Breastfeeding is misunderstood. It may be natural, but that does not make it easy, spontaneous or free. If we want to make policies that respect breastfeeding, we can start by debunking these six myths.

(Featured photo: Rafael Edwards / Flickr)

“Your mother breastfed you until the age of four?! Yuck!”

I was in my early twenties, sitting on a cushion on the floor of the living room of my flat in Santiago, Chile. Some visiting friends and I were all shocked when Marcela, my flatmate, confessed that she remembered the taste of breast milk because her mother had breastfed her and her younger siblings for many years.

The feeling in the room was unanimous – we were grossed out. How could a mother feed a child who already speaks and walks and will remember the experience vividly? We even had a psychologist among us who ventured into Freudian interpretations of how pathological Marcela’s relationship was with her mother.

Fast forward 15 years, and here I am, still breastfeeding my 20-month-old son Lorenzo, with a full understanding of how good it is for him to have access to this superfood*,  while developing a very secure attachment to me.
(*Human milk has amazing properties. For example, its levels of antibodies go up if a child is sick. At night, it has higher melatonin content – the hormone that regulates sleep – to make a feeding baby feel sleepy.
You can read more about human milk’s amazing properties in this piece I wrote)

So, why was I even commenting on breastfeeding in my early 20s with no knowledge at all? Why was a psychologist cornering my friend Marcela like that, with cheap, old-fashioned interpretations? Why was everyone in the room disgusted?

It didn’t help that I had never seen a mother breastfeed beyond infancy. I didn’t even remember my younger brother breastfeeding, as my mom nursed both of us for only five months, following her doctor’s advice.

As I started writing about breastfeeding, I realised that I myself had a lot of unpacking and unlearning to do.

So let me guide you through six myths about breastfeeding – ideas that are so deeply ingrained that I’ve also been guilty of sharing them with others in the past.

Myth #1: Breastfeeding is free

This is a tagline for a lot of campaigns*  – especially aimed at those living in poverty – that breastfeeding is the cheapest option available. I also thought of breastfeeding as free when I first reported on it years ago,  thinking it should be a no-brainer for mothers.
(*Several well-meaning government campaigns and midwife commentary include the idea that breastfeeding is free. For example, see the start of this video by Breastfeeding Promotion Switzerland, an independent organisation for parents and professionals. ‘Breast milk is free of charge, saves money, is readily available, is always delivered fresh, clean, and at just the right temperature … ‘
See the Breastfeeding Promotion Switzerland video here)

Ha, how naive was I?! I didn’t realise just how much time breastfeeding takes until I became a mother myself. In my son’s first months, he was attached to my breast some 12-14 hours a day*.  Did I still think of breastfeeding as free? Certainly not. As  journalist Hanna Rosin wrote:  “It’s only free if a woman’s time is worth nothing.”
(*You may think this is an exaggeration, but the amount of time newborns feed varies hugely. In my case, I was told to feed on demand, and my son’s demand was constant, especially throughout the night.)

Breastfeeding is a form of reproductive labour, or care*, which is never taken into account in the GDP because it doesn’t “produce” anything concrete. By contrast, the market value of milk formula production and sales are counted.
(*Caring for children, the elderly, and also cleaning the house are part of what is considered reproductive labour.
You can find more information on why reproductive labour should be added to the GDP here)

“Breastfeeding is an example of how the economy is mismeasured,” say economists Julie P Smith and Nancy Folbre. Smith estimates that breast milk production in Australia each year is worth about US$4bn, much more than the baby food industry all together.

There is also a mental cost to breastfeeding, which is rarely talked about

You also have to count on the products and services that you may need in order to breastfeed: creams for your cracked nipples, bras and tops that make reaching for the boob faster, pads that avoid staining your tops with whatever leaks, breast pumps, containers and bottles in case you need to freeze your milk. And if you, like most others, need some help in the process, you may have to pay for a lactation consultant  too.

Breastfeeding also has a huge caloric cost. The cumulative energetics of pregnancy and lactation are estimated to consume some 200,000 calories*,  which the mother needs to make up for by intaking more calories. A friend and I often joke about how we lactating women are always ready for a snack, and it is true!
(*Mary Frances Picciano breaks it down in this article: ‘The nutritive demands of lactation are considerably greater than those of pregnancy. In the first 4–6 mo of the postpartum period, infants double their birth weight accumulated during the 9 mo of pregnancy. The milk secreted in 4 mo represents an amount of energy roughly equivalent to the total energy cost of pregnancy. However, some of the energy and many of the nutrients stored during pregnancy are available to support milk production.’
See the full article here)

