Researchers find many mothers feel negative emotions about the way they feed their infants.
The study reveals that most mothers who formula-feed their infants report feelings of guilt, stigma, and a need to defend their feeding choice.
Study leader Dr. Jo Harrold, of the Infant Feeding Group (LiFe) at the University of Liverpool's Institute of Psychology in the United Kingdom, and colleagues recently published their findings in the journal Maternal & Child Nutrition.
Breast-feeding offers benefits for both mother and baby; studies suggest it can lower infants' risk of numerous health conditions, including allergies, childhood obesity, and sudden infant death syndrome (SIDS), while for mothers, it may lower the risk of type 2 diabetes, certain types of breast cancer, and ovarian cancer.
The American Academy of Pediatrics (AAP) recommend that infants should be exclusively breast-fed for the first 6 months of life. After 6 months of age, breast-feeding should continue, say the AAP, alongside a gradual introduction of solid foods.
According to the U.S. Department of Health and Human Services, if 90 percent of new mothers exclusively breast-fed for 6 months, around 1,000 infant deaths could be prevented.
However, a report from the Centers for Disease Control and Prevention (CDC) found that only 49 percent of infants born in 2011 were being breast-fed at 6 months, while only 27 percent were being breast-fed at 12 months.
In an attempt to boost breast-feeding rates in the U.S. and worldwide, health organizations have launched a wealth of campaigns affirming the "breast is best" message. But according to Dr. Harrold and team, this message may be fueling negative emotions for new mothers.
Other mothers the main source of negative feelings
For their study, the researchers recruited 890 mothers of infants up to the age of 26 weeks through an online survey. All mothers were formula-feeding their infants at the time of study.
As part of the survey, mothers were asked questions about their feelings regarding their choice of feeding practice, such as "Have you ever felt stigmatized for the way you feed your baby?" and "Have you ever felt guilty about the way you feed your baby?"
Of the 601 mothers included in the final sample, 67 percent reported feeling guilty, 68 percent felt stigmatized, and 76 percent felt they had to defend their choice of feeding method.
The highest levels of guilt were felt by mothers who planned to exclusively breast-feed and those who initiated breast-feeding but stopped.
Respondents reported other mothers as their main external source of these negative feelings, the team reveals, followed by healthcare professionals.
"Although this is a novel finding in the infant feeding literature, the media-fuelled 'mummy-wars' between breast-feeding and formula-feeding mothers may be a contributing factor," the authors note.
"Informal relationships between mothers both face to face and via social media platforms are an important source of social and emotional support, and the sociocultural significance of infant feeding decisions may be placing these networks in jeopardy," they add.
In relation to healthcare professionals, the team hypothesizes that they may be a source of negative emotions because mothers feel judged by them for not conforming to recommendations.
"Such conclusions are further reinforced by data revealing that the majority of mothers in this study felt unsupported by health professionals and were more likely to rely on the internet for infant feeding information than seek advice from them," the researchers add.
Breast-feeding mothers feel negative emotions, too
In a second study, Dr. Harrold and colleagues recruited 845 mothers of infants aged up to 26 weeks. This time, mothers were either exclusively breast-feeding or combination feeding - that is, part breast milk, part formula.
All mothers were asked the same questions regarding their feelings about their feeding method as those who took part in the first study.
Of the 679 mothers included, 15 percent reported feeling guilty, 38 percent reported feeling stigmatized, and 55 percent felt the need to defend their feeding choice.
The highest levels of guilt were felt among mothers who engaged in combination feeding, and the main sources of negative emotions were from family members and breast-feeding in public.
On further investigation of both studies, the researchers found that among both formula-feeding and breast-feeding mothers, any feelings of guilt and dissatisfaction were directly linked to how they chose to feed their infants, though these negative emotions were much more common among formula-feeding mothers.
"Women who breast-feed feel stressed about neglecting the rest of the family and other obligations, whereas women who do not breast-feed feel a sense of guilt about feeding their child something sub-optimal," explains study co-author Sophia Komninou, of the Department of Psychological Sciences at Liverpool.
"They also feel shame about having to explain to others why they are not breast-feeding, which leads to them feeling like they are failing to achieve the socially constructed status of the 'good mother,'" she adds.
'Breast is best' message may have done more harm than good
Overall, the researchers say their findings show that while the "breast is best" message is communicated with good intentions, it may be more of a hindrance than a help for some new mothers.
"The study demonstrates a link between current breast-feeding promotion strategies and the emotional state of mothers.
The 'breast is best' message has, in many cases, done more harm than good and we need to be very careful of the use of words in future breastfeeding promotion campaigns."
Co-author Victoria Fallon, Institute of Psychology, University of Liverpool
Fallon adds that "social reform" is warranted to support and protect non-breast-feeding mothers, and an alternative approach to breast-feeding promotion is needed to reduce the negative emotions among mothers who do not or are unable to breast-feed.
"It is crucial that future recommendations recognize the challenges that exclusive breast-feeding to 6 months brings and provide a more balanced and realistic target for mothers," adds Fallon.