get the support they need to breastfeed successfully.

US Breastfeeding Rates

Rates of successful breastfeeding in the United States are low relative to other countries. In Rwanda, 88% of children are exclusively breastfed at 6 months, in China 76%, and in Sweden 37%. In the US, only 15% of children are exclusively breastfed at 6 months, despite World Health Organization’s (WHO) and American Academy of Pediatrics (AAP) recommendations to exclusively breastfeed for 6 months.

The U.S. Centers for Disease Control and Prevention’s (CDC) sets health goals for the US population every 10 years. Regarding breastfeeding, the CDC’s 2020 goal is to increase the percent of infants who are breastfed at 6 months to 60%. But, even in California, the state with the most baby-friendly hospital policies and highest rates of breastfeeding, only 25% of infants are breastfed exclusively through 6 months.

Why Are US Breastfeeding Rates So Low?

Why is it, that in spite of the known benefits of breastfeeding, the desire of women to breastfeed, and the recommendations of health agencies, that rates of breastfeeding in the US are so abysmal?

Lack of support in hospitals

The vast majority of US babies are born in hospitals. From the moment babies are born, hospitals are stacking the decks against women’s breastfeeding success. Too few staff are trained properly in lactation issues and staff attitudes can discourage breastfeeding. Hospitals also routinely engage in practices that decrease breastfeeding success, such as distributing formula and bottles, taking the baby away from the mother rather than allowing for immediate bonding time after birth, and encouraging moms to have babies sleep in the nursery, rather than “rooming in” with the mother.

Worldwide, countries that have adopted “baby-friendly” hospital standards have seen dramatic increases in breastfeeding rates. In Cuba, for example, almost all hospitals are designated “baby-friendly” and breastfeeding rates have gone from 25 percent to 72 percent. In the US, only 4 percent of hospital have adopted these standards.

Aggressive Marketing By Infant Formula Companies

Formula companies, hoping to sell their products, market aggressively to pregnant women, sending coupons to expectant mothers, giving free samples and “starter” kits to hospitals to deliver to women, and sending samples to mothers at their homes. While these practices may seem innocuous, they further contribute to an environment that pushes women’s decisions away from breastfeeding, towards formula feeding.

Negative Societal Attitudes

Even as public health officials are pushing for increased rates of breastfeeding, women are reminded over and over again that breastfeeding is not widely accepted in our society. Even among supportive groups of women, plans to breastfeed exclusively or beyond one year are often questioned or frowned upon. Women breastfeeding publicly can face stares, smirks, or inappropriate comments. The 2006 story of a woman being ejected from a Delta flight because she refused to “cover up” while nursing is just one of many stories that demonstrate that breastfeeding in public is not universally acceptable. News stories of women being asked to cover up, move to a bathroom or otherwise private location, and being asked to leave stores or courtrooms, are all too common.

A side product of the negative societal attitudes towards breastfeeding is that nursing is not seen in our culture. Women who do nurse publicly often cover themselves or nurse in “private” places. By keeping it hidden, breastfeeding stays foreign, taboo, and stigmatized. Women do not see it as a normal or natural part of parenting, and don’t see models of breastfeeding moms in their daily lives.

Short Maternity Leave

Studies make clear that longer maternity leaves encourage higher rates of breastfeeding. Yet, the US joins only Liberia, Papua New Guinea, and Swaziland as one of only 4 countries that do not require paid maternity leave. The length of paid leave in European countries vary, but leaves of one year are not unusual, with some countries allowing for up to 4 years of maternity leave.

Inconvenience at Work

Recent law now requires employers to make some reasonable accommodations for nursing mothers, providing them time (though not necessarily paid) and a private space (not well defined) to pump at work. Despite this advance, women still have an uphill battle when considering pumping at work, facing uncomfortable conversations with their bosses and disapproving comments from co-workers. The inconvenience and social unacceptability is enough to convince many women to give up. The irony is that breastfed babies are healthier, so moms who provide breastmilk for their babies are less likely to miss work to take care of their sick children.

What it all means for breastfeeding in the US

Women today face many challenges when it comes to breastfeeding. Even the most committed moms may find themselves unable to nurse due to lack of milk supply, pain when nursing, or a child who simply can not latch on.

Yet, the numbers demonstrate that other factors are at work to decrease the rates of US women who nurse successfully. Policies and practices in hospitals and attitudes and behaviors of families, friends, and communities shape a context in which women start and continue breastfeeding. To make meaningful changes in the numbers of women who breastfeed successfully, we must change that context to one that embraces and promotes breastfeeding and gives women and their babies the greatest chance possible of breastfeeding success.

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    • profile image

      TXmom 5 years ago

      Wow, I had no idea rates were so much lower here than in the rest of the world. Makes you think!

    • LauraGT profile image
      Author

      LauraGT 5 years ago from MA

      Thanks for your comment, TXmom. It is very interesting. I personally think other cultures don't have such a mixed up view of breastfeeding. They see it more, so it's not as strange and is just more widely accepted, which I think makes it easier for moms all around. Also, since it's more the norm, women have more support.

    • Lord De Cross profile image

      Joseph De Cross 5 years ago

      Staggering! Only 15% do breastfeed their babies. And we see why we get coupons for formulas and free packages.

      Thanks for the insighful hub!

      LORD

    • LauraGT profile image
      Author

      LauraGT 5 years ago from MA

      Lord de cross: Thanks for reading and commenting. That's right, only 15% exclusively breastfeed at 6 months, a far cry from the Healthy People 2020 goals. Hopefully, there can be a shift in practices and attitudes that will help move this more in a positive direction!

    • Pamela N Red profile image

      Pamela N Red 5 years ago from Oklahoma

      America have sexualized breasts and forgotten their purpose. Women wear revealing clothes to show them off to men and get implants increasing this problem.