There is also a mental cost, which is rarely talked about. Women feel guilty when they think they “fail” at breastfeeding.  Others feel resentment and downright anger towards the child constantly attached to the boob*, and then guilt and shame for their negative feelings. And even when everything else is in order, there are different levels of comfort, and different cultural standards, for women to breastfeed in public. Whichever way you see it, breastfeeding is not “free” from an emotional perspective**. 
(*This can become a full condition, known as breastfeeding aversion and agitation. Independent researcher Zainab Yate has written a book about the subject, and I will be writing a piece about this soon.
In the meantime, you can see Yate’s work here)
(**Elizabeth, a member of The Correspondent, shared her thoughts about this below my previous piece, and they are a great example of the emotional cost of breastfeeding for women.
If you’re a member of The Correspondent, you can read it here)

Myth #2: Breastfeeding is natural and therefore spontaneous and easy

Wait, there’s a profession known as lactation consultant? You’ve probably heard that breastfeeding is natural*, so why would you need someone to advise you on how to lactate?
(*There was a US government ad that said: It’s only natural. The UNICEF also had it in a campaign in China.
See the UNICEF video here)

I had read about how newborns naturally gravitate towards the nipples*. But I was amazed to experience how my son, soon after coming out of my vagina and being placed on my belly, immediately started sniffing around, looking for my nipple. He somehow managed to find it and drag himself towards it, and started sucking immediately, as the midwives were still helping me expel the placenta.
(*This is called the breast crawl, and it is quite extraordinary.
This website goes into the scientific explanations and observations of it, and there is also a video of a newborn baby doing the breast crawl)

Breastfeeding is natural inasmuch as it is a product of evolution*. In this sense, it is part of our nature as Homo sapiens to feed our infants at our breast. But that does not make it easy.
(*My colleague Lynn Berger says that you can argue that formula milk is a product of our evolution too; we evolved to have scientists who could make artificial milk and bottles and so on. And thanks to this, babies who might otherwise have died, got to live and pass on their genes. From this perspective, formula is just as ‘natural’.
If you’re interested in reading more about the evolution of breastfeeding, check out this BBC article)

In fact, I spent most of Lorenzo’s second night of life in tears as he screamed because he was hungry and I did not know how to attach him properly. Then there were a few gruelling days until there was a proper letdown of milk*. When that happened my boobs hardened up and felt like botched silicone implants. I had to massage myself under a hot shower for hours to let go of the pain and help Lorenzo get access to milk.
(*The initial days after giving birth, the mother produces colostrum, which is a thick and golden yellow concentrated liquid that comes before the milk itself.
More information here)

I was lucky enough to have access to midwives and a free birthing class that put a lot of emphasis on potential issues: my son may not latch on properly, and my nipples may start to bleed (they did); if he didn’t eat enough, I could get clogged up and even get mastitis* as a result. 
(*Mastitis is a serious issue. It is an inflammation of the breast that sometimes involves an infection. It results in breast pain, swelling and warmth and often also in a fever.
Read this first-person account here)

There are also some women who can’t lactate*, and men who do**. That is natural too.
(It is unclear how many women are not able to lactate. Breastfeeding advocates refer to a 1990 study which estimated that between one and five percent of women are physically unable to produce enough milk to feed their babies. The results from this study have not been replicated elsewhere.
This is an interview with one of the study authors)
(**It is possible for men to lactate (look it up!). But what I want to highlight here is the idea of chestfeeding, a term coined to include trans men who nurse their infants.
You can read more about the obstacles trans people face in this piece in The Atlantic)

Breaking up the meaning of the word natural is important because breastfeeding doesn’t happen spontaneously, like urinating. On the contrary, it requires high support. 

One more thing: we’ve come to associate the idea of “natural” with “good”, especially when it comes to pregnancy, childbirth and early childhood. But you know what’s also natural? A wasp paralysing a spider and laying its eggs in the spider’s stomach to gestate, and then devouring the spider after the eggs have hatched. Baby sharks eating their siblings up while still in utero. In other words: whether or not something is natural doesn’t say very much at all about whether it’s also good for us.

Myth #3: Breastfeeding improves a child’s IQ

As I started reading up on breastfeeding, I got lost in dozens of claims, some of which I also replicated in the first newsletter I wrote about the issue. (Mea culpa, I will update that!!)

The most incredible claim is that children who are breastfed will have a higher IQ than those who aren’t. What parent would not take their breasts out for this promise alone?

As it happens, IQ is not the best way to test a person’s intelligence, though it provides a standard that is easier to follow in studies. More importantly, there is no compelling evidence showing that breastfeeding determines a higher IQ. Economist Emily Oster breaks down some of the studies about breastfeeding in her book, Cribsheet. The main issue with these studies, she explains, is that it is mainly more highly educated, richer mothers who decide to breastfeed, and it is very hard to separate the impact of breastfeeding on IQ from the impact of all the other socio-economic factors on IQ*.
(*This is true for this study conducted in Scandinavia in the 1980s: the authors found that the children that nursed longer had higher IQ scores, about a seven-point difference. They also claimed that even adjusting for the socioeconomic differences, the effect persists. But how easy is it to account for all differences, asks Oster?
You can find the study here

Even in studies that pick mothers from the same socioeconomic background, like this comprehensive study in Brazil, the authors recognise that it is hard to find a direct causation between breastfeeding and higher IQ.

