Health promotion messages rarely work when they simply tell people what to do. We all know what a healthy diet looks like, yet that knowledge doesn’t prevent us from ordering another takeaway. Instead our behaviour is driven by the environment in which we live: public attitudes, financial constraints, and support from others all affect our confidence and ability to act.
The same is true for breastfeeding. Despite increasing breastfeeding rates being a strategic priority globally, the involvement of many governments often only goes so far as unhelpful messages extolling women to breastfeed. These don’t work because they don’t change the environment in which women are trying to breastfeed. They might tell women breastfeeding is important but they don’t offer practical support, change negative public attitudes, or help women delay going back to work. All of this pushes many women to stop breastfeeding before they are ready.
Rather than focusing on telling women to breastfeed, governments must recognise their wider public health responsibility, and work to create an environment that actually supports breastfeeding. It shouldn’t be left to charities and volunteers alone. Support should be part and parcel of society – and implementing a new strategy is not as difficult as you might think.
1. Education and support
Good quality education, rather than simply a list of reasons why women should breastfeed, is key to success here. Before the birth, mothers should be offered information on how breastfeeding works, challenges that might arise and who they can get support from. Peer supporter schemes are a highly valued source of practical and emotional help for new mothers, but in many places are absent or have had their funding cut.
But this is not just about teaching mothers, ongoing breastfeeding education is crucial for all who support them, including GPs and childcare staff, so that women get consistent, high quality advice. However, this education is not much use unless staff are also given the time to work with mothers after birth.
2. Public acceptance
Breastfeeding promotion should not just target mothers, but the wider population. A mother may want to breastfeed but if those close to her do not understand why, or how to help, her experience will be more challenging.
The public need to know why it is important to support breastfeeding, and that it has legal protection too. Breastfeeding Welcome schemes – participating organisations display signs saying they are supportive of breastfeeding – can play an important role here to reassure mothers, and also send a strong signal to potential critics.
Public acceptance is not just an issue for adults: children should also learn about the breast, and its role in nutrition, health and reproduction, just as they would any other body part. Doing this would mean that the next generation would not even think to question breastfeeding.
3. Maternal legal rights
Countries, like Sweden, that have longer, well-paid maternity leave and flexible working rights also have the highest breastfeeding rates. However, in the UK for example, statutory maternity pay drops to just £140 a week after six weeks, and in the US it is non-existent – meaning many mothers return to work weeks after the birth.
When they return, many struggle to continue breastfeeding due to poor facilities – despite research showing that when women have private, paid breaks to express, this leads to continued breastfeeding and happier staff. Some simple changes here would not only enable women to breastfeed for longer, but show that society values mothering.
4. Mental health
Caring for a baby invariably leaves new mothers feeling exhausted. In many cultures, childcare is not down to one mother, but a whole village. However, in the West, new mothers are often isolated, lonely and exhausted, which can make breastfeeding feel insurmountable.
In the absence of a village, professional support is again vital. Research has shown that enabling health visitors to spend more time with new mothers, even just to simply talk about they are feeling, can help mothers’ mental health immensely. Community support networks are also vital, to reduce feelings of isolation, but these need encouragement to be set up and thrive.
5. Formula control
Formula milk is lifesaving for babies who cannot be breastfed but advertising these products is simply not necessary. Many of the claims made have already been challenged by health bodies as misleading or unnecessary – but numerous countries, including Britain, still need to stop companies from putting promotions out altogether.
In countries that have implemented these five elements, there have been clear increases in breastfeeding rates. In Norway, for example, both mothers and fathers have extended, well-paid leave after the birth, while laws are upheld, and adverts for infant formula are regulated. Brazil has had success too, following similar changes and investing in over 200 breast milk banks.
We are happy to invest in other health interventions – such as laws around smoking in public places and banning lead paint – so why not extend this public health approach to supporting how babies are fed? If we want to give women the best possible chance of breastfeeding, governments – not mothers – must take responsibility for creating an environment that supports, protects and enables them to do so.