Why are Ireland’s breastfeeding rates stubbornly low?

Available evidence suggests a combination of social and cultural factors at play

The medical consensus is that breastfeeding conveys significant benefits to mothers and babies. Breastfed babies have lower mortality and increased protection against infectious disease, while feeding mothers are at lower risk of several cancers, anaemia, diabetes and osteoporosis.

The World Health Organisation recommends that infants are exclusively breastfed for the first six months, yet breastfeeding rates in Ireland are some of the lowest among high-income countries. A 2016 study suggested that only 55 per cent of Irish babies were ever breastfed, compared with 63 per cent in France, 81 per cent in the UK, and 98 per cent in Sweden.

According to the most recent statistics, 63 per cent of mothers initiate breastfeeding in Irish maternity hospitals, but at six months only 15 per cent breastfeed exclusively, compared with European and global averages of 25 per cent and 38 per cent respectively.

Small, well-educated, and wealthy nations such as Singapore and the Nordic countries are the best performers on these metrics, while Ireland an outlier. Mothers who were not born in Ireland have higher rates of breastfeeding than those born on the island, suggesting that some combination of social and cultural factors is at play.

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Some mothers are not able to breastfeed for physical reasons, while practical reasons will stop some others, especially those with premature or multiple babies. But even those fortunate enough to be able to feed must overcome significant challenges. Tied tongues, let-down, blocked ducts, and the relentlessness of being constantly available to feed make the process exhausting. Societal attitudes can also be discouraging; a friend was directed to the toilet when breastfeeding her daughter in a restaurant, while my wife was told our son was unsettled because he wasn’t getting enough to eat.

Organisations such as Bainne Beatha and La Leche League have had an uphill struggle to reverse the trend

Earlier societies had to develop strategies to feed the large number of children whose mothers died in their infancy. These included various forms of animal milk, but the most enduring was the wet nurse, who breastfed a child who was not her own. In Roman times, wet nursing was a regulated trade, and by the Middle Ages it was an attractive career for lower-income women.

In 18th-century western Europe, hiring a wet nurse was popular among the elite, who considered breastfeeding common and ruinous to their appearance and social lives. Doctors, lawyers, and merchants relied on their wives to run their households and firms, and a wet nurse made better business sense than having to employ someone to replace a breastfeeding spouse. In revolutionary France, wet nurses were required to register and ensure their own children were at least nine months old before taking up employment in case they were killed or abandoned.

Following advancements in chemistry and biology, non-human milk made a resurgence. Canning and powdering made preservation easier, while glass bottles and cork teats were used to deliver the reconstituted formula. In 1865 the chemist Justus von Liebig introduced his Soluble Food for Babies, containing cow milk, wheat and malt flours, and potassium bicarbonate.

In 1867, Henri Nestlé launched his own formula milk. Easy to spoil and difficult to clean, bottles of formula still presented a significant health risk. With the acceptance of germ theory and development of rubber teats, by the 20th-century formula was poised to rival breast milk. As the century progressed, it seemed likely that technological advances would allow humans to surpass their natural limitations.

Breastfeeding seemed primitive and limited and formula milk companies aggressively marketed themselves as superior alternatives. A boycott of Nestlé was launched in the 1970s following investigation of its marketing methods in developing countries. These included salespeople dressed as nurses and free formula in hospitals, which, according to NGOs such as War on Want, led to discharged mothers not being able to afford milk but not being able to produce their own.

In Ireland, attempts to regulate maternal healthcare dogged governments from 1948 to 1951. Eventually, the Mother and Child Scheme was introduced in the 1953 Health Act. This medicalised childbirth and placed responsibility for newborn nutrition with doctors, who were heavily targeted by formula milk advertising.

This, alongside ideas that formula was beneficial and that breasts were inherently sexual, led breastfeeding rates to plummet. Organisations such as Bainne Beatha and La Leche League have had an uphill struggle to reverse that trend. Until cultural attitudes change and better practical supports are offered to mothers, that is unlikely to change.

Stuart Mathieson is a postdoctoral fellow in the School of History and Geography at Dublin City University