How has it happened that the breastfeeding rate in Ireland is one of the lowest in Europe?

SCROLL DOWN the “100 reasons to breastfeed” on a website set up by a group of Irish doctors and it seems the case for breast versus bottle is closed – in theory at least.

Reduce your baby’s risk of cot death, leukaemia and obesity, and boost his or her IQ while you’re at it. Cut your own chances of developing post-natal depression or breast cancer, while burning 600 calories a day just sitting on a sofa.

If these scientifically proven benefits are not appealing, there are another 93 to choose from on www.thebreastway.com.

The evidence in favour of breast milk is now almost “too compelling”, suggests the HSE’s national breastfeeding coordinator, Maureen Fallon. Irish mothers are conflicted by the weight of evidence and the bottlefeeding culture they are immersed in.

As a result, breastfeeding is a peculiarly divisive issue in this country, which has one of the lowest breastfeeding rates in Europe. How did feeding your baby become such a fraught matter, entwined with embarrassment, guilt, resentment and a fair helping of misinformation?

The National Infant Feeding Survey, which was published last month, found just 42 per cent of mothers were exclusively breastfeeding on leaving maternity hospital – this is less than half the Norwegian (99 per cent) and Italian (91 per cent) rates, while it is 78 per cent in the UK and 69 per cent in France.

Not only is the initiation rate low, but then there is a very rapid fall-off with only about 3 per cent of mothers reaching the recommended six-month milestone of exclusive breastfeeding. If it was not for a sizeable number of births to non-national mothers, who are more likely to breastfeed, the rates would be even lower.

However, foreign-born mothers are being adversely affected by our culture too, says Fallon.

“The west Africans are much more likely to mix feed when in Ireland because they don’t really want to appear to be breastfeeding when they are out and about.”

Trying to combine breast and bottle tends to shorten breastfeeding.

Fear and embarrassment is sometimes cited by women who don’t want to try breastfeeding; some feel it is incompatible with a modern lifestyle, while others say they want their bodies back to themselves or are even repulsed by the idea.

Fallon believes our culture is the main stumbling block to breastfeeding. “It virtually disappeared from people’s experience in this country,” she points out. There was a perception that there was little difference between formula and breast milk.

Even though the evidence now comes down firmly on the side of breast milk, feeding habits are slow to change. And many mothers who want to breastfeed flounder in the absence of support. “Women doubt their ability to do it because they think it’s something relatively extraordinary and they anticipate difficulties,” says Fallon. That’s a sentiment echoed by Sue Jameson of Cuidiú, the Irish Childbirth Trust.

“We’re trying not to promote breastfeeding, which sounds a bit weird,” she explains. “We are trying to make breastfeeding just ordinary. If you make it altogether too worthy, you scare people away.”

There is a huge problem with the image of breastfeeding in our society, says Dr Siun Murphy, founder of TheBreastWay website. “People kind of think ‘Oh God you’re breastfeeding the child, do you live on a farm and go around barefoot? Do you ever brush your hair and do you have chickens in the back garden?’”

She thinks mothers are also put off breastfeeding by the mistaken belief that they won’t be able to have a life. “It is quite the opposite to be honest.”

It can be tough for the first couple of weeks, she says, but you’re in bits then anyway: “What do sore nipples add to the equation when you can’t sit down!

“Once you get past that – but sadly most people don’t – is when you are into the easy zone. I have never bought a steriliser or a bottle.

“Overwhelmingly it makes your life a lot easier and I am a busy gal,” says Murphy from Dublin, who is the mother of two children, aged two and four, and is currently doing her surgical training.

“You are out having coffee with your pals and you have a whingey baby in the buggy: pop them on, it’s the end of your troubles and sit back and drink your latte!”

For proponents of breastfeeding, that scenario is one of the beauties of it, but one that makes some people shudder. Although mothers are legally entitled to breastfeed their babies anywhere, and are usually extremely discreet, there are still people ready to take offence – as a recent furore on RTÉ Radio's Livelineprogramme testified.

One breastfeeding woman’s experience of being told by a pub manager, after complaints from two customers, that there was a room upstairs she could use, could have been dismissed as a once-off – until a succession of callers to Joe Duffy postulating that babies should not be breastfed in public suggested such a mindset was more widespread.

“If people feel uncomfortable, it is really their issue, not the mother’s issue,” says Sue Jameson. “If they are uncomfortable, why are they looking at her? Get up and move! You have to go out of your way to be offended.”

