“Understand that this is going to be hard, but you can do it. Be patient with yourself AND your
baby. While breastfeeding is natural, it does not always come naturally. It often takes weeks or
even months for you and your baby to get the hang of it. Reach out for help when you need it”
[1]. This is what Lauren Soger, a new mom, said about her experience with breastfeeding—a
practice that has many health benefits for the mom and baby, but can also be a persistent
challenge for numerous women.
Breastfeeding is becoming the norm emphasized by providers in prenatal and postpartum care
visits, and for good reason! According to Dr. Ann Kellams at UVA Pediatrics, breastfed babies
have better health outcomes with more protection from diarrhea, allergies, asthma, obesity, Type
II Diabetes, and early all-cause mortality. Breast milk provides a variety of anti-inflammatory
properties and immune benefits by providing antibodies to the baby that are specific to the
shared environment. Breast milk also contains compounds like oligosaccharides (types of sugars)
which prevents respiratory infections, glycoproteins (a structure of both a sugar and a protein
molecule) which prevents intestinal infections, and lactoferrin (a protein) which prevents
bacterial growth. Additionally, breast milk can change depending on the environment that the
mom and baby are in to allow the newborn to better adapt to their surroundings—the process is
dynamic [2].
Dr. Kellams notes that breastfeeding is not only helpful for babies, but mothers who breastfeed
have a lower risk of breast cancer, ovarian cancer, hypertension, and Type II Diabetes.
Organizations like the WHO, CDC, and the American Academy of Pediatrics recommend
exclusive breastmilk feeding for at least six months to at least two years [2].
Since 2011, there has been a national movement towards supporting breastfeeding as a health
priority including International Board Certified Lactation Consultants (IBCLCs) providing
lactation support, breastfeeding support (as standard of care), with increased access to donor
milk programs. Lactation and breastfeeding support can range from helping women navigate
how to breastfeed, as well as supporting them through potential challenges of breastfeeding like
infections (mastitis), milk storage, or insufficient supply [2]. However, how feasible is it for all
women to breastfeed?
In 2022, the CDC reported that 83.2% of babies are breastfed from birth, but this quickly drops
off to only 35.9% of babies by 12 months [2]. So what accounts for this disparity? There is a key
gap in breastfeeding education and accessibility to providers. In one study published by the
International Breastfeeding Journal, it was found that access to midwives and lactation
consultants were essential for the continuation of breastfeeding, but this poses challenges for
low-income women who may have limited insurance options [3]. Medicaid only covers lactation
and postpartum support through the first year [4], but breastfeeding is clinically encouraged to
continue up to 2 years. This leaves vulnerable women in a stark position without available
support once they hit a year postpartum—even if they may require prolonged services and
counseling.
Additionally, multiple surveys have shown that many mothers report that breastfeeding versus
formula was not discussed in prenatal visits, leaving them in a challenging deficit of education
when they give birth [5]. In 2011, the Surgeon General’s Call to Action to Support Breastfeeding
found that only 36% of mothers knew that breastfeeding was protective against diarrhea, and
only 25% of the public agreed that infant formula instead of breast milk increases newborn
illnesses [5]. Therefore, the problem lies not within women’s capacity to breastfeed, but instead
within education and accessibility to providers who provide breastfeeding support. The undue
burden that we place on breastfeeding places blame on women who may experience trouble with
lactation that is out of their control. A variety of conditions may contribute to insufficient supply
of breastmilk including hypothyroidism, obesity, retained placenta, having had breast tissue
radiation, postpartum complications, hypertension, diabetes and more [6]. Therefore,
breastfeeding is not something that can feasibly place blame on a single woman as not meeting
her role as a mother, but instead is dependent on various environmental and biological limitations
that may speak to a broader systemic issue of accessibility to quality and equitable healthcare.
Beyond education, there is a heavy amount of social stigma associated with breastfeeding. As
breasts are often sexualized, many women have been discouraged from breastfeeding in
public—even when they must respond to the needs of their children. Breast milk production is
stimulated when the baby latches, but it can be stunted when parents try to feed the baby on a
schedule—leading to further frustration and feelings of inadequacy from the mother, and an
increase in poor adherence to breastfeeding. Feeling like they cannot breastfeed in public,
women are forced to respond to the taboos of society, rather than listen to the needs of her child,
putting her in a position that hinders her flexibility in breastfeeding.
Moreover, in the current demand of our capitalist society, women are heavily pushed into a space
of making choices that are most ‘efficient’ rather than the best for their children’s health. The
Family and Medical Leave Act states that parents are to be given only 12 weeks off, but
guidelines call for breastfeeding for at least 6 months [7]. Therefore, without adequate support in
the workplace and sufficient time off, women are less likely to continue with breastfeeding if
they are unable to pump at work, or have limited time off. Additionally, low-income women may
not be able to afford the price of breast pumps out-of-pocket (which can range anywhere from
$20 to over $500) [8], and Medicaid limits coverage to certain types of breast pumps, which
could be bulky or awkward to handle in the workplace.
