Expert Insights

How expectations around breastfeeding have changed over time

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“All women can breastfeed!” It’s a popular slogan among breastfeeding advocates and lactation consultants, designed to give women confidence in their ability to feed their babies. And while it’s certainly true that most women are physiologically capable of producing enough milk to feed their babies, it’s never been true that all women can breastfeed.

infographic about breastfeeding

The gist on breastfeeding

Parenting is not harder, the society we parent in is. Breastfeeding is not harder, breastfeeding exclusively is.

Common breastfeeding obstacles

Experts estimate that roughly 15% of women are physically unable to breastfeed, for a wide variety of reasons, including thyroid or hormone imbalances, breast hypoplasia, Sheehan’s syndrome, polycystic ovary syndrome, hypoprolactinemia, and prior breast surgery. Anxiety and depression also interfere with breastfeeding, as do inverted nipples, a baby’s tongue-tie, or simply their ability to latch. It’s also always been true that many women who are physically capable of producing breast milk still can’t breastfeed due to responsibilities outside the home. 

Recent data shows: 

  • 42% of women are primary breadwinners
  • 22.4% of women are co-breadwinners

Life before baby formula

Before the invention of infant formula, many women relied on wet-nurses or homemade combinations of watered-down cow’s milk, and many babies died of malnutrition and diarrhea.

In 1981, the World Health Organization (WHO) published its International Code of Marketing of Breast-Milk Substitutes, and resources were poured into breastfeeding advocacy.

Breastfeeding rates are growing but not exclusively

Today, 83.8% of babies born in the US start on breast milk. The rise of attachment parenting, feminist and organic movements, have also had a positive impact. And in the meantime, US baby formula continues to improve, as parents demand higher quality.

But, public health policy now pushes breastfeeding, with no comparable policy changes that would make it easier to breastfeed your baby exclusively for six months, such as federally-mandated paid maternity leave. This conflict sets most moms up for failure; within the first three months breastfeeding rates drop to 46.9%. And, nearly half of women in one study reported early, undesired weaning.

The rise of combination feeding with formula

The 2010 amendments to the Affordable Care Act that facilitate pumping in the work-place are a way closing the gap between the recommendation for six months of exclusive breastfeeding and the absence of maternity leave. Even so…. Most companies don’t comply, and the policy has no enforcement mechanism.

Moms are trying harder than ever to do the right thing and comply with recommendations, but faced with this impossible gap, the best option for many moms is to combination feed, using breast milk whenever possible and formula whenever needed.

Infographic about the history of feeding babies

Expert Q&A with Professor Courtney Jung

Photo of Professor Courtney Jung

We sat down to chat with Professor Courtney Jung from the University of Toronto and author of Lactivism to dive deeper into this topic.

Milk Drunk: When and why did formula feeding become so stigmatized?

Courtney: Societal backlash against formula feeding started in 1958, with a group of seven Catholic mothers who would go on to form La Leche League. It gained steam in 1977 when activists exposed Nestlé’s aggressive marketing practices in developing countries, kicking off the longest corporate boycott in history. Parents began hearing not only that breastfeeding is good, but that formula is dangerous. Our society has come to interpret “breast is best” to mean “everything else is unacceptable. 

Milk Drunk: Moms are often judged for breastfeeding too. Why is that?

Courtney: “Well, the stigma around breastfeeding is driven by puritanical societal norms that associate exposed breasts with sexual impropriety. We’re parenting in a pressure cooker. It seems that every choice we make is going to offend someone, and people feel very empowered to tell new mothers just what they think of their parenting decisions.”

Milk Drunk: Public policies around parenting and breastfeeding haven’t changed that much. What message does that send?

Courtney: “Women are honestly being asked to do the impossible. In the United States, where most women get very little maternity leave, the only women who can breastfeed exclusively for six months are women who don’t work. The rest of us are set up for failure when we find we can’t square the circle between the breastfeeding recommendations and the absence of federally mandated paid maternity leave. And when we turn to formula, we get the clear message that we have failed as mothers.”

Tips to set yourself up for infant feeding success

  1. Understand: Baby’s ability to breastfeed + mom’s supply + mom’s time + mom’s mental health + environmental support = your feeding journey.
  2. Speak up: Tell your support network what is working for you and what isn’t.
  3. Question research: Most clinical studies involving infants don’t tell the full story.
  4. Take action: Set up an Employee Resource Group at work for moms to self advocate.
  5. Work remotely: Ask your employers for more flexibility so you can work from home.


Redesigning the workplace to be family-friendly: What governments and businesses can do, WHO

Breastfeeding Report Card, United States 2018, Centers for Disease Control and Prevention

Barriers to Breastfeeding in the United States, The Surgeon General’s Call to Action to Support Breastfeeding

How often does breastfeeding come undone?

Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction

Recognizing and Treating Delayed or Failed Lactogenesis II

Breadwinning Mothers Are Increasingly the U.S. Norm

The content on this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment. Discuss any health or feeding concerns with your infant's pediatrician. Never disregard professional medical advice or delay it based on the content on this page.

The content on this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment. Discuss any health or feeding concerns with your infant’s pediatrician. Never disregard professional medical advice or delay it based on the content on this page.