The resurgence of breastfeeding at the end of the second millennium

This paper has described several explanations for the increase in breastfeeding initiation that occurred in the previous 20 y, the end of the second millennium. Demographic trends, particularly among African-American women, coupled with the resurgence of breastfeeding in these groups, may have contributed to the increase in breastfeeding during the 1990s, but likely played a minimal role in the earlier, more dramatic increase. The decline of breastfeeding in the earlier part of the century may be attributable in part to maternal employment, but the resurgence in breastfeeding occurred during a period of unprecedented influx of new mothers into the labor force. There is no evidence that health-care providers are providing more support for breastfeeding, and most of the international and national policies postdated the resurgence in breastfeeding, although they may have influenced the upswing in the 1990s. A more plausible explanation of the resurgence of breastfeeding in all major segments of society is the pervasive influence of the natural childbirth movement of the 1960s and 1970s, with its effects on the standard management of childbirth. In addition, the increase of breastfeeding among low income women may be attributable in part to programmatic changes in the provision of supplemental food through the WIC program and targeting of breastfeeding promotion efforts to the specific concerns of these women. Although there has been an increase in breastfeeding compared with earlier decades, it is important to recall the great disparity between the recommended rates and those achieved by American women (American Academy of Pediatrics Work Group on Breastfeeding 1997). Thus, efforts to increase breastfeeding initiation and duration should continue, particularly for the groups of individuals who are at greatest risk of illness, such as minority and low income infants. We suggest that the strategies likely to have a lasting effect on future breastfeeding rates will be societal pressures that affect existing breast-feeding barriers. Such pressures may come from health maintenance organizations, insurance companies and the federal government, which are likely to recognize increasingly the institutional costs of failing to facilitate breast-feeding (Ball and Wright 1999). The provision of flexible work hours and paid maternity leave, either by government or "family-friendly" work-places, could make a difference in the ability of employed women to feed their infants optimally. Thus, we have to agree with the comment that "while it is 'known' that breastfeeding is better, our society is not structured to facilitate that choice" (Retsinas 1987). Our efforts to improve breastfeeding rates have to make visible the wider cultural context in which infant feeding choices are made, and alter those components that make it difficult for American women to feed their infants optimally.