Relearning the Lost Art of Breastfeeding: 
Obstacles and Resources for Iranian and American Women 

by Cynthia Good Mojab

An overwhelming amount of research now proves that breastfeeding offers benefits to babies that cannot be duplicated with formula. These advantages include less risk of illness and disease, including allergies, childhood cancer, diabetes, and Sudden Infant Death Syndrome (SIDS). The benefits of breastfeeding also include less risk of breast and ovarian cancer, anemia and osteoporosis in women who breastfeed; lower feeding and health care costs and less work absenteeism for breastfeeding families; and less pollution of the environment. Based on breastfeeding research, the American Academy of Pediatrics recommends that babies be exclusively breastfed (no water, juice, tea, formula, or other liquid or solids foods) until they are at least six months old and that breastfeeding continue for at least one year. The World Health Organization recommends at least two years of breastfeeding. Yet breastfeeding patterns in Iran, the United States, and many other countries increasingly fall short of these minimum recommendations. 
 

The Decline of Breastfeeding in the United States and Iran

The knowledge that breastfeeding provides unparalleled advantages to babies does not guarantee that a woman will choose to breastfeed or that–having chosen–she will have the information and support she needs to breastfeed. Though breastfeeding is a natural process, it is also a social behavior. When women become mothers in societies in which breastfeeding is the norm, they have societal support and approval, as well as ample models and reliable advisors in their own families. However, the mothers and aunts of women bearing children today may have little or no experience with breastfeeding. Due to complex cultural and economic factors, the lowest rates of breastfeeding ever seen in the US occurred during the 1960s. As formula manufacturers aggressively expanded their markets, breastfeeding rates dropped around the world and continue to decline globally today. In the developing world, only 44 percent of infants (even less in industrialized countries) are exclusively breastfed for any length of time. Worldwide, 1.5 million infants die each year because they are fed breastmilk substitutes. 

The art of breastfeeding has been lost in individual families and in entire societies. In the absence of breastfeeding knowledge, the techniques of formula feeding–such as scheduled, infrequent, and time-limited feedings–are applied to breastfeeding, often resulting in a reduced milk supply, slow weight gain, and premature weaning. Many physicians–trained in a bottle-feeding culture–are unfamiliar with proper breastfeeding management and the rapidly advancing field of breastfeeding research. They may unknowingly offer inaccurate information that can undermine a woman’s breastfeeding experience. While breastfeeding rates have risen in the US since the 1960s, there is still room for improvement. Rates among new mothers vary from 38 percent in the East South Central region to 70 percent in the Pacific and Mountain states. Only 26 percent of US babies are still breastfed at six months; only 14 percent are still breastfed at a year. 

Breastfeeding in Iran has also been negatively impacted by the culture and economics of formula feeding. The duration of exclusive and partial breastfeeding in Iran, especially in urban areas, is less than that recommended by the World Health Organization. In one Iranian study, only 7 percent of women were still exclusively breastfeeding at four months. The perception of insufficient milk is common, as is pressure from close relatives to introduce breastmilk substitutes such as formula, sugar water, and solid foods. Even if accurate breastfeeding advice and support is available within the family, Iranian women living in the US may not have sufficient access to it they are separated from their families by immigration. 
 

Relearning the Lost Art of Breastfeeding

Breastfeeding rates are increasing in areas of the world where governmental agencies and private organizations are working to change the cultural and economic factors that threaten breastfeeding. Effective breastfeeding advocacy includes public education campaigns, the education of physicians and nurses regarding breastfeeding, the creation of breastfeeding-friendly hospital policies, and–especially–the regulation of formula marketing. Breastfeeding rates have risen–and infant illness and mortality have declined–in the many countries that have enacted all or part of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes, adopted in 1981 by the World Health Assembly. The Code prohibits formula marketing practices that undermine breastfeeding, such as public advertising, free samples to mothers, and the promotion of bottle-feeding or free formula supplies through health care facilities. The US government was the only one of 119 countries to vote against the adoption of the Code and still has not taken any action to implement it. Iran has adopted legislation in compliance with the Code. 

Studies in Iran, the US, and other countries show that breastfeeding education increases the occurrence and the duration of exclusive and partial breastfeeding. Mothers are relearning the lost art of breastfeeding in nontraditional but highly effective ways: breastfeeding classes during pregnancy, written materials, breastfeeding instruction immediately after birth, follow-up visits at lactation clinics, home visits by nurses or lactation consultants, and breastfeeding support groups. The rise in breastfeeding rates in the US since the 1960s is due, in large part, to such measures. 

La Leche League International, a non-profit, non-sectarian organization founded in 1956, has played a major role in providing women the support and information they need to breastfeed. It is recognized as an authority on breastfeeding, is consulted by agencies such as the World Health Organization, United Nations Children Fund, and United States Agency for International Development, and is a founding member of the World Alliance for Breastfeeding Action. La Leche League publishes The Womanly Art of Breastfeeding, now in its sixth edition, which combines practical breastfeeding information with current research. It also trains and accredits volunteer breastfeeding counselors. These women have nursed their own babies and lead local breastfeeding support groups in which women can learn how to breastfeed and can build a network of breastfeeding support that may be unavailable in their own families. Over 3,000 La Leche League groups now exist in 66 countries–empowering women around the world to relearn the lost art of breastfeeding and to help recreate a culture of breastfeeding in their communities. 
 

© Cynthia Good Mojab, 1999. All rights reserved. 

This article was first published in Andisheh, Vol. 1 No. 10, December 1999.

Author's note (July 11, 2003): If I were writing this article today, I would not refer to the "advantages" or "benefits" of breastfeeding, as such writing holds formula feeding to be the norm. While formula feeding is the cultural norm in many parts of the world today, it is not the biological norm. As the biological norm, breastfeeding is the foundation of normal - not superior - human health and development. Formula feeding poses many risks for the health and development of human beings. See my July 25, 2002 article in the Oregonian, "The real breastfeeding issue goes far beyond mere guilt" for more on why how we talk about infant feeding matters.