World Breast/Chestfeeding Week 2021

We caught up with Dr Kiran Rahim (@themunchingmedic) to get her insight into breast/chestfeeding in the UK today for World Breastfeeding Week. Here's what she had to say...

As a Paediatrician, I fully support every parent’s right to feed her baby however she wishes. The choice between breast/chestfeeding and formula feeding can be daunting, especially if you are a first-time parents. Sadly having spent many many hours on the postnatal unit, talking to parents and their partners I know all too well the shame, guilt and embarrassment women feel surrounding decisions on how they feed their babies. Feelings that are furthered by the little support they may receive from services as well as the opinion of others. Opinions that range from ‘Breast is best’ to ‘Oh I could never breastfeed’.

As a mother and as a doctor specialising in baby and child health, I was lucky enough to have the knowledge and support from family and friends, that supported me in my decision to breastfeed my boys until they were two. I felt a huge sense of accomplishment and pride that I was able to do something, that at the time wasn’t wholly encouraged or supported! I could not write this blog without touching on the benefits of breastmilk. Whilst I don’t agree with the notion ‘breast is best,’ I cannot deny the reality that the health benefits of human milk far outweigh that of formula milk and supports your baby’s, gut and immune system development. Breast/chestfeeding is proven to have tremendous benefits for both baby and mama for as long as it continues. However breast/chestfeeding isn’t the right choice for everyone and its important parents are supported in their feeding choices without judgement from family, friends AND healthcare professionals. I always bear this is mind whenever I engage in decisions with parents.

Are we giving women in the UK a fair chance to breast/chestfeed?

My experience isn’t common, particularly in the South Asian community in the UK, where acculturation has led to detrimental attitudes and beliefs around breast/chestfeeding. Interestingly, South Asia has one of the highest breast/chestfeeding rates in the world with breast/chestfeeding rates at 6 months around 95-97%. South Asian women are also more likely to feed their babies until their second birthday. In contrast, the UK has one of the worst breast/chestfeeding rates in the developed world with eight out of ten women stopping breast/chestfeeding before they want to. This comes as no surprise as investment in maternal health care services has seen a rapid decline in funding which has meant that key services, like breast/chestfeeding support have been taken away from postnatal wards, communities and birth centers, leaving women and their partners alone in navigating their feeding journeys. Many women cite problems with latching, feeding difficulties and lack of adequate support as reasons for stopping breast/chestfeeding earlier than intended. Others report feeling grief, anger and sadness because they did not get to feed their babies how they planned or received the support they needed.

The cultural and societal attitudes towards breast/chestfeeding are also important and influence breast/chestfeeding practices. In many parts of South Asia, breast/chestfeeding is encouraged as a spiritual act that will be rewarded. For example, in Islam women are told they will be rewarded for breast/chestfeeding and this serves as an important driver for women to initiate and continue breast/chestfeeding. In parts of Africa, the breasts are seen as biological organs that are intended to feed babies, so breast/chestfeeding is normalised. However in the UK oversexualisation of the breasts has led to detrimental attitudes towards breast/chestfeeding, both amongst women and in wider society. Many women may feel embarrassed to feed and perceived or actual negativity from others can influence their decision to feed. In a recent study White British mothers expressed that the embarrassment and stigma associated with breast/chestfeeding were one of the reasons they chose to bottle feeds.

Interestingly, acculturation in the UK has led to negative impacts on breast/chestfeeding beliefs and behaviours in women from BAEM communities, with lower rates of acculturation associated with higher rates of breast/chestfeeding and vice versa.

In some cultures breast/chestfeeding is associated with poverty and ‘low educational’ status and so women from wealthier backgrounds opt to use formula to preserve their ‘status.’ There is also a lot of misinformation around breastmilk not being enough for babies, and the need for supplementation with formula to ensure the baby is a ‘healthy weight’. In my own journey I can remember several women advising me to supplement with formula because ‘it’s better for the baby’ as this is what had been passes down generationally to them. In the white British population, there are common perception around ‘lack of milk’ that are further enforced by poor understanding of normal newborn feeding behaviours such as ‘cluster feeding.’

Amongst all ethnicities in the UK, white British mothers were least likely to breast/chestfeed and could not outline any benefits in relation to breast/chestfeeding for either the baby or the mother in one study. They were also more likely to hold the most negative views towards breast/chestfeeding.

This is an important consideration because formula companies spend x10 more on marketing their products that the government spend on breast/chestfeeding education and support un the UK. Furthermore 67% of UK public think there is no biological difference between breastmilk and formula. There is also evidence that people from poorer socio-economic backgrounds buy formulas marketed as ‘gold’ etc because they believe it offers their child the ‘best’.

How can we support women better?

Research shows that women commonly stop breast/chestfeeding due to problems such as inability to latch, sore/painful nipples and insufficient milk supply. Women are often unprepared for the physical and emotional challenges of early breast/chestfeeding and feel that they are left to ‘learn the hard way’ due to lack of time, expertise or practical assistance from health professionals in the early postnatal period. Language barriers, cultural beliefs and systemic discrimination further lead to women from minorities feeling unsupported in their breast/chestfeeding practices.

Instead of holding the government and national policy makers accountable, the blame has fallen consistently on mothers/parents and their families for ‘not supporting’ breast/chestfeeding. Rather than having a one size fits all approach, particular attention needs to be paid to cultural and socioeconomic factors that may influence a woman’s decision, so services can be both educational and supportive. This means providing families with ALL of the facts that will help them with their decision, which may or may not be to breast/chestfeed.

As a society we must remember that new parents, and particularly birthing people, do not need to justify their decision on how they feed their babies. Whether it’s breastmilk, formula milk, mixed feeding or bottle feeding doesn’t matter, what each family needs is correct information and importantly support. Each family is unique and has the right to do what is best for them. We must remember that feeding babies is not simply about nutrition. It’s about forming a bond, feeling joy, closeness, awe and so many other emotions, irrespective of how we feed our babies. This is something to remember when you encounter women that have made different feeding choices to you. Breast/chestfeeding grief is a real phenomenon in the UK and something we must recognise in this week.

Every feeding journey matters

Whilst breastfeeding was the right choice for me and family, I know that for many it isn’t and there is no shame or guilt in this. As parents we make many choices about what we perceive to be the ‘best’ thing for our child and feeding is just one of them. Instead of becoming evangelical about breastmilk or formula feeds, we must engage women in open and honest conversations and support them in their parenting journeys. This means access to education, investing in maternal education and providing adequate postnatal services and support. Every feeding journey is different and what we need is a society that allows women a fair chance to breast/chestfeed if they want to, with adequate support from healthcare providers and legislation. All women deserve support for their feeding choices and ALL women deserve to feel happy about how they feed their babies.