Mothers who cannot breastfeed have been given terrible advice

MEDICINE IS A neatly sorted discipline. From head to toe, all major parts of the body have a specialism: cardiology for the heart, urology for (male) genitals, neurology for the brain, even psychiatry for the embodied mind. All, that is, but one. Mammary glands, though possessed by one half of humanity and admired by the other, lack a dedicated field. Science, too, has neglected the body’s milk-making function. This lack of “lactology” is bad for infants and mothers.

More than 130m women give birth each year. Of the nearly 2bn women and girls alive today who have not yet done so, over 90% can expect to have a child at some point. Most mothers try to breastfeed, but two in five of those who do will encounter at least some problems. For some it hurts, like being bitten by a critter you can’t swat away. For others, producing enough milk to feed their baby proves impossible. And often, the advice they receive is both painful and useless. Yet despite the vast unmet demand for better advice and treatment, scandalously little is known about the subject.

A search for “low milk supply” or “low milk production” returns a meagre 14,000 academic papers on PubMed, a database of 40m medical-research papers. “Erectile dysfunction”, which afflicts perhaps 300m men (mostly minimally), elicits 32,000 studies. This neglect matters. Mothers are free to choose not to breastfeed. But most want to try, because the benefits for their babies, such as helping ward off infections, are large. A study in the Lancet, a medical journal, in 2016 found that if all babies were breastfed, 823,000 deaths of children under five would be averted each year, partly because in poor countries formula is often made with dirty water.

Understanding why some women give up, and what can be done to reduce their number, is therefore of immense value. Instead, doctors often dismiss their problems, offer dubious guesswork as advice or tell mothers to switch to formula. In parts of Europe between 20% and 40% of newborns are fed powdered milk before leaving the hospital. Pregnancy care in some places scarcely mentions breastfeeding, perhaps on the assumption that it will be easy because it is natural. So is childbirth, but that does not make obstetricians redundant. The gap left by medicine is filled by non-physicians on breastfeeding helplines and “lactation consultants” who in the absence of hard facts often base their counsel on hunches.

A better understanding of breasts would allow doctors to make important distinctions. Some mothers produce enough milk but have trouble releasing it. For them, the answer may be to stimulate the flow by putting the baby to a nipple more often, or by using a breastpump. For mothers who cannot produce enough, different approaches are needed. For years doctors assumed this problem was rare: that no more than 5% of mothers suffered from inadequate milk supply.

Recent research, by scientists who have bothered to look, suggests that the true figure is closer to 10% or even 20%. The causes of low milk supply are often linked to complicated biological pathways beyond a new mother’s control, as we explore in our “Weekend Intelligence” podcast. Some are genetic. Others may involve conditions like obesity, diabetes or autoimmune disorders, which expectant women cannot just wish away by willpower alone.

Mothers grappling with such problems deserve a rigorous diagnosis and proven treatment from a specialist medical lactologist. Instead the standard advice is to tether themselves to a breastpump at least eight times a day and all will be fine—though such a brutal regimen is not grounded in any research. When all is not fine, women are often made to feel that the fault is theirs for a lack of effort. In fact, they have not failed their children. Rather, medicine has failed them. ■