Despite all the evidence that breastfeeding is best for babies, many people still hold negative opinions about it. For example, Kathryn Blundell—then deputy editor of parenting magazine Mother & Baby—wrote of breastfeeding that ‘seeing your teeny, tiny innocent baby latching on where only a lover has been before feels, well, a little creepy’ (Rock, 2010). Meanwhile, BBC radio DJ Alex Dyke condemned ‘earth mothers…with moustaches' who breastfed in public—a practice, he said, that ‘has to be stopped’ (Shepherd, 2015).
On the one hand, there is an evidence base confirming the multiple health benefits conferred by breastfeeding, plus the World Health Organization (WHO, 2016) recommendation of exclusive breastfeeding to 6 months, with continued breastfeeding alongside foods up to 2 years or more. But on the other hand there are individuals who view breastfeeding in a negative light. Such attitudes may have prompted the rise of lactation advocacy, so-called ‘lactivism’, in the UK (Boyer, 2011). Yet despite this, Brown (2015: 57) states: ‘In the UK, although 81% of mothers breastfeed at birth, by 6 weeks only 55% breastfeed at all.’ In Scotland, meanwhile, only 36% breastfeed exclusively for 6 weeks or more (Bradshaw et al, 2013).
It is unsurprising that in a study of maternal attitudes towards breastfeeding in Glasgow, Stockholm (Sweden), Granada (Spain) and Reggio-Emilia (Italy), Scott et al (2015) found that compared to Swedish mothers, Scottish and Italian mothers who breastfeed are less likely to do so in public. Although most Scottish women in the study disagreed with the statement ‘women should not breastfeed in public places such as restaurants', only 57.3% who chose to breastfeed had done so in public. The authors suggest that the perception that society generally disapproves of breastfeeding in public may have influenced women's behaviour.
The Baby-Friendly Initiative (BFI), set up by the WHO and UNICEF, was established in the UK in 1994 to encourage maternity services to promote successful breastfeeding practice. However, the results of a small study (Hunter et al, 2015) carried out in an English hospital found that the environment and working conditions on a typical British postnatal ward present significant barriers to the introduction of breastfeeding support interventions. It cites lack of time and relatively few staff as two of the challenges to successful intervention.
McLelland et al (2015) found that in Australia—where breastfeeding initiation rates are 96%, but only 15% of babies are exclusively breastfeeding at 6 months—the challenges to the BFI are similar to the UK. Meanwhile, Nolan and Layte (2015) report that in 2010 Ireland had the lowest rates of breastfeeding out of 14 European countries, measured both at birth and at 48 hours postpartum. The authors note that just 46.1% of Irish-born mothers were breastfeeding at hospital discharge; the figure was 84.2% for immigrant mothers. They say this underlines the need for interventions aimed at countering the negative attitudes to breastfeeding that are observed in Irish society.
If appropriate interventions are to be successful in both Ireland and the UK, the reasons for women preferring to bottle-feed rather than breastfeed will need to be examined. When Carroll et al (2015: 643) considered women's views of their feeding choice in Ireland, the notion of the ‘pushy midwife’ was aired by at least one woman, who observed that ‘the midwives came around and they wanted everybody to breastfeed but I felt a bit under pressure to do it and I wasn't comfortable doing it. If anything, they probably persuaded me to bottle feed more than breastfeeding…’
But despite what some perceive as ‘pushy midwives’, it seems that this is not the heart of the problem. As Brown (2015: 57) acknowledges, bottle-feeding is ingrained into Western culture: baby facilities in shops and restaurants are depicted by graphics of bottles; few women breastfeed in public; and ‘more overtly, the reactions a new mother faces from strangers and even family members when she breastfeeds her infant can be demoralising and threatening.’
It seems that while society continues to struggle with the cultural issues around breastfeeding, it is appropriate that opinions such as those expressed by Blundell and Dyke continue to be challenged.