What causes the dramatic drop in breastfeeding rates in the first 6 months? Lying.

84257279 - lies word cloud on a white background.

Breastfeeding initiation rates in the US are the highest they have been in nearly 50 years.

As this chart from the Surgeon General’s Call to Action on Breastfeeding demonstrates, the rise has been dramatic, tripling from 1970 to 2007:


But you’ll also notice that breastfeeding rates fell off dramatically by 6 months both in 1970 and all the way through 2007. The number of women breastfeeding exclusively at 6 months is only a tiny fraction of those who had been breastfeeding at birth. The proportion of women breastfeeding at 12 months was only half the rate of women breastfeeding at 6 months.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Facing intense pressure, women who have no particular commitment to breastfeeding as well as those who have no intention to breastfeed, are forced to lie.[/pullquote]

The most recent data I could find shows that from 2011 to 2015 79.2% of mothers initiated breastfeeding, 20% were exclusively breastfeeding at 6 months, and 27.8% of mothers were still offering some breastfeeding at one year. The dramatic drop off is common at all maternal ages, all ethnicities, and every education and economic level. College graduates have the highest breastfeeding rates across the board: 91.1% at birth, 27.7% exclusively at 6 months, and 40.3 offering some breastmilk at a year.

Lactation professionals look at these numbers and insist (without any evidence of any kind) that the dramatic drop off in breastfeeding rates is due to “lack of support” for breastfeeding.

I look at these rates and reach a very different conclusion: there’s a whole lot of lying going on.

The foundational lie is the insistence that nearly every woman (once she is properly “educated”) wants to breastfeed.

The truth is that aggressive breastfeeding promotion efforts have become the norm in industrialized countries led by poorly named Baby Friendly Hospital Initiative that isn’t remotely friendly to babies and ignores mothers altogether. Ugly tactics — locking up formula, making women sign consent forms for formula, forcing lactation consultants on everyone — have become standard practice. There is tremendous pressure on hospital staff to increase breastfeeding rates at discharge and that pressure is transferred unabated to mothers. In the face of that pressure, women who have no particular commitment to breastfeeding as well as those who have no intention to breastfeed, are forced to lie.

A piece in yesterday’s Nursing Times, Changing the conversation around breastfeeding, notes:

In the UK, 81% of women initiate breastfeeding at birth but within the first day, exclusive breastfeeding has dropped to 69% – and down again to less than 50% by the end of the first week.

…[W]hy are so many women who want to breastfeed stopping before they would choose?

I suspect that they didn’t want to breastfeed at all; they merely said they did in order to stop the endless harangues from midwives, nurses and lactation consultants. No one who truly intends to breastfeed drops it after only one day. They obviously were not committed to it in any meaningful way. They just said they wanted to breastfeed to get the staff off their backs.

Moreover, there’s no guarantee that the breastfeeding rates at 6 months and one year are accurate. They are the results of reports by women, women who know that it is more socially desirable to claim to be breastfeeding, therefore they are likely to be inflated. If that’s the case, the drop off in breastfeeding rates is even more stark than advocates claim.

The other lie beloved of lactivists is that the difference between breastfeeding success and failure is support for breastfeeding.

There has arguably never been more support for breastfeeding in the past 100 years yet breastfeeding rates still drop off dramatically over time. Judging by the graph I posted above, breastfeeding support makes no difference to breastfeeding rates. While breastfeeding rates at 6 months and 12 months have risen over time, that reflects the fact that more women initially decided to try breastfeeding. The proportion of women who stop between birth and 6 months remains nearly unchanged. That suggests that factors other than support are responsible for the dramatic drop off.

These factors include the intrinsic failure rate of breastfeeding (up to 15% of first time mothers will not produce enough breastmilk in the early days), pain, frustration and inconvenience. Moreover, nearly every woman knows many people who were formula fed and they turned out just fine. No matter how often and how loud lactivists blare the purported benefits of breastfeeding, it is pretty obvious that most of those benefits are illusory.

What explains the dramatic difference in extended breastfeeding between college graduates and everyone else? Of women without college degrees only approximately 20% are breastfeeding at one year while 40% of college graduates are still doing so. I suspect that both structural factors and priorities are responsible for the difference. The structural factors include access to maternity leave and jobs compatible with pumping. In addition, many women with college degrees have made reaching the one year mark of breastfeeding a priority; they are achievement oriented to begin with and breastfeeding to one year has been promoted to them as an achievement.

What do breastfeeding rates tell us about breastfeeding promotion efforts? They have been successful in increasing initial breastfeeding rates though a significant proportion of the increase is illusory since it represents women lying about their intentions. They indicate that ongoing breastfeeding support has little to nothing to do with breastfeeding rates. Though the absolute number of women breastfeeding at 6 and 12 months has risen, the proportion of those who initiate breastfeeding who are still breastfeeding at 6 and 12 months has not changed; the majority of women still quit.

We’ve spent millions of dollars promoting breastfeeding, but what do we have to show for it? Not much. Yes, breastfeeding rates have risen, though far less than it appears. There’s no evidence that it has saved lives (with the exception of extremely premature infants) and no evidence that it has saved money, let alone returned the investment.

We’ve conducted a massive social experiment and virtually none of the promised results have occurred. And we’ve turned new mothers into liars. That doesn’t sound like success to me.