Doctors point to overwhelming evidence that breast milk is superior to formula. But breastfeeding rates in the United States continue to be low. Reasons for that may be lack of paid maternity leave in the U.S., challenges breastfeeding at work, the role of WIC in subsidizing formula and the fact that for many women, breastfeeding, although natural, is a learned skill and there aren't enough people teaching techniques.
In this episode more than a dozen women will share their stories about motherhood, breastfeeding, and society’s demands.
Three years ago, here on Inside Appalachia, we heard a baby being born in an episode called “Hippies, Homebirth, and the History of Birthing Babies in Appalachia.” In this episode, we’re turning to the next chapter, the first few weeks and months after giving birth.
History of Formula Versus Breastfeeding
Babies have been breastfed for most of human history. In the late 1800s, formula was invented, though it didn’t become affordable for most moms until the 1940s. That’s when doctors began pushing formula as the preferred way to feed infants, and breastfeeding rates declined.
But then in the 1990s, studies began to show that breast milk is better than formula. It has perfect combinations of proteins, nutrients, and fats that a baby needs, and the chemical makeup of breastmilk changes as a baby grows.
Today, most moms in the United States start out breastfeeding, but many stop as complications arise. In this episode, we’ll hear some of the reasons why this might be.
Benefits of Breastfeeding
There are lots of studies that show that breastfeeding protects infants from getting sick. “Babies who are breastfed have fewer respiratory infections, things like colds, the flu, RSV, less diarrheal illnesses, so less stomach bugs,” said Kailey Littleton, a pediatrician and lactation consultant in West Virginia. “They [also] have a lower incidence of SIDS, which is sudden infant death syndrome.”
The American Academy of Pediatrics recommends that infants be breastfed for the first six months of their lives. After six months, doctors recommend introducing some solid foods, while continuing to breastfeed for a year or longer. The World Health Organization says babies should be breastfed for at least two years.
There are also studies that show breastfed babies are less likely to get diabetes, heart disease, and even some types of cancer.
But there aren’t many scholarly studies that look at whether the benefits of breastfeeding might be linked to a mother’s social or economic class.
One study published last year in the journal Social Science & Medicine: Population Health shows that babies whose mothers intended to breastfeed, but don’t, have some of the same benefits as babies who were breastfed. Although this study still shows that breastfed babies are healthier overall, the results aren’t as remarkable and some of the other breastfeeding studies.
There are also a few studies that compare siblings, when one baby was breastfed but their brother or sister was not. Generally, these studies show that the benefits aren’t significantly higher for the breastfed babies, suggesting that a mother’s social or economic status may be the most important indicator of a baby’s long-term health outcomes.
Even though these studies show that breastfeeding does provide benefits, they reveal that the health benefits might not be as significant as originally thought, when a mother’s socioeconomic status is taken into account.
We do know that breastfeeding rates are linked to socioeconomic status. Women with low incomes are less likely to breastfeed than women with higher incomes. In this show, we’ll hear some of the reasons why the disparity exists.
Only 17 percent of Americans have paid family leave time through their employers, according to the Bureau of Labor Statistics. In the early 1990s, the Family Leave Act was passed. It requires most employers to offer workers three months off after the birth of a baby -- both men and women. But here’s the catch, employers don’t have to pay them for the time off.
Also, businesses with less than 50 employees are exempt from the Family Leave Act, so it’s legal for small businesses to fire workers if they take time off after a birth.
What this means is that many parents -- especially mothers -- who can’t afford to take unpaid time off return to work soon after having a baby.
We don’t know when, on average, women in Appalachia return to work. There isn’t any research on that. But some breastfeeding advocates say they believe a need to return to work quickly may be one of the reasons women in Appalachia are less likely to breastfeed, compared with national breastfeeding rates.
Working Moms in West Virginia
Nearly 900 women answered a West Virginia Public Broadcasting survey about being a working mom in Appalachia. From this, we were able to glean some insight into what working women in our region face, especially when it comes to the challenges of breastfeeding.
- More than half of the women said they breastfed their babies.
- More than half also said they received no paid time off work.
Returning to work after giving birth can be hard, regardless of how parents choose to feed their babies. In this episode, we’ll hear how it affects moms who breastfeed.
