the Lost Art of Breastfeeding:
and Resources for Iranian and American Women
Cynthia Good Mojab
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.
Decline of Breastfeeding in the United States and Iran
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.
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.
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.
the Lost Art of 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.
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.
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.
article was first published in Andisheh, Vol. 1 No. 10, December 1999.
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.