Abstract
Thus, I find it most difficult to join the enthusiastic and seeming positive responses of all too many well-meaning supporters or advocates of breastfeeding to the recent Time magazine cover ostensibly picturing a mother breastfeeding her nearly 4-year-old toddler. To remind those who have forgotten, Time chose to stage a provocative visual image as a “come on” for its lead article on “attachment parenting” by picturing a svelte (if not downright sexy), standing woman baring her breast to a mature toddler, who while perched on a chair is barely latching on to her breast. What this image has to do with “attachment parenting” is beyond me, and I am sure that Dr. William Sears is no less concerned by the disservice this picture has done to his principles of child rearing. For how for heaven's sake can such an unnatural image of a breastfeeding mother, à la Time magazine, which depicts a detached mother with absolutely no physical or emotional attachment to her child (not even minimal eye contact let alone any reassuring comforting or cuddling positioning), represent the essence of the supporting attachment process advocated by Dr. Sears?
However, what concerns me beyond this outright travesty of responsible journalism is the response of all too many of my colleagues who are most happy by the fact that Time magazine by making breastfeeding a “cover story” put breastfeeding on the public agenda. In fact, the result has been that the focus of radio, television, and other media has been on a mother who is the epitome of physical fitness (if not appeal) and thus is testimony that extended breastfeeding (for years) can be associated with a desired feminine image. Unfortunately, such an image, in my opinion, is more appropriate for a fashion magazine aimed at the leisure middle class rather than addressing needs and issues of mothers in the real world.
What troubles me even more is that by shifting the focus to the issue of the logistics and benefits of breastfeeding toddler infants, the real challenge of getting mothers to exclusively breastfeed for 6 months and to have mothers continue breastfeed until 1 year while introducing complementary solid foods is being overlooked. The still most unsatisfactory reality is that only 43% of mothers are breastfeeding at all at 6 months postpartum, and at 1 year the rate is a dismal 22%. At 3 months postpartum only 33% of mothers are exclusively breastfeeding, and at 6 months this is only 13%! No less so is the disparity in these rates among the various populations of mothers, with a rate of initiation of breastfeeding of only 30% in African-American mothers under 20 years of age. Faced with such numbers it is hard to understand how Time magazine's idealized mother can serve as the “poster mother” for breastfeeding advocates, let alone serve as a role model for minority mothers from a low socioeconomic culture.
Clearly focusing on the issue of how many years to breastfeed should not be our priority given the reality of the above breastfeeding data. The focus of our battle has to be how to increase the initiation rates in those populations where breastfeeding is not socially, culturally, or logistically acceptable and how to sustain breastfeeding (hopefully exclusive) beyond a minimal number of months. To that end it would, in addition, also be wise to dissociate breastfeeding from “attachment parenting” or from any specific parenting style. This is not our battle! The disadvantages of not breastfeeding should be understood to be independent of the parenting style that is chosen by the mother (and father).
While it is clear that there are no data as to indicate any deleterious effect of continuing to breastfeed after 1 year, there are also no evidenced-based data to indicate that breastfeeding per se as a single variable provides any advantage. Thus, the pronouncement in the recently published Policy Statement of the American Academy of Pediatrics, 1 which recommends “continuation of breastfeeding for one year or longer as mutually desired by mother and infant,” is a rational, balanced, and nonconfrontational approach to this issue.
The bottom line is that it will do us well to choose not only our battles but also our allies and to be sure that we focus on the real public health problems related to breastfeeding and not get drawn into counterproductive journalistic or personal publicity campaigns. As King Solomon proclaimed: “To every thing there is a season and a time for every purpose under the heaven.” 2