On unreasonable conditions for breastfeeding

As recently as last summer (’22), the American Academy of Pediatrics (AAP), the US equivalent of our public health authority, tightened the recommendation on breastfeeding for its citizens. From previously recommending breastfeeding for one year or more, two years or more is now recommended. This is in spite of 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 US are able to do, even if the desire to breastfeed exists. When the new recommendations were announced, they were covered in most news channels, such as the NY TIMES or USA Today.

Like many other countries, the US follows the World Health Organization’s (WHO) advice on breastfeeding, which recommends exclusive breastfeeding for the first six months. Thereafter, the WHO recommends continued breastfeeding for two years or more, in addition to real food, which is less common for countries to adopt as a government recommendation. However, as of last year, in 2022, the United States has endorsed this recommendation. The AAP claims that it has been indicated that such prolonged breastfeeding may have health benefits for the breastfeeding mother, in terms of reducing the risk of high blood pressure, diabetes, breast and ovarian cancer.

The AAP’s policy on breastfeeding is said 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 while breastfeeding, such as respiratory infections, ear infections and diarrheal diseases. The AAP also mentions the link between breastfeeding and reduced risk of obesity**.

*OBS: It is unclear whether the relationships are related to breastfeeding itself or whether other factors may have caused the differences between the observed groups.
**OBS: There is no mention of how common/uncommon these infectious diseases are or that the causal link with obesity has not been established.

A mockery?

The AAP’s reasoning is specious, some say, as it made the change in the breastfeeding recommendation in the midst of the crisis created in the country by a shortage of infant formula last year. The recommendation has also been criticised for being so far removed from reality.

The US still has one of the shortest and least generous parental leave periods 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 dealing with financial losses, or losing their jobs. Even maintaining breastfeeding for the first six months can be difficult, or often impossible, even for those mothers who are physically able and willing. If you are recommended to breastfeed for two years, there must be something close to reasonable conditions for it, otherwise it may be difficult to take the recommendation seriously, according to the public and critics. The AAP has previously and in the context of the revised recommendation stressed the importance of increased support, such as paid parental leave, to enable more mothers to breastfeed. Despite this, the recommendation is seen as a mockery by many.

The change in the government recommendation on breastfeeding has stirred up emotions and a debate about the unreasonable demands placed on mothers and the conditions for starting a family in the US. The topic has also shed new light on the issue of breastfeeding as a ‘free’ option.

Allison S. Gabriel – Professor of Organizational Psychology said 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 contributor to The Times, Jessica Grose, adds to the problem: “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.”