The bottom line is that, even if there is a difference, it is hard to prove that it was caused by breastfeeding alone.

Debunking this is important because we need to give people who can’t or don’t want to breastfeed support too, instead of stigmatising them.

Myth #4: Breastfeeding is just a source of calories

I must admit that one of my very first worries when thinking about breastfeeding was how much my child would eat, and whether it would be enough. I knew of doctors who asked mothers to weigh their kids before and after feeds to see whether their kids were eating enough. But imagine if you were weighed before and after every meal, as if your needs and desires were constant day after day.

The point is that breastfeeding is not just about a transferral of calories. It is not just a simple meal. While breastfeeding, the baby is in direct contact with the mother, and a dialogue takes place, with an exchange of glances, touching and sounds. (Look, I know, I have also taken advantage of breastfeeding to read and message friends, but overall I do interact very closely with Lorenzo when I am nursing him.)

Many scientists think that human milk may adapt to a child’s needs when the child sucks, highlighting that many of the possible benefits of breastfeeding may come from the mother-child interaction, not the milk itself.

This matters because if the mother-child interaction is essential to breastfeeding, then we need to rethink which policies can actually support this. If we put more emphasis on the process rather than the product, then expressing milk  may not be enough.

Myth #5: Breastfeeding has an expiry date

Let’s go back to my very first misunderstanding about breastfeeding: how grossed out I felt by my friend Marcela’s experience of breastfeeding until she was a toddler.

It turns out that Marcela’s mum was right – breastfeeding doesn’t have an expiry date. The World Health Organization recommends exclusive breastfeeding for the first six months of life and continued breastfeeding until two years of age or beyond. 

Most research focuses on breastfeeding in the first six months of a baby’s life, but very little has been carried out on extended breastfeeding. For example, we don’t know much about how much milk composition changes when lactation is sustained for multiple years, or for mothers who tandem feed (who feed two children of different ages at the same time). We do know, however, that in different societies and countries around the world, breastfeeding ends between the age of two and four. And if we look at our closest primate relatives, chimpanzees and gorillas, they wean between the ages of three and five.

So, is there a preferred duration of breastfeeding? Despite what I and my friends thought over a decade ago, and despite what some paediatricians may still tell you, there is no clear evidence that there is an optimal age for breastfeeding, and it is very much up to parents, cultural norms and work commitments.

Myth #6: Breast is best

You probably know this by now: I am a big fan of breastfeeding because it’s worked quite well for my son and for me over the past 20 months.

But do I think “breast is best”*? No. Breastfeeding worked for us because I have a very supportive husband who could travel with us when I had to, I could manage to sleep while breastfeeding, and I worked from home, so I could type away while Lorenzo fed.
(*The phrase ‘breast is best’ has been used widely for campaigning in favour of breastfeeding, even by official government campaigns.
See for example this campaign by the NYC Department of Health and Mental Hygiene)

But what about those women who have to go back to work just after giving birth, maybe after a C-section? Is breast best for them? And those who can’t breastfeed? And adoptive parents, or gay fathers?

Formula is best for them in many occasions, just as it can be great for a woman who can sleep more as her partner feeds the baby at night. 

Breast is best only if you have the right support, and if it works for you.

Breaking down myths for more freedom of choice

Assessing the real value (it’s not free) and effort (it’s not easy!) of breastfeeding will help us recognise how much work breastfeeding actually involves and create policies that respect breastfeeding as a proper occupation. Think of maternity leave, for example: how can a government like the United States recommend exclusive breastfeeding for six months and not implement a law whereby women can get paid leave to do so?

Also, making sure we don’t repeat unfounded claims (breastfeeding has an expiry date, or lowers the IQ, or it is simply best) and we know all the pros and cons of breastfeeding might help us feel more secure in our choices. This is a conversation that we all need to have: for so many women, a lot of the pressure comes from the cultural norms and expectations. For example, my mother and her generation think I am spoiling Lorenzo by breastfeeding him at this age. Thankfully, I have read enough about extended breastfeeding to feel convinced about my choice, but it would be a shame if I felt forced to hide* or stop altogether because of this pressure.
(*A member of The Correspondent, Jisha, wrote to me to say she can’t show her family members in India that she is breastfeeding her daughter, who is four.)

When it comes to breastfeeding, I’m done with stigmatising people*.
(*Another way to look at it is to say that I am pro-choice when it comes to breastfeeding. I am borrowing the expression from writer A Rochaun Meadows-Fernandes, who wrote about it in this moving piece.
Read Meadows-Fernandes’ piece here

This article first appeared in The Correspondent, the member-funded platform that shut down on 1 January 2021.

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