The HSE (Health Service Executive) recently released The Irish Maternity Indicator System 2019 with some very worrying statistics. The report shows that only two out of three Irish mothers initiated breastfeeding – the lowest rate in the world. To further compound the problem, just 37% continued to breastfeed upon discharge from maternity hospital and only 13% continued after six months, compared with a European average of 25% and a global average of 38%.
Despite decades of research, science cannot replicate the endless benefits of breastfeeding. Breast milk contains essential enzymes, hormones and antibodies that are vital for babies’ normal growth, development and health, protecting them from allergies and illnesses such as chest, ear, and stomach infections. It also changes and adapts to meet the baby’s needs at each stage of development.
Breastfeeding plays a crucial role in reducing and preventing obesity by regulating babies’ food intake and setting up appetite controls; it also helps protect against Crohn’s disease, irritable bowel syndrome, and celiac disease. Breastfed babies are less likely to develop high blood pressure, high cholesterol, and cardiovascular disease, as well as having higher IQs, better developed neurological systems, and sharper vision.
The 2020 book, Molecular Nutrition, describes breastfeeding as “representing optimal nutrition during immediate postnatal life.” Conversely, formula provides no benefit to the baby beyond basic nutrition.
Breastfeeding is important for mothers too. It helps the uterus return to normal size more quickly. It reduces the risk of breast and ovarian cancer, diabetes, osteoporosis, high blood pressure, high cholesterol, and cardiovascular disease. Every time a mother nurses her baby, she releases the hormone oxytocin. Oxytocin not only causes a mother to release her milk but it enhances feelings of attachment and falling in love with her baby, and protects women’s mental health by reducing stress levels and improving sleep patterns.
On a superficial level – but no less important – breastfeeding saves time and money, burns calories, eliminates the need to carry bottles and is ready when the baby needs it at the perfect temperature with no need for sterilisation.
Why are Irish statistics so low?
A century ago, breastfeeding in Ireland was standard. So what changed?
A 1954 study of feeding trends in Ireland demonstrated that working class mothers were most likely to initiate breastfeeding, and that babies born into larger families were less likely to be breastfed. Once infant formula became available here in the 1950s, women had the opportunity to choose between breastfeeding or formula feeding. As formula became less expensive, breastfeeding started to decline, rapidly altering the culture.
Aggressive manufacturing and marketing by infant formula companies in the 1970s facilitated a massive shift away from breastfeeding and towards formula feeding. Increased advertising in parental magazines and on television undermined women’s confidence. Since its introduction into Irish society, the infant formula industry has generated huge wealth for the Irish economy, worth billions every year. €1.3 billion of formula was exported from Ireland in 2017 alone.
A 2014 study of maternal behaviours demonstrated that women from other countries who give birth in Ireland are six times more likely to breastfeed than women from Ireland. The study also showed that older women were more likely to breastfeed, and that mothers who work full-time are 113% more likely to stop breastfeeding compared to mothers who did not return to work.
The study concludes that a mother’s socio-economic status is a major determinant in maternal behaviours. Factors such as age, social class, education, and employment status contribute to the choices made by mothers. Women of higher income, education and social class are much more likely to breastfeed and for longer.
Working-class mothers were doing the heavy lifting when it came to breastfeeding before the widespread introduction of infant formula. They were the demographic most susceptible to formula companies’ advertising campaigns and it is the same demographic of working-class mothers today that are least likely to participate in breastfeeding.
Two generations of potential breastfeeders were lost. Therefore, mothers of today have no guidance, skill or knowledge from their mothers or grandmothers. This is a crucial missing factor when comparing Irish rates to worldwide averages.
There is much misplaced stigma surrounding breastfeeding in Ireland. It could be argued that Ireland, as the only English speaking catholic country, is uniquely placed to experience both catholic guilt and the stereotypically prudish, conservative, anglicised attitude. Yet across the Anglosphere, rates range from 94% in New Zealand to 90% in Australia and Canada to 81% in the UK and 79% in the US.
The excuse of “Catholic Ireland” that is paired with an obligatory eye-roll is also a fallacy. Predominantly catholic countries tend to have high breastfeeding rates, including 97% in Colombia and Poland, 95% in Mexico and the Philippines, 89% in Italy, and 87% in Portugal. To blame religion at all is somewhat absurd. The most religious and most conservative societies, i.e. Muslim countries, almost exclusively score in the 90th percentile for breastfeeding rates.
Another straw man argument is the over-sexualisation of female breasts. This reason or excuse is rolled out every time Ireland’s low breastfeeding rates are discussed. But is this an exclusively Irish problem? Are we Irish the only society to sexualise women’s breasts?
No, of course not. Breasts are just as sexualised in other high income countries, comparable to Ireland, yet breastfeeding rates are not affected. The breastfeeding rates in Sweden, Finland, Denmark, Netherlands, Japan and South Korea are all above 90% and breasts are just as sexualised there as here.
The sad fact is that this aversion to breastfeeding has ingrained in our collective societal psyche for generations. But Ireland is evolving (although sometimes at a glacial pace) and the problems of our past do not need to determine the progress of our future.
What can be done?
There are no simple solutions to difficult problems. People have become scared to talk about breastfeeding, but not preparing women during pregnancy becomes a self-fulfilling prophecy. The honest reality of breastfeeding is that it is difficult, relentless and exhausting. Mothers need and deserve support.
Education is key to improving breastfeeding rates. Policymakers need to understand the lifelong health benefits of breastfeeding over formula for them to provide the education and support necessary to foster a positive breastfeeding culture. While young, would-be mothers can most benefit from this, it is crucial to educate everyone in society. The optimum time to begin is primary school. Something as seemingly trivial as which bottle nipple to use for mothers who express can have far-reaching effects on a baby’s ability to properly latch on and nurse.
Many women claim they cannot physically breastfeed. While some will struggle, the vast vast majority just need professional support. A huge problem with this support, however, is that so many mothers, grandmothers, nurses and midwives themselves did not breastfeed and therefore do not have the skill or experience to pass on. Social and cultural norms of migrants regarding breastfeeding can and should be used to encourage positive change in Ireland through government sponsored support initiatives.
We also needed a society that better supports women to be both mothers and workers. Despite much progress, women still experience structural barriers to participating in the workforce when they become a mother, particularly if they wish to continue breastfeeding. Facilitating breastfeeding in the workplace, increased paid maternity leave and tangible paid paternity leave are all aspects of support in which Ireland falls far short of international best practice.
The pressure surrounding breastfeeding can leave mothers feeling judged and even depressed. There must be a paradigm shift in Ireland to enable women to view their unique abilities as a source of pride and empowerment.
If you have any thoughts or opinions, please comment below.