      Breasts are for babies, not men, until America changes this attitude these statistics will continue.

    • profile image

      kelleyward 5 years ago

      Thanks for sharing this useful hub. I'm gonna to link this to my new hub I wrote on how to wean a breastfed baby. I nursed all three of my boys for 1 year each and it was a wonderful experience. I can't imagine not having this experience as a new mom. I think many moms don't receive the support they need to continue breastfeeding and therefore give up or never start in the first place. Thanks for sharing this! Take care, Kelley

    • lovesleftovers profile image

      lovesleftovers 5 years ago from Texas

      Thanks so much for this article! It’s an extremely important subject and you’re helping to get the word out that breastfeeding is best for both babies and moms. A recent study showed that breastfeeding moms lost their baby weight faster and more naturally. And, like you mentioned, it’s free. Estimates show that the amount of money saved on formula is equal to the purchase price of a new kitchen appliance. I breastfed all three of my children and I remember that it was difficult with my first son. I was fortunate enough to have a patient and knowledgeable nurse to show me properly, but that was quite a few years ago. Incidentally, all my children were bottle fed once their teeth came in (ouch), but by then they had received the necessary nutrients and antibodies that babies need. Thanks again for sharing this wonderful, informative article!

    • kkflowers profile image

      kkflowers 5 years ago

      I find it a little shameful that our government doesn't extend disability benefits to a more reasonable time (at least 3 months!) In a way, I was lucky that I was laid off before the baby came so I didn't have to go back to work and I could collect unemployment after disability. My heart goes out to all the moms that have to stop breastfeeding and go back to work as well as the one's that manage to pump and continue while working!

      I also had a very rough start to breastfeeding and tearfully thought I wasn't going to be able to continue. We made it through, thanks to the free visits to the lactation consultants at our hospital and my perseverance and now at 5 months, still going strong! Maybe I will share my experiences on a hub one day to help others with similar situations... :)

      Thanks for the hub!

    • kschimmel profile image

      Kimberly Schimmel 5 years ago from North Carolina, USA

      Pamela is right on. A woman breastfeeding while covered up is considered shocking, while a Victoria's Secret fashion show doesn't raise an eyebrow. I nursed 5 of my 6 and could have nursed all if I hadn't been too proud to ask for help with my first baby.

    • LauraGT profile image
      Author

      LauraGT 5 years ago from MA

      Pamela N Red and Kschimmel: Thanks for commenting. I agree that we have a very mixed up view of women's breasts and that they are too often sexualized. It's sad that women feeding their children is layered with this.

    • LauraGT profile image
      Author

      LauraGT 5 years ago from MA

      Kelleyward: Thanks for your comments. I agree that getting support is such an important factor in breastfeeding success. Where our society fails, women can hopefully make up the difference by setting up supports for themselves and for each other!

    • LauraGT profile image
      Author

      LauraGT 5 years ago from MA

      Lovesleftovers: Thanks for reading and sharing your experience. It's amazing how the support of even one person can make a big difference. Imagine if all women were supporting by not just the individuals the individuals in their daily lives but also the institutions that usher them into mother hood!

    • LauraGT profile image
      Author

      LauraGT 5 years ago from MA

      kkflowers: Thanks for sharing. I'm glad it has worked out for you! Yes, it is horrible that women have to choose between their careers and their children, especially on something as basic as breastfeeding.

    • KCap profile image

      Kelly Capozzi 4 years ago

      This is a really good hub. I am very passionate on the subject and wrote a similar hub after there was so much controversy over that photo of women breastfeeding in uniform.

      I received a tremendous amount of support from the nurses in the hospital when I had my son. My situation was little different than most because my son was premature so I had to pump rather than nurse but it was strongly encouraged and supported by all. I think that the main reason that the rates are so low in the U.S. is because of the way it is viewed in the public. It makes people uncomfortable and it really shouldn't. What will make people more comfortable with it is to be exposed to it more and starting at a young age. Before I had my son, I might have seen a handful of women in my life nurse their babies. If children are taught from a young age that this is how mommies feed their babies and they are exposed to it then it will be"normal" to them as they grow up. Americans just need to get over their stigma about breasts and stop sexualizing them. Just my 2 cents

    • LauraGT profile image
      Author

      LauraGT 4 years ago from MA

      KCap: Thanks for sharing your story and perspective. I completely agree that a lot of the problem is in our societal norms around breastfeeding. I think in some parts of the country it has become completely fine to breastfeed in public. But, I'm still distraught by how many young mothers feel that they can't breastfeed in front of others, even other mothers, and feel that they need to cover themselves up or go to another room. Well, one breastfeeding mother at a time...

    • exphoebe profile image

      exphoebe 4 years ago

      What a great hub! You are so right on pointing out the many reasons women tend to bottle feed instead of nursing their babies. I have nursed all of my children I believe that is the reason my children are usually healthy and have a strong bond with me.

      I live in Utah and just recently read an article where breastfeeding in a church became an issue. I never ran into much opposition myself but definitely have felt alienated while breastfeeding. Some LDS churches have specific rooms for nursing mothers and when you have a newborn you will spend most of church time in there. Socially you are cast out during the breastfeeding month. LDS claim the open breastfeeding creates a porn problem. Ridiculous!

    • LauraGT profile image
      Author

      LauraGT 4 years ago from MA

      Thanks for your comment exphoebe. It makes me sad that breastfeeding is still seen as something that needs to be kept separate. It's especially interesting in that in a church setting, a holy setting, something so natural as feeding one's child would be seen as at all related to pornography! I think if some of these folks saw breastfeeding in public they would be disappointed by the lack of breast exposure!!

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