Hello,

Thank you for your attention to breastfeeding.

To truly enable women to make and successfully act on informed decisions
about infant feeding, and at the same time to be sensitive to their
feelings, we need to go beyond recognizing that it can be hard to breastfeed
but and ask why, and then to take steps to address the barriers that make it
difficult to breastfeed.  Many women want to and feel badly not because
they've been pressured to breastfeed but because they lacked the support and
assistance to be able to succeed in their good intentions.  It's neither
accurate nor helpful for physicians or others to tell women, who've
struggled against the barriers to breastfeeding, that their effort was a
waste because breastfeeding doesn't matter to their child's health.  There
is a preponderance of evidence about the importance of breastfeeding to US
families, as well as the social factors that make it hard for them to nurse
(e.g. 'physician ignorance and apathy', per the American Academy of
Pediatrics, unsupportive workplaces, threatening laws, social
disapproval....).  As a medical anthropologist and physician who's research
is focused on maternal and child health, I can tell you that the primary
barriers are social, not biological.  By this I include social factors (like
lack of guidance, lack of help with problems, infrequent nursing due to time
constraints) that set women up to have physical problems that lead women to
give up earlier than they wanted, like sore nipples and inadequate milk
supply.  Fundamentally, it's not breastfeeding that's the problem but the
barriers to women being able to breastfeed.  We should focus attention
there.  That path offers the best chance of truly helping women have choices
and feel good about them.

Best wishes,

MaryAnn O'Hara, MD, MPH, MSt
University of Washington
Robert Wood Johnson Clinical Scholars Program

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