May 31, 2023
By Yinny Chan, Drexel University College of Medicine

“Breast is best” is a common phrase used to promote breastfeeding. However, providers should still be cognizant of the barriers to breastfeeding and the shame that mothers may feel when they are unable to or prefer not to breastfeed.

Embarrassment when breastfeeding, especially in public places, can be a barrier for women. Despite policies that exist to protect the right of a woman to breastfeed her child in public, restaurant and shopping center managers have reported that they would discourage breastfeeding in their facilities or suggest a more secluded area (McIntyre et al., 2001). Another factor in the embarrassment of breastfeeding in public is the sexualization of breasts in American society that can lead to discomfort with the idea of breastfeeding. One study surveyed female undergraduates and found that women who scored higher on measures of self-objectification were more likely to view public breastfeeding as indecent and to be concerned that breastfeeding would be embarrassing. (Johnston-Robledo, 2007)

Mothers are often motivated by the benefits of breastfeeding for the infant and themselves. However, there seems to be a lack of knowledge about these specific benefits. It has been found that information about breastfeeding and formula is rarely provided by obstetrician-gynecologists during prenatal visits (Moore et al, 2007). Breastfeeding is a learned skill and can present many challenges that prevent mothers from initiating or continuing breastfeeding. The discrepancy between a mother’s expectations about breastfeeding and the reality has been identified as a key reason that mothers stop breastfeeding within the first two weeks postpartum (Mozingo et al, 2000). A clinician can play a large role in these instances in providing education regarding the benefits of breastfeeding, as well as providing early guidance on breastfeeding techniques.

Mothers’ returning to work can be a significant barrier to breastfeeding, as work hours can be inflexible and there may be a lack of privacy for breastfeeding or pumping, lack of storage available to store expressed breast milk, and limited maternity leave benefits. In order for a workplace to optimize support for a breastfeeding mother, a clean, private area should be provided for breastfeeding and proper break times should be allowed without penalty against the mother.

Health care providers have a large role to play in creating an open conversation about breastfeeding. These conversations should ideally start prenatally or even before to help normalize breastfeeding. Potential difficulties and concerns of patients should be considered in order to help each individual woman.

Sources/Resources:

• Johnston-Robledo, I., Wares, S., Fricker, J., & Pasek, L. (2007). Indecent exposure: Self-objectification and young women’s attitudes toward breastfeeding. Sex Roles, 56(7), 429-437
• McIntyre E, Hiller JE, Turnbull D. Community attitudes to infant feeding. Breastfeed Rev. 2001;9(3):27–33
• Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2007(3):CD003519. [Reference list]
• Mozingo JN, Davis MW, Droppleman PG, Meredith A. “It wasn’t working.” Women’s experiences with shortterm breastfeeding. MCN Am J Matern Child Nurs. 2000;25:120–1
• Office of the Surgeon General. (2011). Barriers to breastfeeding in the United States. Rockville, MD: Office of the Surgeon General