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Center for Health Literacy Promotion 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 possible”.
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” long term 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 formula.
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.
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 I use 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 relatives.
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 breastfeeding.
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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