Such distaste seems to be a problem more among other women than men. “The older generation, particularly women who didn’t breastfeed themselves, find it difficult to understand a) why you would do it and b) why you would do it out,” says Jan Cromie, spokeswoman for the La Leche League in Ireland, a voluntary breastfeeding support organisation.

Murphy says she only ended up breastfeeding because her mother and best friend did, but then she could not understand why more of her friends were not doing it. She decided to set up a new, hip website, and enlisted medical colleagues, all breastfeeding mothers themselves, to be the “expert babes” available to answer queries on TheBreastWay’s advice forum.

One such expert babe, Dr Naadia Ibrahim, who trained in Ireland, is a GP in England, where she sees a lot more breastfeeding mothers out and about. But that doesn’t mean they are always made to feel welcome.

Last May, a mother in Nottingham who was breastfeeding her 11-week-old baby beside a swimming pool was told by an attendant that no eating or drinking was allowed on the poolside. The city council later apologised, putting the incident down to “confusion” over wording of the rules at the public leisure centre.

“I think Irish people are quite shy; culturally it is not a thing to go out and feed,” says Ibrahim and she believes the provision of breastfeeding rooms is helpful. However, as a mother of two young daughters, she is “comfortable to get my boobs out anywhere”, so never uses designated areas. “They are always near toilets and stuff!”

The other drawback is that being encouraged to feed behind closed doors does little to normalise breastfeeding in wider society. Most women, by the time they are pregnant, have already made up their minds whether they’ll breastfeed, says Cromie.

“If you don’t know anybody who has breastfed, it is quite a leap to say ‘oh maybe I will breastfeed’,” she points out. “Or if you know somebody who has breastfed and they’ve had the most horrendous pain, it’s going to be much harder for you to think ‘oh maybe I’ll try that’.”

Currently we are not creating enough advocates for breastfeeding, says Fallon. “People are starting and stopping within a month. They have put in a lot of work and really haven’t had the pay-off.” It is mothers who have come through the sometimes difficult establishment of breastfeeding, who then realise, she adds, that this is just “fantastic, enjoyable and convenient”.

Cuidiú just wants women to make an informed choice. “Find out what formula actually is before you feed it to your baby,” says Jameson.

“If somebody has read all the bumph and chooses to bottle feed they are usually happy. Those who choose to breastfeed and get on with it are fine as well. The ones the organisation would be concerned about are the women who say they really want to breastfeed and, for one reason or another, it goes pear-shaped. They are the ones we look out for.”

"At the hospital I was actually told to give him a bottle. It was very busy at the time"

NIAMH NASH sees the bottle versus breast issue from both viewpoints. She started to breastfeed her first son, Ethan, but within two weeks gave up. She did not have any support, not even in the maternity unit of the Bon Secours Hospital in Cork where she gave birth four years ago.“At the hospital I was actually told to give him a bottle. It was very busy at the time for them and there was nobody around to help.”

When she returned home to Glanmire, she had no friends or family around who had breastfed. She was afraid Ethan wasn’t getting enough milk and that he wasn’t latching onto the breast properly.

“At the time I felt it [stopping] was the best decision for me, I felt under too much pressure. When I did give up, I just kind of felt relief.”

But second time round, it was a different story and she is delighted to be breastfeeding eight-month- old Lucas who was born in the Cork University Maternity Hospital.

“I had more support. I thought they were great in the CUMH and the public health nurse this time round was very reassuring.”

The first two weeks are really hard, she says. “People think it is the most natural thing in the world: that the baby would latch on and that’s it, but it’s not as easy as that. It is hard work, but the most rewarding thing I have ever done.”

Having recently returned to part-time work as a receptionist at a doctor’s surgery, the new pressure she is encountering is people saying “are you still breastfeeding, when are you giving up?” – despite the recommendation by the World Health Organisation, and the HSE here, that breastfeeding be continued to at least the age of two.

Part of the reason Niamh decided to breastfeed her second child was that Ethan has a nut allergy, as well as asthma and eczema. She is not attributing his problems to bottlefeeding but it has been shown that breastfeeding can help reduce the risk of such allergies. Her husband, Kevin, was prepared to support her in whatever choice she made.

Although she would recommend breastfeeding to other women, she does not feel comfortable feeding in public and tries to avoid it.

“I would feed in front of my female family members but not my dad or my brothers,” she adds. “I am quite shy about that. My 85-year-old grandmother loves seeing me breastfeeding, although my mum would have been a bit funny about it. I don’t know how it skipped the generations.”

• For more information see: www.thebreastway.com; www.breastfeeding.ie; www.cuidiu-ict.ie; www.lalecheleagueireland.com

• swayman@irishtimes.com