Factors affecting feeding decisions

Breastfeeding by Picasso

Following on from my earlier blog, where recent articles highlighted the problems of low levels of breastfeeding in developed and developing nations, in addition to the main problem - parents being affected by myths and misinformation about breastfeeding - a further seven influencers will now be discussed.


 1. Heavy marketing campaigns of formula companies 

You don't have to pay anybody to breastfeed, so there are no adverts to counter the likes of SMA (Pfizer) and Aptamil (Danone), e.g., in 2008, approximately £8 million was spent on advertising infant milks on television in the UK (Business Insights, 2009).
The Infant milks publication by the Catherine Walker Trust contains more information on the formula milk industry in the UK. The International Baby Food Action Network (IBFAN) website lists how breastmilk is undermined and World Health Assembly (WHA) rules broken, including: 

• Promotion using free supplies, e.g., Hipp donated unsolicited supplies of its infant formula to health facilities in Armenia
• Inappropriate language for the country being sold to, sometimes companies include under-lid leaflets in native languages that will only be read after buying the product, undermining choice
• Inappropriate formula distribution as disaster relief, e.g., Mead Johnson donated formula after New Orleans was hit by Hurrican Katrina in 2005, Bright Beginnings (US) donated formula after the Asian Tsunami of 2005 and linked its donation to a celebrity endorsement in its PR campaign
• Labels which undermine breastfeeding, e.g., supplementing breastfeeding interferes with lactation and makes an early end to breastfeeding more likely, yet labels sometimes encourage this. In Finland Nestle Nan claims that it "can be used from birth as an addition to breastmilk or to substitute it". 
• Promotion to health professionals, e.g., Wyeth invites health workers to its SMA-branded study days in the UK, including the chance to win an expenses paid trip away.

There is quite a mountain of marketing from formula companies for us poor mums to get our heads around. In addition, most people trust scientists' and doctors' opinions. Formula milk is marketed as having x property for y healthy thing for their baby, and you'd think you're doing a good job for your child by going for it. The ability to control and measure, monitor, the amount of formula being given to your child, and know (based on the information on the packaging) that the milk has x, y, z nutritional content is reassurring to parents, especially if facts about breastmilk are more fuzzy (see 2.).

 2. Lack of education

For example, inconsistencies in advice from the medical professionals. The sayings 'breast is best' and 'feed on demand' are spoken, but not necessarily explained. I'll later describe my experiences of such confusion after having my daughter in a later blog. See also the NHS's breastfeeding campaign website, which is quite hard work to get through.

Furthermore, we got most of our breastfeeding information from the National Childbirth Trust (NCT) antenatal classes (a 6 week course) we took part in before having Abigail. These were paid for privately. The free NHS antenatal class lasted a few hours and really focused on pain relief in labour. I don't remember much about breastfeeding, apart from the midwife instructor dismissing my question about breastfeeding as contraception, saying that it wasn't reliable and only worked if you were someone who breastfed exclusively and, in a rather cynical tone, "carried your baby around all day" (she clearly had an aversion to hippies). [I later found out from my GP that breastfeeding did provide contraception for the first 6 months. See FHI]. Surely there is something missing if breastfeeding advice is only given in detail if you pay for it?

If new Mums aren't completely clear on the benefits vs. costs of breastfeeding to formula feeding, if they haven't been shown how and why breastfeeding works (a clear guide to how to do it and why you do it that way), they are more likely to be swayed by the myths and misinformation, hearsay and old wives' tales floating around them as they try to figure out what they want to do. The myriad of parenting books only help to confuse further, e.g., Gina Ford's strict rules on parenting do not work with the biological processes behind breastmilk production and breastfeeding ("contented baby"?).

3. Stagefright

Figuring out how to get the positioning right to breastfeed was hard enough, without the added embarrassment of breastfeeding in front of an audience. Having the confidence to breastfeed in all environments is difficult. As things clicked more, breastfeeding in front of people other than my husband and my NCT class Mums, (who were also in exactly the same figuring-things-out stage as me), got a bit better.

