On World Breastfeeding Week, experts reflect on the benefits and difficulties new mothers experience when nursing their children.

The journey of motherhood is undoubtedly a kaleidoscope of emotions, from excitement to fear, worry, joy and everything in between.

Despite the uniqueness of the experience for each and every mother, be it in pregnancy or childbirth, women are often bombarded with unsolicited advice and information from others over child-rearing.

Of the most common topics of discussion, is breastfeeding— one of many miracles and strengths of the female body.

While breastfeeding can be a breeze for some mothers, it can be a mentally and physically taxing for others. Some mothers opt for formula-feeding instead of breastfeeding, albeit often at the cost of a social stigma known as “bottle-shaming”.

Previous studies found that mothers who shift to formula feeding commonly find themselves defending their decision, while experiencing stress or guilt. The factors experts associate with these emotions are primarily connected to breastfeeding’s significance as the optimal source of nutrition for a baby.

Numerous celebrities such as Jennifer Lopez, Ashley Graham and Khloe Kardashian have opened up on being bottle-shamed, either for choosing to mix formula and breast milk or for sticking to the former. Their public testimonies allowed some mothers to feel less isolated in their experience.

Maha El Akoum, a public health professional, noted that “demonising formula” leads to the risk of shaming mothers.

“There are many ways to help babies grow, develop and be healthy – including having a mother that is healthy and happy,” El Akoum, who is also the Head of Content at World Innovation Summit for Health (WISH), told Doha News.

Breastfeeding benefits

Breastfeeding has long been promoted as the best option for baby nutrition, given its many benefits for both mother and child, while allowing them to bond through the skin-to-skin contact.

Local entities in Qatar, including Hamad Medical Corporation (HMC) and Sidra Medicine, have introduced numerous initiatives over the past few years, that promote breastfeeding, including providing lactation experts to assist mothers even before their delivery.

Qatar’s labour law also grants new mothers an hour-long break for breastfeeding for an entire year, starting from the end of their 50-day maternity leave.

In listing the benefits of breastfeeding, El Akoum noted that breast milk, especially the colostrum, contains antibodies that help a child’s immunity development while reducing risks of numerous diseases such as colds and gut infections.

“During the first few days of life, the mother produces a thick, yellow fluid called colostrum, which contains a high amount of proteins and is loaded with other beneficial compounds that help the newborns’ immature digestive tract develop,” El Akoum explained.

On the other hand, breastfeeding has added benefits for mothers, including the decrease of risks of breast cancer, supporting heart health, and reducing the risk of developing diabetes and postpartum depression (PPD).

“A study published in 2012 in the International Journal of Psychiatry in Medicine found that women who breastfed for four months lowered their risk for PPD. However, for women who are suffering from PPD, breastfeeding can become extremely challenging,” El Akoum penned for Doha News in 2021.

Breastfeeding difficulties

Despite the countless benefits of breastfeeding and campaigns by health providers, women around the world still face difficulties in the process, which may lead to their decision to choose formula instead.

According to El Akoum, some of the most common struggles mothers face are breast soreness due to poor latching along with other physical pains, in addition to issues related to the milk supply.

“Pain is the top reason that breastfeeding mothers quit. In addition, sometimes breasts can become sore due to engorgement and/or blocked ducts that can then lead to mastitis – an infection that can require antibiotic treatment,” El Akoum said as she outlined the possible causes.

Other reasons new mothers face is the lack of flexibility in their schedule as well as the restricted diet a mother must adhere to in order to avoid passing on certain foods to the infant through the milk. The same also applies to medications.

Dr. Lisa Smyth, a senior lecturer in the School of Sociology, Social Policy and Social Work at Queen’s University Belfast, added that breastfeeding can be physically and socially demanding.

“It also requires access to additional calories for the mother, and unrestricted time to feed more frequently than is needed when using formula. These physical and material costs are often invisible, and tend to be borne by mothers themselves without support,” Dr. Smyth told Doha News.

A study by the HMC in 2012 surveyed 453 mothers to look into the local rate of breastfeeding. A total of 24.3% of the mothers said they exclusively breastfed their children in the first six months.

The reasons cited by 44% of the mothers who didn’t exclusively breastfeed included a lack of sufficient breast milk after delivery, whereas 17.8% others said formula is easier and more available after birth. A total of 16.3% mothers cited their return to work and 6.5% others said they had lacked proper knowledge on breastfeeding.

The remaining 4.9% had said that their infant did not tolerate breast milk.

‘Formula-shaming’

Regardless of the reasons or circumstances surrounding a woman’s decision to not breastfeed her child, studies have found that society tends to guilt mothers or shame them for choosing formula instead.

“Shame is a powerful social emotion which supports strong moral norms in a way that encourages conformity. It is a very painful emotion that we routinely do our best to avoid,” Dr. Smyth said.

The social expert also pointed to the indirect pressure public health strategies exert on women as they promote breastfeeding over formula.

“The promotion of breastfeeding often takes a highly moral form, as the well-known phrase ‘breast is best’ indicates[…]the moralising pressure to breastfeed tends to be directed both at individual mothers themselves, and sometimes also at fathers,” Dr. Smyth said.

Numerous research papers have examined the guilt or shame mothers experience, especially from their own healthcare providers and peers for resorting to formula-feeding. 

More recent research published on Maternal & Child Nutrition in 2021 found a higher prevalence of guilt among formula-feeding mothers, highlighting feelings of failure and fear.

“Perceiving that healthcare professionals were promoting breastfeeding as a moral obligation and perceiving that breastfeeding was overly medicalised were both linked with guilt and undermined maternal autonomy,” the research paper concluded.

Beyond scientific research, moral and social perceptions, the religion of Islam grants mothers the concession to not breastfeed if they are unable to do so.

“Mothers may breastfeed their children for two complete years for whoever wishes to complete the nursing period,” [Al Baqarah: 233]

The Quranic verse adds: “And if you wish to have your children nursed by a substitute, there is no blame upon you as long as you give payment according to what is acceptable.”

In assessing the struggles surrounding breastfeeding and formula-feeding mothers, El Akoum places major emphasis on the role of society in supporting new mothers. 

The Qatar-based expert stressed that the lack of support from family and friends coupled with an absence of professional help contributes to the toil of motherhood.

“It’s not always easy for mothers to navigate through those issues especially when family members and close friends are not supportive, and when professional help is not always available or accessible,” El Akoum said.

“While breastfeeding is extremely important, there is so much more to parenting and it is important to keep this in mind in order to help both mother and baby flourish,” she concluded.