American women's low breast-feeding rates aren't due to lack of desire, a new study finds. Moms say they want to breast-feed, but they end up falling short of their goals. Experts believe it's due to lack of support.

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Few new mothers actually hew to the public-health recommendations that they breast-feed exclusively for the first six months, but it’s not for lack of desire.

A new study in the journal Pediatrics finds that most mothers want to breast-feed their babies exclusively — offering just breast milk, not infant formula — for at least three months, but just under a third of those women reached their goal.

“We’re not supporting women to meet their own intentions, which is just sad,” says lead author Cria Perrine, an epidemiologist at the Centers for Disease Control and Prevention (CDC) who focuses on infant feeding.

In a negative commentary on how likely women were to reach their breast-feeding goals, Perrine noted that those women who intended to breast-feed for the least amount of time were the most likely to succeed.

The American Academy of Pediatrics recommends that mothers feed their babies only breast milk for the first six months of life and continue to breast-feed, along with introducing table foods, until baby’s first birthday or beyond because breast-feeding offers myriad health benefits for baby and mom.

Previous research has documented that few U.S. mothers meet the guidelines; only about 15% of moms are still exclusively breast-feeding at six months. But experts didn’t know if the low breast-feeding rates resulted from mothers’ lack of interest in breast-feeding or because other factors were making it difficult to persevere.

(MORE: Extended Breast-Feeding: Is It More Common than We Think?)

Now Perrine has showed that it’s the latter. She and colleagues looked at data from an infant feeding study launched in 2005 that followed 3,000 women in their third trimester of pregnancy. The women were asked about their intentions regarding exclusive breast-feeding; those intentions were then tracked monthly over the course of a year. They found that 60% of moms said they wanted to breast-feed exclusively; 85% of that group wanted to do so for three months or more and 58% said they planned to continue for at least five months, but just 32.4% actually met their goals.

Of the 85% who said they wanted to breast-feed exclusively for at least three months, just 45% succeeded; of the 58% who said they planned to nurse for at least five months, only 25% did. “One of the biggest shockers is this entire group we looked at wanted to exclusively breast-feed,” says Perrine. Just 1% of them said they intended to breast-feed exclusively for less than a month, but 42% stopped within that first month. “To me, that demonstrates we are not supporting mothers to feed their infants the way they’d like to,” says Perrine.

In other findings, married mothers and those with other children were more likely to achieve their goals; obese mothers and those who smoked were less likely. Some factors tended to improve the odds of success, including initiating breast-feeding soon after delivery and not giving newborns supplemental formula or pacifiers in the hospital. Moms whose babies didn’t receive formula in the hospital were 2.5 times more likely than moms whose babies got formula to meet their stated breast-feeding goals. Forty percent of babies received supplemental formula in the hospital.

Hospitals play a critical role in jump-starting a successful breast-feeding relationship, and those that are most committed to getting breast-feeding off to a good start — by encouraging babies to remain in their mothers’ hospital rooms where they can nurse on demand, for example, or breaking the tradition of sending new moms home with free formula samples in diaper bags paid for by formula manufacturers — are getting certified as “Baby-Friendly” facilities. But only 4% of hospitals can claim that distinction.

(MORE: Fewer Hospitals Hand Out Free Formula to New Moms)

“I think it starts with hospitals, which need to support mothers to feel confident when they leave,” says Perrine. “Employers and families have to be on board, and communities have to be comfortable with women breast-feeding in public. But hospitals are the front line. If women don’t even get started, there’s no way they can meet their goals.”

Once they’re released, moms also need follow-up care. “Most women are in the hospital two days and that is not enough time to feel confident,” says Perrine. “Just because breast-feeding is natural doesn’t mean it’s easy.”

Or intuitive. Breast-feeding moms could set themselves up for greater success by setting reachable goals, says Bettina Forbes, co-founder of Best for Babes, a breast-feeding advocacy organization that decries the “booby traps” they say new mothers face when trying to establish breast-feeding. Those traps include cultural disapproval of nursing in public, too few Baby-Friendly hospitals, insufficient legal and employer protection and physicians who “appear to support breast-feeding but are woefully under-educated on even the basics of lactation management or how to refer moms to a specialist.”

“A strategy of building on success works well in all aspects of life from training for a race or planning to lose weight,” says Forbes. “Why should breast-feeding be any different? If every expecting mother were seen by a board-certified lactation consultant that can help her set goals appropriate for her situation, and work with her to develop a plan to overcome any barriers along the way, breast-feeding rates would skyrocket, and we would all benefit.”

MORE: Bring Back the Binky? Study Finds Pacifiers Actually Boost Breast-Feeding