Factors that contributed to this were:

i. I wanted to breastfeed (it has always seemed logical to me)
ii. Practise
iii.  I was too tired to care about what other people thought anymore
iv. My husband, family and friends were 100% supportive of my choice to breastfeed

As time went on, I figured out how to feed discretely, so that people didn't notice (I had a conversation with a lady in M&S cafe once and she never twigged!). But I'd still go into another room to feed Abbie some of the time, e.g., when visiting friends and in-laws. It takes alot of confidence to breastfeed your baby in front of other people, especially in public, when the cries for a feed has been loud and already drawn alot of attention to you, and you're thinking in your head "have I got the right top on to position everything right with people looking at me?".

It is a big hurdle to get over and if things are already a bit wobbly to begin with, and perhaps you're not necessarily supported by those around you to continue breastfeeding, it would be understandable that some might opt to swap in formula now and again, and perhaps fade out breastfeeding altogether. Also, the general public aren't always very helpful - supportive nods and smiles always made my day on wobbly days out, but tuts and funny glances did the opposite and made me feel very small indeed.

Ikea provides a breastfeeding corner to its cafes, a closed off area that isn't smelly or dirty, but comfortable and welcoming, it almost tells a nervous new mum, "it is ok to breastfeed your baby in public, it is n o r m a l". Most don't provide anything like that, you should see some of the babychanging/ nursing rooms (or rather, cupboards), they don't exactly encourage. I think more facilities for private, but open areas to breastfeed would help self-conscious new mums. I know that it would have taken alot of stress off me.

This website lists breastfeeding friendly facilities, but I think the majority are of the smelly cupboard variety, rather than the Ikea cafe corner. 

In sum, carrying out any activity that isn't widely carried out across the country, and seen being done on a regular basis - something so familiar that you don't even think about being embarrassed or uncertain about doing it - is difficult. As much support as possible should be given to those that try to breastfeed, so that their confidence and opportunity isn't squashed, particularly in the early stages.

4. Lack of support

It is a team effort

This follows on from Confidence: I was able to practise and so become more confidence in breastfeeding because my husband was completely with me and supportive of us breastfeeding our child: "Us" is used here because when I was pregnant, we discussed and both wanted Abigail to be breastfed. Having those around you at the early weeks/months who are supportive of your decision helps so much. Additional factors were that I was breastfed, so my family had no problem with it either; my NCT friends were all breastfeeding too.


Being in a situation unlike this may knock confidence and perhaps lower opportunities for practise, perhaps leading to somebody avoiding breastfeeding in front of their less understanding friends or family. Not feeding on demand in order to avoid awkward / unsupported situations may potentially interfere with milk production and so deplete resources, leading to problems in maintaining feeding.

Practical support is particularly important here. Having a partner who understands that you need to sit and feed for long periods of time, that you won't be getting much sleep and will need help to make sure you still eat, drink and rest in between feeds. Casaubons book blog describes the same view:

"Fathers and brothers, husbands and friends - we all have enormous power to enable breastfeeding. We can stop by and take the older kids or do a load of laundry for a new Mom so she can nurse. We can pass a woman nursing a baby in a public place and tell her how much we like to see that. "

Even though it is women who are biologically able to feed, our husbands/partners are so important to enable us to do so. I cannot emphasise enough how much my husband has done for me and our little family by his neverending support.

5. Over reliance on science

... whilst simultaneously losing belief in the incredible ability of the human body.

There are many intelligent people and laboratories, who along with their resources of computers and technical wizadry, have researched and developed many alternatives for what the body does itself. This can never completely replicate the body's highly complex biological systems.

For example, my Dad is a GP, and has talked to me about how concerned he gets when people with thyroid problems (over- or under- active) don't seem to realise how serious the condition can be. Instead, they think that everything is fine because they can just take supplementary thyroid hormone treatment and that this will replace everything that is lost. It isn't the case. The treatment can only replace in part what is an intricate interconnection between different metabolic and hormonal systems.

Milk secretion / synthesis by the mammary epithelial cell

This is one example of how confident people can be about replacing a human function with a man-made solution. Sometimes we have no choice, e.g., diabetes, hypo/hyperthyroidism, and these diseases shouldn't be taken lightly. When we do have a choice, i.e., unnecessarily replacing formula milk with breastmilk, it is perhaps taken more lightly than it should be. The value of this free, fantastically complex, evolved nutritive substance needs to be respected a little more. For more information on its complexity, see Human Milk and Lactation, by Dr. Carol Wagner.

