Breastfeeding rates are lower than professional health organizations recommend. When women do not know the basics of breastfeeding, rates of breastfeeding may be even lower. The basic benefits of breastfeeding for the infant, the mother, and society are not general knowledge and not typically shared in a family setting.

Many women look to their obstetricians to give them information about breastfeeding. However, many women do not get any information about infant feeding while they are pregnant. In fact, the providers themselves may erroneously believe that infant formula is equivalent to breast milk. Another obvious source of information is a breastfeeding class or childbirth class, but attendance rates hover around 50 percent for childbirth classes, and information is not the same in each class.

One of the biggest problems is the lack of familial support for breastfeeding. Having the support of your partner is beneficial during both initiation and continuation of breastfeeding. Having support from extended family is also helpful. This support makes mothers more likely to start breastfeeding and to continue, even in the face of problems.

Society tends to see bottle feeding as the norm for infant feeding. This is largely because most of us have seen images of infants with bottles or been around infants with bottles, making breastfeeding seem like the less common choice. Being surrounded by marketing programs for infant formulas has led many to misunderstand breastfeeding. This culture can contribute to a lack of general knowledge about breastfeeding’s benefits.

There are many difficulties that can occur with breastfeeding, particularly without knowledge, lack of support, and adequate professional help. Many mothers say that sore nipples, worries about the baby getting enough milk, and other concerns were their reasons for discontinuing breastfeeding. A lactation consultant or even a peer counselor can provide help during this time.

One issue that looms large in mothers’ minds is maternity leave. Breastfeeding, while natural, is something that takes time to establish. When a mother is worried about returning to work or pumping at work, breastfeeding is more likely to be left behind, and weaning may occur earlier. Women who have more time off after having a baby tend to breastfeed longer.

Prior to the Affordable Care Act (ACA), only about 25 percent of employers offered breastfeeding space and time to employees. This led many women to choose to wean prior to returning to work. The ACA provisions have increased the number of employers who are supportive of breastfeeding, providing spaces and time to pump. However, many women still may work in environments that make pumping difficult.

About 10 percent of all babies are born prematurely. When a baby is born prematurely, they are less likely to be breastfed. Even when the mother wishes to breastfeed, there are often difficulties in the actual breastfeeding. However, breast milk is the perfect food for premature infants and can lower the rates of necrotizing enterocolitis (NEC) and other problems. Skin-to-skin care in the neonatal intensive care can help babies grow faster and breastfeed more.

When breastfeeding became less common, it became embarrassing. Additionally, public images sexualizing the breast became more common than images of breastfeeding. Women have even been harassed in public for breastfeeding. Many states have enacted laws that say breastfeeding women and infants are allowed in public spaces and excluded from public indecency laws. But this doesn’t stop people from complaining, which may make some mothers avoid breastfeeding or try to cover up.

All of these issues make formula feeding seem easier and less prohibitive, despite the fact that the evidence shows that a lack of breastfeeding can have a negative effect on both infant and maternal health, in addition to economic issues. Formula is seen as easy, convenient, and affordable, without the privacy issues, embarrassment, or work complications. The U.S. is working to change the attitudes of the public to match what is reflected in the medical literature.

The good news is that breastfeeding help is available. The first place to look would be the hospital where you plan to give birth. Ask about any breastfeeding classes they offer for you and for other family members. You should also ask about the lactation support they provide you after you have the baby.

Many hospitals have lactation counselors who are available to help you get started and solve problems. There are also lactation support experts available in some doctors’ offices. Groups like La Leche League International also provide mother-to-mother support. You may also find that there are breastfeeding peer counselors available from the Women Infants and Children Program (WIC). Getting help from someone who has been there can make all the difference in the world.

Office of the Surgeon General (US). The Surgeon General’s Call to Action to Support Breastfeeding. 2011. https://www.ncbi.nlm.nih.gov/books/NBK52688/. Accessed November 2, 2017.