Breast is best - usually.

Breastfeeding was celebrated this past weekend with a mass latch on across the country, and in some cities, flash mob breastfeeding events were being held. A great expression of one of Canada's public health successes

Breastfeeding rates have neared 90% after dropping two generations ago to less than one-third.  An amazing celebration of both public health and feminism in reclaiming what is by far the best option for most babies.

Like many things in medicine and health care, the marginal value becomes questionable of moving through various levels of breastfeeding from supplementing with other formula (or for older infants solids), through occasional juices and water to never using anything but the real McCoy.  Not to suggest that there is no value, only to emphasize that there is  greater importance in supporting parents in any breastfeeding than to leave individuals feeling guilt over their choices.

Breastfeeding is now adopted most by older mothers, the most educated and the most economically endowed.  It has almost become a sign of social status.  Granted rates remain lower as one travels east across Canada, Aboriginal women are less likely to breast feed, as are those in non-marital relationships.

Current national guidelines stress exclusive breastfeeding for the first six months of life. Our data is less clear than breastfeeding initiation, but few jursidictions will boast achieving even 50% breastfeeding rates at 6 months, let alone at 4 months. 

Hence the question needs to be reiterated, why and how do we support families in sustaining breastfeeding?  Moreover, given that so many women choose to not maintain exclusive breastfeeding through the first half year of life, let alone continue latching up to one or two years of age – why do our public health programs remain focused on just initiation? Or moreover focus on those who seek support because of what pathologizes anomalies of breastfeeding?

The highest risk for weaning early is among those that would benefit most through socioeconomic challenges, through social conditions or just through lack of education.   Too often the professional women, highly motivated and for whom the marginal benefits of sustained breastfeeding become the target of misdirected comments and efforts – as they seek public health support in other aspects of their parenting role.

Breast is best, and better when sustained. But at least let us be focused in what value we are achieving in our comments and efforts.