Breastfeeding and breast milk evolved over millennia. Breastfeeding is an intimate, some would say, almost sexual experience. It can bring profound pleasure and yet cause distress and pain. Breast milk is a complex living fluid containing nutrients - proteins, fats and carbohydrates - and also hundreds of biologically active components including live cells.
Increasingly sophisticated milk formulae are available - but there are no true breast milk substitutes because the composition of human breast milk has not been replicated, is unique to each mother, and changes over the course of a single feed as well as over the period of lactation. Breast milk truly is a magic potion.
Breastfeeding reduces infections in the baby. Protection is greater with exclusive than with partial breastfeeding, and in settings where the risk of infection is higher; the evidence is strong, consistent and biologically plausible. Breastfeeding also appears to improve childhood scores in tests of intelligence. For mothers, breastfeeding provides protection against breast cancer. Evidence of reduced overweight, obesity and diabetes in children and protection against ovarian cancer and type 2 diabetes in mothers is less certain. Breastfeeding is not the same as ingesting breast milk. Expressing milk and providing it by bottle removes the wonderful self-regulation of intake seen in breastfeeding babies. Storage diminishes protective characteristics and nutrient content, as cells and fats adhere to plastic, and cooling and freezing inactivate many components. And how can pumping compare with the immeasurable joy of your own baby snuggled against your breast?
Let's be quite clear: breastfeeding is a very good thing, and the benefits conferred upon infants and children are greater where the risks of adverse outcomes are higher. Let's also be quite clear about modern milk formulae: in contrast to the products of yesteryear, they are safe and when constituted correctly, provide sound nourishment, so no mother who makes a conscious, informed decision to use formula should feel or be made to feel guilty. However, tragically, though the bottom line is that babies, mothers and nations would benefit from high rates of breastfeeding, the reality is that prevalence is appallingly low in the UK and many other countries.
Women, children, families, the public and Governments certainly need to be well informed about the benefits of breastfeeding, and should consider it normal and natural. But haranguing women to breastfeed, or express breast milk, isn't the answer. Nor is over-egging the argument in favour of breastfeeding. Overly didactic advice about how to breastfeed and for how long, isn't particularly helpful either. These approaches are a turn-off, and ultimately counter-productive. The principal problem we have in the UK is a very short duration of breastfeeding. In England in 2015/16 almost three quarters of mothers started breast-feeding but by two months the proportion continuing was no more than two fifths. In other parts of the world, a false perception that formula is better than breast milk - often fuelled by the ignorant or the unscrupulous - does untold damage.
Sustaining breast-feeding would be immeasurably helped if healthcare workers were to chill-out a bit in the manner in which they provide support and if mothers' approached the prospect of breastfeeding in anticipation of a joyous, pleasurable experience, rather than a duty, a chore, and a set of lessons to be learned. If Governments want to reap the wider, not inconsiderable benefits of breastfeeding to the health and financial wellbeing of the nation, they need to ensure employment law is supportive and that women will not lose out financially or in their career progression should they choose to breastfeed. And then too, there's the attitude of society. When women are made to feel shame about breastfeeding in public and even prohibited from doing do, and when many children and young people consider it "yucky" (as we found when we consulted our young people's groups) it's time society took a very long hard look at where archaic attitudes to female bodies originate, and placed them firmly where they belong, in the annals of bygone eras.
Neena Modi
Professor of Neonatal Medicine, Imperial College London
President, Royal College of Paediatrics and Child Health
1st August 2017