The difficulty of breastfeeding in public and low breastfeeding duration rates

Increasing breastfeeding duration rates is widely recognised as an essential step in improving early childhood health and reducing child health inequalities.  Breastfeeding’s broad-ranging health benefits for both babies and mothers have been proven time and again by myriad health researchers working across different fields in a wide range of countries and cultural contexts (including the global North).  However, breastfeeding duration rates in Wales are some of the lowest in the UK, and indeed some of the lowest in the world.

This research summary highlights the importance of public reaction in women’s experiences of breastfeeding outside the home in the UK in women’s decisions about how long to carry on breastfeeding.  Although most UK women initiate breastfeeding, the last Infant Feeding Survey (conducted in 2010) showed that 45% stop within the first six weeks.  The most recent data from Public Health England suggests that the numbers breastfeeding at six weeks may be falling again.  Wales is at risk for a similar decline.   Our work examines what happens to breastfeeding when new mothers begin to spend time outside the home in the first weeks post-birth as well as how breastfeeding in public is experienced by those who carry on breastfeeding for longer periods of time.

 Our work shows that:

· Negative experiences of breastfeeding in public and concern about potential negative experiences can lead to the decision to bottle-feed whilst out and about (thus adversely affecting milk-supply), and the decision to stop breastfeeding.

· New mothers can be very uncomfortable about the prospect of breastfeeding in public, sensitive to public reaction, and aversive to the prospect of making others uncomfortable.

· Even seemingly small, non-verbal expressions of discomfort from strangers (stares, glares, tuts, etc) can be enough to create a negative experience for mothers in early days of breastfeeding.   In other words, a woman does not need to be ‘told off’ to have a negative experience breastfeeding in public.

· Women who establish breastfeeding and carry on, as per WHO guidance, feel uncomfortable breastfeeding in public once their babies are in the second half of their first year of life.  Those who carry on into the second year or beyond are often told that they are doing something ‘unnecessary’ or ‘odd’ and feel stigmatised for the behaviour.  As with women breastfeeding in the early weeks, women breastfeeding for longer periods of time are often acutely aware of others’ reactions, whether actual or anticipated.

We want to highlight to this consultation that:

· Breastfeeding is a key feature of infant and early childhood health;

· Breastfeeding duration rates in Wales need to increase in order to increase levels of early childhood health and reduce current levels of health inequalities;

· It is the responsibly of government – and not individual women—to change the culture around the acceptability of breastfeeding in public in order to enable more women to breastfeed longer;

· Being able to comfortably breastfeed ‘anywhere’ (and, importantly, beyond the confines of one’s own home)is a crucial factor in establishing and maintaining breastfeeding over time;

· Members of the public can play a role in women’s experiences of breastfeeding and decisions about when to stop;

· In order to make breastfeeding outside the home easier to do, much stronger signalling is needed about the acceptability of breastfeeding ‘anywhere and everywhere’.  

These findings are based on qualitative research undertaken by Kate Boyer and Sally Dowling including interviews, ethnography, survey work and participant observation in the South West of England between 2007 and 2015.  

They are published in the following work:

Boyer, K. (2017) The emotional resonances of breastfeeding in public: the role of strangers in breastfeeding practice Emotion, Space and Society (forthcoming)

Boyer, K. (2012) Affect, corporeality, and the limits of belonging: breastfeeding in public in the contemporary UK, Health and Place (18) 552-560.

 Boyer, K. (2011) ‘The way to break the taboo is to do the taboo thing’ breastfeeding in public and citizen activism in the UK, Health and Place 17 (2): 430-437.

As well as in the books Beyond Health, Beyond Choice (Smith, Hausman & Labbok, Eds) and Motherhood, Politics and Space currently under contract with Roman and Littlefield Press. 

During 2015 and 2016 Boyer and Dowling ran a seminar series funded by the Economic and Social Science Research Council on: Social experiences of breastfeeding: building bridges between research and policy which brought together social science academics with policy makers and practitioners at 6 events in Bristol and Cardiff. 

See http://www1.uwe.ac.uk/hls/research/healthandclinicalresearch/seminarseries.aspx for information, talks and podcasts from this event.    

Dr Kate Boyer: BoyerK@Cardiff.ac.uk  Lecturer in Human Geography, School of Geography and Planning, Cardiff University, Cardiff, UK  Profile: http://www.cardiff.ac.uk/cplan/about-us/staff/kate-boyer

Dr Sally Dowling: sally.dowling@uwe.ac.uk Senior Lecturer, Department of Nursing and Midwifery, University of the West of England, Bristol, UK Profile: http://people.uwe.ac.uk/Pages/person.aspx?accountname=campus%5csj3-dowling