 6.  Convenience of not breastfeeding

If you breastfeed:

• You will need to be open to feed on demand. In the early weeks, months, this will mean feeding very frequently, day and night. Formula milk requires feeds every four hours [although see KT comment below] from the very beginning. Such gaps (four hours rather than, at first, 20 minutes between feeds) allows for more freedom. Sleeping is therefore more disturbed for the breastfeeding mother.
• You alone are responsible for the feeding of your child for the first six months. The responsibility of feeding cannot be shared. Although this can be supported by expressing breast milk.
• You are responsible for the content on your breastmilk, i.e., no drinking, smoking and certain dietary restrictions. (Although, drinking and smoking is a bad idea with babies anyway). You can prepare for a night out using expressed milk, however.

However... there is a convenience to breastfeeding:

• You do not have to pay for your milk.
• You do not have to go to the shops for milk and so do not have to worry about running out at 11pm or 5am or when you're stuck in a traffic jam on the motorway or stranded at an airport.
• You do not have to worry about sterilising bottles and paraphernalia. Breastfeeding is always sterile.
• Your breast milk is never prepared wrongly, contaminated or spoiled.
• You do not have to worry about a thirsty baby in hot weather, whether or not to give additional cold-boiled water as the breastmilk composition will adapt to suit environmental conditions.
• You don't have to get out of bed to prepare formula in the middle of the night (especially if you co-sleep)
• Post-pregnancy weightloss is supported by the calorific-requirement of breastmilk production (the weight gained in pregnancy helps build stores for the recovery from childbirth and for breastfeeding).

7. Increased sexualisation of breasts?

I agree with Nicholas Kristof's suggestion. There has been an increasing presentation in the media of breasts as sexual objects alone, and perhaps a discomfort in the idea of breasts as anything else.

Perhaps with the over-representation of breasts as sexual objects, it is difficult to switch across to its other, but primary use, which after all, our bodies have evolved and so been especially designed to do. The balance should be brought back a little (i.e., breastfeeding be more familiar), it may reduce the level of squeamishness that sometimes comes up when considering it?

There seems to be more pressure on women, from a young age, to be perfectly-shaped, sexual beings. The growing sexualised culture in western society is weighting factors regarding sexual looks and ability, and away from other aspects of our lives and other talents, roles and abilities of women.

When thinking about caring for their new baby, mothers may worry about changes to their bodies as a result of giving birth and breastfeeding (again, more myths or misinformation, e.g., sagging breasts found to not be caused by breastfeeding (Rinker, 2007)), that may lead to rejection from their partners, or society even? The celebrity fashion of planned caesarean births, also hint to this way of thinking, (although this also might be to do with the "too posh to push" assumption on rising planned caesarean requests).

Some women might see the potential for a clash, rather than coexisting relationship, between sexuality and motherhood, affecting their preference for breastfeeding. The potential to take on all aspects of being a mother, in addition to still being the things that they were previously is possible though. Perhaps if more famous Mums advocated breastfeeding, this would help those affected by such media presentations.

Summing up

The reasons that I've come up with that may help us to understand why many are not taking up, or continuing with, breastfeeding after the first few days in hospital are not conclusive. Some may not be affected by these factors at all, some factors more than others etc. These factors however, are those where otherwise healthy Mums do not choose to breastfeed, when they could have done. I'm not questioning those who medically or clinically otherwise cannot or would find it very difficult to, could not, e.g., parents of adopted children, or just down to mere practicality have opted not to, e.g., parents where the Mum is the main earner and the Dad is the stay at home parent.

There could also be a reason that I haven't thought of. Maybe, because I have the tendency to think too deeply about things, perhaps there are just some people who just automatically think to formula feed, rather than breastfeed (just as I automatically think the opposite). Maybe they were formula fed by their Mums, had a pretty good family life, no health issues, or anything else to make them think that they need to move away from what's the norm from what they do in their family. No particularly in depth thinking about what to choose, just naturally go for formula. I imagine that this is the case for quite a large population of Brits, and that the additional factors above only confirm their decision moreso.

Imagine if the culture changed so that it didn't need to be such a conscious decision to breastfeed, but automatic.