Breastfeeding inspires strong feelings, including at times vicious exchanges between mothers.
Those who feed their children with formula often feel patronised by breastfeeding advocates. Women who breastfeed or support others who do so because of the well-documented health benefits are naturally somewhat put out to be compared with fascists imposing their views.
Perhaps it is time during this National Breastfeeding Week to end the mother wars and focus on the systemic factors with far-reaching impacts that influence individual decisions. We have not had a culture of breastfeeding since the 1960s. Although breastfeeding figures show some improvement, we are starting from a very low base.
For example, the HSE pointed out that since 2015 there has been an 18.6 per cent increase in the percentage of babies who are still breastfed at the three-month developmental check-up stage.
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However, just under a third (32 per cent) of babies are exclusively breastfed at that stage. Another 10 per cent are fed by a combination of breast and formula, which means by three months, 58 per cent of Irish babies are receiving no breast milk at all. This is abysmally low by international standards. When I had my children, I was determined to breastfeed, not least because I was surrounded by friends and sisters-in-law who breastfed their children.
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I wish mine were a happy story of instant success and thriving babies. Not so much. Perhaps that is why I have sympathy for women who opt for the bottle. Although I breastfed all four of my children, it was far from easy. My babies’ weight gain was slow, much to the visiting public health nurse’s disapproval. Without support from volunteers from breastfeeding support groups, there were many times when I would have quit.
There are 59 lactation consultants who work for the HSE, but only 35 are working in maternity units. Given that there were 54,678 babies born in Ireland in 2023, that indicates how many mothers are not receiving much-needed help in those essential first few days. While funding for HSE lactation consultants and hospital-grade pumps was mentioned in the budget, unlike other measures, there were no specific figures given for how much would be allocated.
Qualitative research published in 2023 on breastfeeding support in maternity hospitals quoted mothers who said that when their babies had difficulties learning to latch, they were just offered formula. This included babies with tongue-tie, an easily-remedied condition where the baby’s tongue cannot move freely, resulting in pain for the mother and frustration for the baby. One mother reported having to pay €100 to access a breast pump, but formula was handed out for free.
A report on infant feeding in direct provision states that since many mothers do not come from countries where free formula is given in maternity hospitals, this undermines breastfeeding rates in asylum seekers. Surely it undermines it for everyone? In theory, any healthcare professional should be able to help establish or maintain breastfeeding, but understaffing and overwork affect breastfeeding rates too.
There are some terrific people working in our health services who make every effort to support breastfeeding. However, even the HSE’s report on progress in breastfeeding acknowledges “challenges in the staffing levels of midwives and public health nurses.”
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There is also the small matter of a multimillion euro formula industry. According to Teagasc, Ireland’s annual exports from six global infant formula manufacturers based here are worth €1 billion including a huge market in China, so we are hardly innocent bystanders.
Officially, no company can advertise infant formula, that is, for babies under six months old, but formula manufacturers use all sorts of tricks to keep their brands in our faces.
That includes marketing so-called follow-on and growing up milks. Despite concerns about ultra-processed foods’ effect on health, formula manufacturers can advertise ultra-processed growing-up milks for babies over 12 months with impunity, even though official HSE guidelines say they are completely unnecessary. This keeps the brands visible and therefore works as a form of almost subliminal promotion for infant formula. The companies also make expert use of digital media, including recruiting influencers.
Our attitudes to breastfeeding need to change. Limerick’s hospitality sector, and in particular, Kilmallock, has dedicated itself to being breastfeeding friendly. Everywhere else should follow suit; instead, mothers are sometimes asked to leave or cover up in an illegal and bizarre form of misplaced Puritanism. Similarly, although mothers returning to work are entitled to one hour for breastfeeding or pumping, how many workplaces have sanitary, private and inviting spaces with milk storage facilities?
Far more important, though, is the need to stop framing breastfeeding versus bottle-feeding as a dispute among mothers. We can never know someone’s individual reasons for not breastfeeding. Perhaps some or all of the systemic factors have made it impossible. But we do know that generally speaking, our culture is not breastfeeding friendly, and we should focus instead on changing that.