Barriers to Breastfeeding

Without question, breastfeeding rates are higher among educated, affluent women. And even they face cultural and lifestyle obstacles. What's getting in your way?


When I started a new job in the early '90s, Something stunning happened at my first staff meeting: A co-worker discreetly pumped her breasts during the half-hour gathering. This was no act of boldness, I later learned--simply business as usual at this particular office. After my son was born a few years later, I knew I could return to work and keep nursing without difficulty, given that pumping would be convenient (extremely so, obviously!) and no big deal to my co-workers.

Not every new mother is this fortunate. Work culture, it seems, often dictates whether a woman quits nursing prematurely. "The working mom who is a lawyer has a place to pump," says Ruth A. Lawrence, M.D., a co-author of Breastfeeding: A Guide for the Medical Profession, 6th ed. (Mosby). "For the woman who works at a fast-food restaurant or on an assembly line, there is no such place." But where a woman works isn't the only dynamic that can affect her breastfeeding options--or whether she chooses to nurse her child at all. Where she lives, the color of her skin, her income, her family's mind-set--all can make a difference. But it wasn't always this way.

Infant feeding in a modern world Until the 1940s, mother's milk alone nurtured our species. After World War II, family life in the United States changed. Americans, who had been accustomed to living in one multigenerational home, were, for the first time, moving all over the country. Women didn't have their mothers, aunts, grandmothers or sisters around to teach them how to breastfeed. "They had their babies in isolation," recounts Lawrence, who serves as director of the Breastfeeding and Human Lactation Study Center at the University of Rochester School of Medicine and Dentistry in New York. "All of a sudden, infant feeding became medicalized."

Without the counsel of female family members, women turned to doctors for help with breastfeeding--often with questionable results. Indeed, pediatricians in the 1950s and 1960s often told new mothers they didn't need to bother breastfeeding their babies--not with the formulas that were newly available on the market. It was a brave new world, one where a sitter or nurse could feed your baby with "scientifically formulated" nutrition.

Some mothers saw this as a great advantage. "It was the educated women, who were perceived as wealthier, leading the march," says Lawrence. "They had been lured into thinking that science could do it better, that the formulas could do it better."

Most women took the bait: In 1956, the year the breastfeeding education and advocacy organization La Leche League International was founded, only 18 percent of new mothers were nursing when they left the hospital.

We've come a long way, baby ... or have we?

Thanks to an educational push by organizations such as La Leche and government public-health campaigns, breastfeeding is more widespread today. But it's still not as universal as it ought to be, considering the numerous health benefits it confers to both mother and child. In fact, certain sociocultural factors can influence whether a woman will nurse her child, and for how long. Consider the following:

Geography In the South, less than 55 percent of babies are breastfed when they leave the hospital; less than 30 percent are still nursing at 6 months of age. In Western states such as California, Oregon and Washington, more than 75 percent of babies are initially breastfed; at 6 months, more than 50 percent of these infants are still nursing.

Ethnicity Eighty-two percent of Asian children are initially breastfed, and at age 6 months, 47 percent are still nursing; for Hispanic/Latinos, it's 79 percent and 42 percent, respectively; for white children, it's 76 percent and 42 percent; for American Indians, 67 percent and 33 percent; and for black/ African-Americans, 60 percent and 27 percent.

Income Across all races, the percentage of infants ever breastfed is 23 to 26 points higher among those whose parents are in the highest income group compared with those in the lowest.

Marital status Seventy-eight percent of children born to married mothers are initially breastfed, and 45 percent are still nursing at 6 months of age. For unmarried moms, the stats are 60 percent and 25 percent.

These disparities can be explained by a single common factor. "Women who breastfeed tend to be more educated," says Kathy Baker, manager of the peer-counseling program at La Leche League. "They're more aware of their options."

Lawrence agrees. "It was educated women who led the march to the bottle, and now they're leading the march back to the breast," she explains. "There's about a 20-year lag--the less-well-educated women are just getting the message today."

Yet there's one other cultural dynamic that can influence a woman's decision to breastfeed, and it's a big one.

Family values?! Why do some men see themselves as competing with their own baby for their wife's breasts? Why is nursing in public such a big deal? The answer to these questions lies in one simple word: sex.

The undeniable purpose of a breast is to nurture our young. Yet in America, the breast is largely seen as a sex object. "There is a tremendous values conflict in the U.S.," says Wanda K. Jones, Ph.D., Deputy Assistant Secretary for Health (Women's Health) at the U.S. Department of Health and Human Services. "The breast has been taken out of its role."

When Babytalk magazine featured a cover photo of a baby nursing at his mother's breast a few years ago, the editors received thousands of letters from readers, some of them accusing the magazine of "flashing" or being "gross." A government's public-service ad generated similar responses, muddling its very important message. "The ice cream with cherries was seen as too close to sexualization by some people," explains Jones, whose Health and Human Services office funded the ad campaign.

The good news is that we are becoming more of a breastfeeding culture. But to keep moving in the right direction, we must once again begin to understand what breasts are really for. "Many people in our culture do see the breast primarily as a sexual object," says Katy Lebbing, manager of the Center for Breastfeeding Information at La Leche League. "And unless they've been educated, they'll keep seeing it that way."

So while various and complicated factors influence a woman's decision to breastfeed, the one thing you can do--regardless of your skin color, how much money you make, where you live or whether you went to college--is to educate yourself about the incredible benefits of mother's milk.