IT MAY SURPRISE many to hear that Ireland has the lowest rates of breastfeeding in Europe and one of the lowest rates in the world.

The most recent figures from the Irish Maternity Indicator System show that in 2019 only 62% of Irish mothers initiated breastfeeding their newborns after birth.

Within 72 hours of discharge from the hospital, this number drops to 42%. The research shows that after three months, only 31.2% of mothers continue to breastfeed. By six months, just 6% of Irish mothers are breastfeeding their babies.

Ireland’s initiation rate may not at first seem low but when compared with rates of 90% in Australia, 81% in the UK and 79% in the US, it’s clear that Ireland is lagging behind its counterparts. Ireland’s figures show a staggering dropoff which begs the question as to why Irish women are choosing not to breastfeed in such large numbers?

The Public Health perspective

The World Health Organization and the HSE both advise that babies should be exclusively breastfed until six months of age, with complementary feeding of solid foods until two years of age. Parents who cannot breastfeed are advised to feed their babies infant formula in place of breastmilk, up to one year of age.

According to the WHO, breastfeeding has significant benefits for mother and baby and is an important component of a country’s economic prosperity. Breastfeeding can protect against myriad illnesses, can lead to increased intelligence and academic achievement, and help develop greater bonds between mother and child. For mothers, breastfeeding is also linked to lower rates of ovarian and breast cancer, and a reduction in the incidence of diabetes.

With the environment firmly on the agenda there are additional environmental considerations that must be factored in, such as the lack of plastic waste associated with breastfeeding and the absence of carbon emissions generated from either manufacturing or transport.

There’s also the practical matter of cost to consider – breastfeeding is by far the cheaper option for families. So if breast is best, as the saying goes, why then are Ireland’s breastfeeding rates so stubbornly low?

Prepare and equip

Antenatal courses often skew towards birth and labour preparation, with less attention given to the practicalities of babies’ day to day needs. To adequately equip parents for breastfeeding there needs to be more focus on giving practical information about lactation in advance of babies’ arrival.

Professional supports are critical and standardised training for healthcare professionals in maternity settings and in the community, would mean more feeding supports and interventions for families.

Research published in 2016 in The Lancet, entitled Breastfeeding in the 21st Century, points to the fact that the duration of breastfeeding is notably lower in higher-income countries than in those that are resource-poor.

This seems an interesting anomaly given the official advice from global and national public health bodies overwhelmingly supports breastfeeding as the preferred method. Some of the reasons for these suppressed breastfeeding rates may be cultural, but there are undoubtedly other barriers at play including lack of information and systemic weaknesses too.

The ESRI’s seminal Growing Up in Ireland study draws links between increasing rates of birth by caesarean section, with lower levels of breastfeeding. It is thought that this could be due to the early hours of the baby’s life coinciding with the recovery time post-surgery, during which mother and baby are apart. If this is the case, then policy should be tailored to offer specific assistance to women who wish to breastfeed after a caesarian birth.

Challenging

Whilst the benefits are clear, any woman who has tried it will admit that breastfeeding is difficult. It is as much a science as it is an art, and particularly for those mothers that encounter challenges, it can sometimes be as demanding as it is beautiful and beneficial.

Not all babies are born knowing how to breastfeed and not all mothers can or wish to either. Babies may have conditions such as tongue-tie or reflux that make breastfeeding challenging. Mums might suffer from low milk supply, blocked ducts or mastitis. Mums may also be embarrassed or not feel supported to feed in public, or they may simply wish to share the load more with a partner. Any one of these issues can be overcome, yet it could also end a breastfeeding journey.

Access to lactation consultants is therefore crucial for new parents to get the information and advice that they need as soon as they need it. Community support groups currently act as vital sources of practical information and solidarity for struggling parents but they largely rely on volunteers. These networks should be underpinned by an accessible public network of professional lactation consultants to provide the levels of assistance needed.

Are breasts bad for business?

In trying to raise awareness of the benefits of breastfeeding, advocates and public health officials are constantly competing with certain corporate interests. The booming infant formula market is worth an estimated €60 billion globally, with the bulk of sales in the US and Europe.

Ireland based formula companies reportedly produce 13% of that overall global supply. By its nature infant formula is technically a ‘breastmilk substitute’ product and so to put it simply – breasts are bad for business.

In recognition of these competing interests, the World Health Assembly – the decision-making body of the WHO – acted in 1981 to introduce the International Code of Marketing for Breastmilk Substitutes. This aimed to regulate the marketing of synthetic or processed baby formula and baby food products.

In Ireland, this Code was also enacted in national legislation. As a result, the marketing, promotion, discounting or advertisement of Stage 1 formula (for babies under six months) was banned and strict rules around labelling and discounting were introduced. Formula companies are also required to state on their packaging that breastfeeding is preferable.

In reality, formula companies are extremely adept at working within these rules. Companies set up loyalty schemes such as parents’ clubs and advice hotlines to try to win customer loyalty in other ways.

Other products were developed, including ‘follow on’ milks which are heavily advertised. In its information booklet Caring for Your Child, the HSE advice clearly states, however, that “Follow on formula milk is not necessary”. But what about all those lovely ads proclaiming the benefits of follow on milk for growing toddlers? It turns out that cow’s milk is actually just as good and only a quarter of the price too. Could have fooled me.

Support, not judgement

If policymakers are serious about increasing breastfeeding rates, backdoor marketing tactics around infant formula need to be curbed. It is a significant step in the right direction that the Minister for Health Stephen Donnelly has recently announced the recruitment of 24 new lactation consultancy posts nationally, but there are still actions that can be taken to ensure that all healthcare professionals in post-natal care are equipped to advise and support parents in feeding and lactation.

We still have some way to go in Ireland in breaking down cultural barriers to breastfeeding too. On a recent trip to the zoo with a friend who was breastfeeding her baby, I was shocked to hear a couple in their 30s loudly shaming her to “put it away”. This unfortunate episode shows that there is sadly more to be done to create an environment where women feel empowered to feed their babies in whatever way they so choose.

Nevertheless, while exploring public health advice or advocating for improved policy around breastfeeding, it’s important to avoid judgement or putting pressure on parents.

Parenting is difficult enough without casting a judgemental eye over a family’s preferred feeding method. Information is power, however, and the best choice any parent will make will undoubtedly be an informed one. So empowering parents with information and support is key to happy, healthy parents and babies.

Cllr. Deirdre Geraghty-Smith is a mum and a Fianna Fáil councillor on Meath County Council. National Breastfeeding Week runs from 1-7 October.