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Easier Said Than Done: Why is it So Difficult to Breastfeed?

June 13, 2012

Exclusive breastfeeding for six months is arguably the cornerstone of any package to reduce child malnutrition because it is widely assumed to be very easy. In practice, however, breastfeeding is not that simple. Here are some reasons why several women are unwilling to stick to the prescription of exclusive breastfeeding for 6 months:

If they know they will do it: the assumption of any behavioral change campaign is that women do not know the benefit of breastfeeding. One tells them and they will stick to exclusive breastfeeding, so the argument goes. Karen Grepin points out why breasfeeding is not that simple and why some women might prefer not to breastfeed even if they know is the recommended by their doctors.  Pain, stress and conflicting doctors’ advise are just some of the reasons for why women might not be enthusiastic to chose exclusive breastfeeding.

Easier said than done: Let’s assume that some mothers are convinced that breastfeeding is the best option for them and for their children’s health. They state that they intend to breastfeed. That is what one was aiming for right? A new study reveals that intentions and awareness are not enough. The study followed up 3,000 pregnant women asking during their pregnancy what was their goal for breastfeeding. It then observed how many of them meet their own goal. And here comes the surprising finding: 60% of the women declared during the pregnancy the intention to exclusively breastfeed for a certain number of months. When the babies were born and it came down to actually breastfeed it turned that breastfeeding is easier said than done: the majority (exactly 2/3)  of the mothers who intended to breastfeed exclusively for 6 or more months did not meet their own goal.

So you have mothers who knows that breastfeeding is good and they want to breastfeed yet they do not actually breastfeed. Why? The study looked at how women who did not meet their goal differ from those who did meet their goal.  Researchers observed that smoking, obesity and setting the goal too high (e.g. intention to breastfeed for more than one year) all made the achievement of the goal more problematic. The environment where the births take place also seemed to matter a great deal: mothers who started to breastfeed within an hour of delivery or were not given baby formula in the hospital were more likely to meet their breastfeed goal.

Although these findings do not offer conclusive evidence about obstacles to breastfeeding (further research is needed to tease out which of the factors observed to be associated with reduced likelihood to turn intention into practice actually cause this to happen ), they offer an interesting insight: information alone is not enough, because breastfeeding is not just a matter of personal choice. The hospital in which a mother delivers, what a nurse says or does not say, the availability of infant formula or regressive conditions such as obesity are all external factors which go beyond the control of the woman.  If women are to actually breastfeed, external factors are to be taken into account so that what women say is also what they will do.

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