When I gave birth to my first child the nurses didn’t want to release me from the hospital – I was that bad at breastfeeding. They pulled and stretched my nipples, treating them like pieces of silly putty, rather than the soft and tender flesh that they were. If you’d told me that I’d eventually breastfeed for over six years (and counting), spread out among three children, I would have likely responded that there was absolutely no way. Along the way I have become acutely aware of the cost of breastfeeding, both in the extensive amount of time that I have dedicated to it, and the financial sacrifices that I have made in order to be available to breastfeed.

The World Health Organization (WHO) recommends mothers worldwide exclusively breastfeed for six months, and should continue breastfeeding once food is introduced, up to two years or more. The American Academy of Pediatrics (AAP) suggests six months of exclusive breastfeeding and one year or more of breastfeeding with complementary foods. The AAP also states within its guidelines: “Infant nutrition should be considered a public health issue and not only a lifestyle choice.” Translation: if you’re not breastfeeding you’re endangering society.

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What these organizations fail to consider is how their recommendations conflict with the professional realities of a woman’s life, particularly for women in the US.

“Unfortunately, exclusive breastfeeding guidelines were implemented before all of the societal systems for exclusive breastfeeding support are in place,” says Jody Segrave-Daly, co-founder of the Fed is Best Foundation, and a veteran neonatal nurse and lactation consultant. “This places an unbearable burden on mothers in the US, no matter what their income is.”

When I gave birth to my first child I was 22, I was living in poverty and desperate to make breastfeeding work. I believed it was the most frugal option. But truthfully, breastfeeding took its toll on me, and it was not as cost-effective as I had first believed.

For one, there’s the equipment many women require to breastfeed, including pumps, storage bags, nipple ointment, nursing bras, breast pads and even consultations with lactation consultants, should you require assistance in the journey. Writer Kaitlin Bell Barnett has said that six months of nursing cost her $2,000, while a year’s worth of formula would have cost around $1,200 to $2,000.

There’s also an unspoken cost that many breastfeeding proponents neglect to mention: the cost of a mother’s time. Dr Courtney Jung, author of Lactivism, which takes a critical stance toward the notion that “breast is always best”, estimates that six months of breastfeeding could require about 900 hours of a mother’s time.

I would guess that in the first six months of breastfeeding, when the only source of nutrition for my baby was breastmilk, I probably spent five hours breastfeeding throughout a 24-hour period. That’s 910 hours over six months, not far off Jung’s approximation.

Based on my estimate, I nursed 35 hours a week, with no days off. That’s equivalent to a full-time job. How are these time demands supposed to coexist with the demands of a full-time job?

Don’t forget that over three-quarters of civilian workers in the US have no paid parental leave, and for this reason one in four mothers return to work only two weeks after giving birth in the US. (I’m Canadian, but I’ve been in a similar situation to American mothers because as a self-employed worker I didn’t have access to paid time off for my youngest child.)

One solution to this conflict between the time required for breastfeeding and the necessity of returning to work, some say, is breast pumps. The Affordable Care Act (ACA) requires private health insurers to cover breast pumps, and one study asserts that more women are now attempting to breastfeed, and breastfeeding for longer periods of time, now that breast pumps are more readily accessible.

While one could argue that a woman who pumps – and is at work while her baby is fed a bottle of pumped milk – isn’t breastfeeding for those hours, she is pumping. In my calculations, I didn’t even account for time spent pumping. If a pumping mother spends 20 hours a week on breastfeeding and pumping, an extremely conservative estimate, that’s still equivalent to a part-time job, in addition to her full-time work.

The cost to those women is unbelievable, given the entire burden of breastfeeding is placed on them

Even today, however, only 40% of women have access to both a break time to pump, and a private space to do so. And what’s more, the idea of breast pumping as a solution seems more like a triumph for capitalism than a win for women. Jung points out that it keeps women in the workplace, gives money to the breast pump manufacturers, allows companies to bypass having to pay women for maternity leave, and the government comes out looking like it’s passing groundbreaking legislation for women.

“There’s a relationship between the absence of maternity leave and pumping,” Jung said in a phone interview. “The legislation that passed takes into account that breastfeeding is impossible, and tries to square the circle with pumping.”

The only effective way to give a woman a fair chance at breastfeeding is with policy that makes it easier for her to do so while also supporting her need to earn an income.

Jung says that paid maternity leave is the only solution to level the playing ground for working women who want to breastfeed. “The fact that there’s no maternity leave in the United States makes it incredibly impressive that we have the rates of breastfeeding that we do have. Women are killing themselves to get the numbers that we’ve got … The cost to those women is unbelievable, given the entire burden of breastfeeding is placed on them, with no help at all – except, here, have a breast pump,” said Jung.

I find it most jarring that women in the US are told, by the nation’s professional association of pediatricians, that the rates of breastfeeding are a public health crisis.