Therefore, it is valuable to consider that although breastfeeding should be heavily encouraged
and educational initiatives should be funded, breastfeeding continues to be a challenge, even
with adequate support, in our capitalist society. Breastfeeding initiatives represent the
prioritization of children’s health, but without sufficient maternity leave, and social taboos of
breastfeeding, we continue to strain mothers while increasing the reproductive burden they
already carry.
While breastfeeding has a wide range of health benefits, would encouraging breastfeeding
increase feelings of postpartum anxiety or depression if some women are unable to breastfeed?
Without proper support, encouraging women to breastfeed can leave mothers to feel “sad or like
they are being left to fend for themselves in a new and demanding situation” [9]. 1 in 5 women
will experience Perinatal Mood and Anxiety Disorders (PMADs), with 75% of those with
symptoms being left untreated [10]. Therefore, movements towards encouraging breastfeeding
for those who have poor accessibility to lactation support, as well as those with contraindicated
conditions like HIV, may increase PMADs like OCD, PTSD, generalized anxiety, depression,
bipolar disorder and more [10]. Existing stigma surrounding mental health puts mothers in a
position where they are not only unable to access the correct support, but are more hesitant in
asking for help when they start experiencing feelings of inadequacy or guilt when they
experience challenges in breastfeeding.
Ultimately, breastfeeding is not just something that can be encouraged by physicians in
appointment settings, but requires full-fledged support socially, in the workplace, and by
insurance companies. Providing adequate access to lactation support, as well as increasing the
time of maternity leave and providing more in-depth informed choice about breastfeeding would
drastically change how women choose and think about their breastfeeding capabilities. In a
broader sense, the acknowledgement and increased support for PMADs is a necessary aspect of
postpartum care that needs more attention—validating women’s experiences with mental health
and providing them outlets of communal and medical support would be indelible in changing
how women experience the pressures of motherhood. Regardless, it is most important to ensure
that women are acting through informed choice, knowing all of their options instead of merely
emphasizing “breast is best.”
References:
1. Sogor, L. (2023, November 14). Spotlight: Lauren Sogor. Women's Health. U.S.
Department of Health and Human Services.
https://womenshealth.gov/blog/spotlight-lauren-sogor
2. Kellams, A. (2025, January 25). The Role We All Play in Supporting Breastfeeding:
Helping Families Achieve their Breastfeeding Goals [Lecture].
3. Hakeem, R., & Labbok, M. (2019). The impact of breastfeeding on maternal health
outcomes: A systematic review of the literature. International Breastfeeding Journal,
14(1), 25. https://doi.org/10.1186/s13006-019-0216-y
4. Centers for Medicare & Medicaid Services. (2012, January 10). Lactation services: A
critical component of maternal and child health care [Issue brief]. U.S. Department of
Health and Human Services.
https://www.medicaid.gov/medicaid/quality-of-care/downloads/lactation_services_issueb
rief_01102012.pdf
5. American Academy of Pediatrics. (2017). Breastfeeding and the use of human milk. In
Pediatrics, 129(3), e827-e841. https://www.ncbi.nlm.nih.gov/books/NBK52688/
6. Kent JC, Ashton E, Hardwick CM, Rea A, Murray K, Geddes DT. Causes of perception
of insufficient milk supply in Western Australian mothers. Matern Child Nutr. 2021;
17:e13080. https://doi.org/10.1111/mcn.13080
7. U.S. Department of Labor. (n.d.). Family and Medical Leave Act (FMLA). U.S.
Department of Labor.
https://www.dol.gov/general/topic/benefits-leave/fmla#:~:text=Time%20taken%20off%2
0work%20due,of%20family%20and%20medical%20leave
8. Pumps for Mom. (n.d.). How much does a breast pump cost? Pumps for Mom.
https://pumpsformom.com/breast-pump-101/cost-to-get-a-breast-pump/#:~:text=Meanwh
ile%2C%20single%20battery%2Doperated%20or,Ameda%20Breast%20Pumps%3A%20
%24125%20%E2%80%93%20%24300
9. Hamnøy, I.L., Kjelsvik, M., Baerug, A.B. et al. Breastfeeding mother’s experiences with
breastfeeding counselling: a qualitative study. Int Breastfeed J 19, 34 (2024).
https://doi.org/10.1186/s13006-024-00636-x
10. Salvatierra, L., & Goodall, T. (2025, January 15). Breast/chestfeeding + PMADS
[Lecture].