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Beginnings Guides Blog

Breastfeeding Recommendations & Maternal Health Literacy

Reports have been circulating on the Internet: researchers
find that the recommendation to exclusively breastfeed babies
for six months is just too hard for modern women and is making
mothers feel bad. The study author suggests the advice is fine
for the developing world, but should be changed to “breastfeed
as long as you can and introduce solids as close to six months as
There are several health literacy lessons to be learned from this
questionable reporting on questionable research.
The evidence is exceptionally clear and strong
First, we should note that the recommendation to feed infants
only breast milk for at least six months is not just a suggestion
from some guy in a diner. It is the evidence-based consensus from
the U.S. Centers for Disease Control, American Academy of
Pediatrics, the World Health Organization, and virtually all health
agencies on the planet. This level of consensus is rare and requires
an extremely strong evidence base.
Is the recommendation unhelpful for mothers?
The evidence exists for a long list of health benefits to mother
and child that last a lifetime and save billions in healthcare costs.
The study’s author says the recommendation is “idealistic” and
“unhelpful” as an individual goal and calls for balance between
these “theoretical” longterm benefits and immediate family well
being.Fair enough. But that can be done at the individual level
without undoing worldwide policy making and without concluding
that women are incapable of (or just too busy) for this womanly skill.
The perfect food is free
The big problem for breastfeeding is this: it’s free. This study
feeds a broadly-held perception that breastfeeding is for poor
people in backward countries that cannot afford or reliably use
With this twisted thinking we are willing to disregard all the
science behind the global breastfeeding recommendation in
favor of the belief that in 30 years scientists have made a better
formula than what Mother Nature developed over millennia.
Health Literacy Lessons
According to the World Health Organization, Maternal Health
Literacy means the cognitive and social skills which determine
the motivation and ability of mothers to gain access to, understand,
and use information in ways that promote and maintain their
health and that of their children. 
Part of health literacy for mothers, health promoters and
clinicians alike, is reading critically, asking where is this information
coming from and how reliable is it?  What does it mean to me in
my situation? How can Iuse it for health?
Read it for yourself.  The study is published in BMJ Open- that’s
British Medical Journal Open, an open access journal.
BMJ ought to be a reliable source. But here’s the detail that matters
(it’s in the abstract): 541 pregnant women in Scotland were invited
to participate in monthly interviews; 72 volunteered to participate.
Of these, 36 were interviewed along with some of their partners and
This is not a representative sample. People who volunteer to
participate in surveys typically feel very strongly one way or the
other. We need to ask, how are these 36 women different from
the 505 who declined?  Further,  the sample is too small to draw
any conclusions beyond the individuals involved.
Telling them what to do does not work
Breastfeeding advocates, health educators, parent educators,
home visitors, clinicians can learn an important lesson re: promoting
maternal health literacy from this article. When education
is perceived as “unrealistic, overly technical and rule based”, it is
not going to motivate anyone to take action for health.  But you
already knew that...The problem here is not the breastfeeding
policy; it’ s the delivery of information.

Stay tuned for a model reflective conversation to promote
To balance the oft quoted Scottish mothers who were not well served by
their lactation consultants and who struggled with breastfeeding, see our
Facebook Poll for comments from our volunteer sample of mothers who
work in women’s health. We asked: Do you think recommending
breastfeeding for a minimum of 6 months is unrealistic or unattainable? 
No one said Yes.
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