Tomorrow, Thursday 4 June, the results of the latest in a long running series of government surveys on feeding babies will be published. Usually referred to as just the Infant Feeding Survey (or IFS), this is the ninth survey since the series began in the 1970s, asking British mothers about how they feed their babies – and yes, it is still just mothers that the government expects to be feeding babies. Since it was first carried out in 1975, the survey has supported the government agenda to promote breastfeeding, while inadvertently revealing uncomfortable truths every single time.
The series was actually cancelled after the 2010 survey and this is the first one since. It was breastfeeding advocacy organisations who lobbied for it to be reinstated. They have long relied on the survey to support their claims and call for more investment in their services.
A statistic from that last 2010 survey has been manipulated particularly successfully. This was the finding that ‘80% of women who stopped breastfeeding would have liked to have carried on longer’. You will come across a variation of this claim anywhere that anyone argues for or defends breastfeeding promotion policies, from politicians to charities and breastfeeding advocates. The argument is that these women could have breastfed longer with ‘more support’, though there is no evidence to suggest that this is the case.
To us, this always seemed the least interesting or useful finding to come out of that 2010 survey. Unfortunately, biology doesn’t care what women want! And it is not surprising that so many women plan to breastfeed, given that it is the advice of all health agencies. In any case, the women behind that statistic were not asked in any detail for their feelings on stopping breastfeeding or if they had regrets. There is not much room for nuance in the multiple choice question: ‘I would have liked to breastfeed for longer’; ‘I breastfed for as long as I intended’; ‘I breastfed for longer than I intended’.
When the latest results come out tomorrow, we will be more interested in the answers to another question: why did women stop breastfeeding? Government advice is that all women should exclusively breastfeed their babies for a year. The 2010 survey found that 81% of women attempted to initiate breastfeeding. By six weeks, less than a quarter were exclusively breastfeeding.
The respondents in 2010 reported three reasons above all others for stopping breastfeeding early: insufficient milk, difficulties with latching the baby on and painful breasts or nipples. Insufficient milk was the top reason women gave for stopping breastfeeding at any later stage in the baby’s first year.
Five years before in 2005, the picture had been the same (see table below). What about before that? The surveys from between 1980 and 2000 are not available online, however, a report by SACN (The Scientific Advisory Committee on Nutrition) from 2018 confirms what I suspected. It says:
‘The reasons mothers stop breastfeeding had been consistently described in IFS since 1980….the principle reasons were difficulties with attachment to the breast or nipple pain, and a perception that breast milk was insufficient or the infant was hungry.’
Let’s go back to the seventies for a moment – a time of a ‘revival of breastfeeding’ internationally. Where did the first UK Infant Feeding Survey come from?
A working group within the Committee on Medical Aspects of Food Policy (COMA) had written a report in 1974. It opined that ‘The United Kingdom is, in general, no longer a breast fed or breast feeding nation’ and called on the Department of Health to encourage women to breastfeed. Despite their biases and assumptions, this working group acknowledged that there was in fact little data on how babies were actually being fed. So they recommended the government carry out a national survey.
When the results of the first survey were in, its commissioners were surprised to find that half of the women surveyed had started off breastfeeding. This was more than they had hypothesised (was the UK really no longer ‘a breastfeeding nation’?) But they were even more surprised that half again of those women had stopped breastfeeding within the first six weeks. Most confounding of all, were the reasons women gave for stopping. Of women who stopped before six weeks, 61% said they had insufficient milk, 19% said they had painful breasts or nipples and 12% said the baby would not suck or rejected the breast.
The working group could not believe these answers. In fact, they did not believe them. When the survey results were published, they wrote in a summary:
‘The most frequently mentioned reason given by mothers for stopping breast feeding was insufficient milk. Answers ranged from those of mothers who said that their milk dried up completely to those who assumed that the baby’s crying indicated hunger and therefore that they did not have enough milk to satisfy their child. The most common answer was that the mother did not have enough milk and so had to give bottles as well…It seems unlikely that such a high proportion of mothers as was found in the survey were really incapable of producing enough milk for their babies.’
For the thirty five years of surveys that followed, interpreters continued not to believe women’s reports of serious breastfeeding problems, above all low milk supply. Times, attitudes, governments, maternity care and infant feeding policy have all changed, but women’s answers to this question have been as consistent as they have been consistently dismissed. This is because what women report about why they stop breastfeeding does not fit the narrative that has framed breastfeeding since the 1970s.
The ideas that underpin the promotion of breastfeeding are that serious breastfeeding problems are rare (they are common), exclusive breastfeeding is viable and safe for nearly all babies (it is not), ‘breastfeeding support’ can solve most problems with latching, low milk supply or pain (there is no evidence for this).
Government commissioned the same survey eight times, got the same answers about why women stop breastfeeding eight times and ignored them eight times. The quote about doing the same thing over and over again and expecting different results being the definition of insanity springs to mind.
So, when the latest survey results are published tomorrow, over 50 years after the first one, will women report for the ninth time that they stop breastfeeding early because of insufficient milk, latching difficulties and pain? If they do, how will authorities respond? Will they continue the well worn tradition of gaslighting women? Will they continue to argue that women just need more breastfeeding support and more investment in policies that have been operating for decades? Or will this finally be an opportunity to ask what is going on? Will someone in government even stop to wonder what serious harms might result from promoting exclusive breastfeeding when a percentage of women have long reported they are unable to produce enough milk? We are not hopeful. Unlike authorities, we will not make the mistake of expecting a different response nine times later!
Sue Haddon
(Below, top). Table from SACN’s 2018 report comparing reasons women gave for stopping breastfeeding in the 2005 and 2010 surveys.
(Below, bottom). Table from the 1975 survey showing reasons women gave for stopping breastfeeding (before six weeks rather than two weeks as in the later surveys).
