As recently as last summer ('22), the American equivalent of our public health authority, the American Academy of Pediatrics (AAP), tightened its recommendation for breastfeeding for its residents. From previously recommending breastfeeding for a year or longer, it now recommends two years or longer. This despite the fact that it turns out to be far from reality and the current situation, and also very far from what most mothers in the United States have the opportunity to do, even if the desire to breastfeed for that long would exist. When the new recommendations were announced, it was written about in most news channels, see for example the NY TIMES or USA Today .
Like many other countries, the United States follows the World Health Organization's (WHO) advice on breastfeeding, which recommends exclusive breastfeeding for the first six months. After that, the WHO recommends continued breastfeeding for two years or longer, as a complement to solid foods, which is more unusual for countries to adopt as a government recommendation. But as of last year, 2022, the United States is thus supporting this recommendation. The AAP claims that it has been indicated that breastfeeding for such a long time can have health benefits for the nursing mother, in the form of a reduced risk of high blood pressure, diabetes, breast and ovarian cancer.*
The AAP's breastfeeding policies are stated to be based on the same reasoning as the WHO; that breastfeeding has been shown to reduce the risk of infectious diseases for the infant during the period of exclusive breastfeeding, such as respiratory infections, ear infections, and diarrheal diseases. The AAP also mentions the association between breastfeeding and a reduced risk of obesity.**
*NOTE: It is unclear whether the associations are related to breastfeeding itself or whether other factors may have caused the differences between the observed groups.
**NOTE: It does not mention how common/uncommon these infectious diseases are or that the causal relationship with obesity has not been established.
A mockery?
The AAP's argument is a farce, some say, as the change in breastfeeding recommendations was made in the midst of the crisis that arose in the country due to the shortage of infant formula last year. The recommendation has also been criticized for being so far removed from reality.
The US still has one of the shortest and least generous parental leave systems in the Western world. Many American parents are forced to return to work very quickly after having children due to the lack of paid parental leave and difficulties in coping with financial losses, or losing their jobs. Even maintaining breastfeeding for the first six months can be difficult, or often impossible, even for mothers who are physically able and willing. If breastfeeding for two years is recommended, there must be something close to reasonable conditions for it, otherwise it can be difficult to take the recommendation seriously, say the public and critics . The AAP has previously and in connection with the amended recommendation emphasized the importance of increased support, such as paid parental leave, so that more mothers can breastfeed. Despite this, the recommendation is perceived as a mockery by many.
The change in the government's breastfeeding recommendation has stirred emotions and a debate about the unreasonable demands placed on mothers and the conditions for starting a family in the U.S. The topic has also shed new light on the issue of breastfeeding as a "free" option.
Allison S. Gabriel - professor of organizational psychology says in HuffPost : "Then there's the fact that this new guidance came in the midst of the ongoing formula shortage that's been rife with shameful messaging about how women should "just breastfeed" because "breastfeeding is free" — as if those are viable solutions to the problem. "
A debater in The Times, Jessica Grose, further problematizes: "Adding insult to injury: the guidelines were released days after the Supreme Court overturned Roe v. Wade , "when millions of American women are alarmed about restrictions on their reproductive and physical autonomy" — a move that "struck many as clueless and even callous."
