The American Academy of Pediatrics (AAP) recently updated its breastfeeding recommendations for the first time in a decade. In a policy statement, the AAP continues to recommend exclusive breastfeeding up to six months of age and also added the recommendation that breastfeeding continue for two years or more “as mutually desired by mother and child.”
There several things to applaud in this guidance. First, the recommendations align with recommendations on extended breastfeeding established by the World Health Organization (WHO) and American Academy of Family Pediatricians (AAFP). Second, the guidance recognizes that, when mutually desired by both mother and child, extended breastfeeding benefits mothers too, not just babies and toddlers.
While there is much to celebrate with this updated guidance, there is something important missing from the equation: support.
Research shows that children from wealthier families are more likely to be breastfed than babies born into a low-income family. Among the reasons that a mom might stop breastfeeding earlier than desired are unsupportive work policies, lack of parental leave, cultural norms or lack of family support, and unsupportive hospital practices. In Motherly's 2022 State of Motherhood survey, 35% of moms said they didn't meet their breastfeeding goals because they had to return to work.
These hurdles to extended breastfeeding—when mutually desired—still exist despite the new guidance. Although the AAP has called for additional breastfeeding support, to date, little has been done to remove these hurdles.
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For instance, in the same week that the AAP issued its updated breastfeeding recommendations, the U.S. Senate failed to pass the PUMP for Nursing Mothers Act, which would have extended workplace breastfeeding protections to at least 9 million breastfeeding parents during the ongoing formula shortage.
“We need societal changes that will help to support this, such as paid leave, more support for breastfeeding in public and child care facilities and workplace support,” said Dr. Joan Meek, a professor emeritus in the department of clinical sciences at the Florida State University College of Medicine and lead author of the new recommendations.
Until these societal changes happen, the new AAP recommendations may have the unintended impact of exacerbating inequities that already exist. Mothers who have high-paying jobs at companies who offer paid leave or remote work options are more likely to be able to continue extended breastfeeding. Unless and until there is universal paid family leave, access to safe and affordable childcare, insurance coverage for breastfeeding supplies (like breast pumps), and extended lactation support, the socioeconomic factors impacting breastfeeding will persist.
The AAP’s policy statement acknowledges the hurdles and urges pediatricians to advocate for the necessary policy changes and societal support. Pediatricians can push for policy changes, which are desperately needed to meet that two-year breastfeeding recommendation.
The new recommendations may also unintentionally cause shame for those moms who can’t or don’t breastfeed. In Motherly's 2022 State of Motherhood survey, among moms who didn't meet their breastfeeding goals, 38% of moms said it was because they were physically unable to and 27% said it was because they didn't want to breastfeed. Breastfeeding can be an emotionally charged issue, and there is no one-size-fits-all approach to something as personal and integral to parenthood as how we feed our children. We need judgment-free places to discuss our breastfeeding goals and challenges (whatever they are), and then we need family members, friends, a community and health care professionals to support us on that journey.
“This is the recommendation, but in actuality — in practice — we don’t want parents to feel bad if they can’t get there,” Dr. Dale Lee, a specialist in pediatric gastroenterology and nutrition with Seattle Children’s Hospital, said. “I think breastfeeding is wonderful, and I want to really highlight the benefits of it. But I also want to say to parents that it’s not as though you are mandated to provide breast milk, and that you are a failure if you don’t.”
In order to support breastfeeding moms—and all moms, for that matter—we need change beyond the policy level, as well. We need a holistic shift in our collective mindset when it comes to motherhood, feeding children, and caring for families. Let’s remove the stigma of extended breastfeeding, eliminate judgments about breastfeeding in public, and take the temperature down a few notches on conversations about how we feed our babies. Let’s make decisions for our own families and whole-heartedly support other families in theirs. Unless we make these changes and get the much-needed and long-overdue support, the new recommendations may just be words on a paper.
Motherly designed and administered its 2022 State of Motherhood survey through Motherly’s subscribers list, social media and partner channels, resulting in more than 17,000 responses creating a clean, unweighted base of 10,001 responses. This report focuses on the Gen X cohort of 1,197 respondents, millennial cohort of 8,558 respondents, and a Gen Z cohort of 246 respondents. Edge Research weighted the data to reflect the racial and ethnic composition of the US female millennial cohort based on US Census data.