Commentary: Why some mothers feel pressure to stop breastfeeding older children despite benefits

STOKE-ON-TRENT, England: Breastfeeding beyond infancy is recommended by the World Health Organization (WHO), which advises that children should be breastfed until two years old.

For children, breastfeeding for longer is associated with reduced infections, a lower chance of misaligned teeth, a lower likelihood of obesity and higher intelligence.

And for mothers breastfeeding for more than a year, it has also been linked to reduced rates of breast and ovarian cancer. 

In Rwanda, Sri Lanka and India, over 75 per cent of children continue to receive breast milk at two years old.

By comparison, the United Kingdom has one of the lowest global breastfeeding rates. In 2016, the Lancet journal stated that less than 1 per cent of babies in the UK still received breast milk at 12 months old.

However, some continue to breastfeed well into infancy.

To better understand this experience, my colleagues and I spoke to 24 women who were breastfeeding their children for longer than a year.

Participants were aged between 27 and 42, and all were living in the UK with a partner. Most were currently breastfeeding one child, and three were breastfeeding two children.

The majority had either one or two children, and the age of the breastfed children ranged from 13 months to four years.

We found that those breastfeeding past a year in the UK felt intense pressures regarding the accepted length of time to breastfeed that could leave them conflicted about their breastfeeding choices.

UNACCEPTABLE TO BREASTFEED OLDER CHILDREN?

The breastfeeding of older children is often sensationalised by the media, and messages about the unacceptability of breastfeeding older children are pervasive.

One woman told us that “even my pro-breastfeeding family started asking when I was going to stop [when my baby was] around 15 to 16 months”.

While few directly experienced it, mothers frequently alluded to the risk of negativity and judgement for breastfeeding an older child, and many described restricting breastfeeding to private locations to avoid this.

One mother said: "I feel as your child gets older, breastfeeding out and about is a little bit more kind of frowned upon. … I do feel a little bit more conscious now that she is older of what people might be thinking … I think people expect you to have stopped by the time your child is that age".

In comparison, some participants explained confidence breastfeeding in a range of locations including park benches, playgrounds and cafes.

“I’m just not self-conscious about it, I’ve never had any bad experiences but I think I don’t always notice when people are maybe making side-eyes or comments under their breath, I tend to just be head down in my own little world, but in a way that’s a good thing because it’s meant I’ve kept my confidence up”, said another participant.

Her disclosure of never having received any overt negativity suggests an awareness of censure surrounding public breastfeeding.

Several participants chose public breastfeeding images to share with us as an attempt to challenge this negative perception and support other women wishing to breastfeed.

PEER SUPPORT

Many told us that they were helped through challenges by support from partners and breastfeeding peers, and also mentioned the value of observing others breastfeeding older children for normalising this behaviour.

"It’s really nice to know different mums at different stages, because it shows how it can fit into your life, because at the very beginning you think you’re going to be attached to this baby for the next like another two years and you are never going to be able to leave the house or wash your hair without, you know, but when you actually speak to mums at different stages you realise that that is not the case", said one mother.

Despite this support, social pressures caused many mothers to feel conflicted about their choices, particularly when attempting to wean their child.

Another mother said: "I am trying to restrict [breastfeeding] her out of the house. … I’m telling her “no, we will do it when we get home”, and she doesn’t really like it. … She normally cries, pulls at my top, screams milk. I feel really conflicted at that point because I sort of think, if that’s what she wants, why aren’t I doing it? Am I not doing it because of other people’s perceptions?"

Normalising breastfeeding an older child could help to validate these mothers’ choices, provide role models, help them to feel supported and free them from parental guilt. Increasing public breastfeeding imagery is a potential step in the right direction.

Amy Burton is a Senior Lecturer and Health Psychologist at Staffordshire University. This commentary first appeared on The Conversation.