Mental Health and Breastfeeding
Some studies have shown that moms who breastfeed have a lower chance of developing post-partum depression. However, the results do vary study to study, and depending on whether women showed signs of mental health issues before giving birth. A 2014 study published in the Maternal and Child Health Journal showed that when women intend to breastfeed, but then are unable to for various reason, they tend to have a high chance of developing postpartum depression.
Motherhood is often portrayed in popular culture as a time when women are glowing with warmth, love, and happiness. The reality is sleep deprivation, coupled with huge hormonal shifts, the need to return to work quickly, and the struggles of caring for a brand new human being, and you have all the ingredients for a mental health disaster. We’ll hear the story of several women’s struggles with maternal mental health.
Milk Sharing- Not Always Safe
In 2017, the American Academy of Pediatrics issued a recommendation that at-risk, premature babies be fed donated, pasteurized breastmilk, if their mothers aren’t able to breastfeed. The milk comes from milk banks certified by the Human Milk Banking Association of North America. Donors are tested for contagious diseases.
But informal systems of milk sharing exist, too. And they could be putting some babies at risk. A study published in the Journal of the American Academy of Pediatrics ran some tests on human milk purchased over the internet - and yes websites exist that sell breastmilk, although it’s not legal. The study found that most of this milk was contaminated with bacteria. And while some types of bacteria are safe, even beneficial, other types are dangerous for infants. The researchers found a lot of the dangerous kind in the donated breastmilk, likely from poor pumping, storage or shipping practices.
Last year, the CDC began asking people how they feel about informal milk sharing. Of those who answered, about 30 percent said they, “believe it is acceptable for mothers to feed their baby with the breast milk obtained informally from another mother (not including pasteurized breast milk from a milk bank).” Only 20 percent said they disagree.
Today, the majority of women in America work outside the home, including women who’ve recently given birth. At the same time, according to a study by the Pew Research Center, women today actually spend more time with their children than they did in the 1960s.
Molly Clever, an assistant professor of sociology at West Virginia Wesleyan College and herself a mother of two kids, teaches a course on gender studies. She says sociologists have a term for this -- "intensive motherhood". "Basically, the idea is that you have to be with your children all the time. And that your status as a mother is tied to how much you sacrifice of yourself, to raise your children,” Clever said.
“The more exhausted you are, the more sleep deprived and time deprived and stressed out you are, the better you're seen as a mother. And the better you are able to see yourself as a mother. And these are very incompatible things, to be both a good mother and an exhausted and stressed out mother. The interesting thing about that is that ideology rose more in the 1980s and 1990s, as a reaction to women spending more time in the paid labor force and less time at home,” Clever said.
Glynis Board guest hosts this episode. She closes the show with these personal thoughts:
"Unpaid maternity leave, breastfeeding challenges, social pressures -- I really wish we could solve these issues here in this episode. But we’re journalists -- not superheroes. Still, I want to share one personal experience that has shaped how I approach these kinds of things.
My little guy was probably a month old when I got a message from another mom I knew. I didn’t know her well. So it really surprised me. She told me about how after she first had a baby she felt depressed, isolated, even trapped. But that it passed. She told me about how hard it was to breastfeed at first. But then things got easier. She said I could call her if I needed to.
I cannot tell you how much that note meant to me. I was living in rural Preston County at the time and struggling with so many emotions. Worried about having to return to work in a few short weeks. Frustrated that I couldn’t slow time — as crazy as that might sound.
But that note made me suddenly feel like I was part of the mom club. Everywhere I looked there were other members. And they had my back. A few years later an acquaintance of mine had a baby. I sent her a similar note." --Glynis Board.
Roxy Todd is our producer. Eric Douglas is our associate producer. Our executive producer is Jesse Wright. Ibby Caputo edited our show this week. Our audio mixer is Patrick Stephens. Zander Aloi helps with promotions. Tweet at us on Twitter @InAppalachia - we love that.
You can also send us an email to Inside Appalachia@wvpublic.org.
Editor's note: a previous version of this article identified Molly Clever as an associate professor at West Virginia Wesleyan College. Clever is an assistant professor.