Ireland's breastfeeding rates are abysmally low. According to the recent Breastfeeding in a Healthy Ireland: Health Service Breastfeeding Action Plan 2016-2021, only 46 per cent of babies are exclusively breastfed on discharge from hospital, the lowest rate in Europe.
The World Health Organisation (WHO) recommends exclusive breastfeeding for the first six months and continued partial breastfeeding until the child is two years of age. In Ireland fewer than one in eight babies are still breastfed at six months and even fewer until they are two years old.
Now it seems that Catholicism might be partly to blame for the low rates, according to a new study published in the British Medical Journal Global Health in December016. The study found a negative correlation between the proportion of Catholics and breastfeeding initiation rates in western countries. This correlation was consistent for within-country data for France, Ireland, the UK and Canada.
In the US, the positive correlation between a state's proportion of Catholics and its breastfeeding initiation rate was confounded by race, education and socioeconomic status (SES). After controlling for education and SES, Catholicism was negatively correlated with breastfeeding rates as in the other four nations.
Western countries with a higher proportion of Protestants were closer to meeting WHO recommendations. The authors concluded that “women living in a country or region where Catholicism has historically dominated are less likely to initiate breastfeeding, and breastfeeding promotion policies should be adapted to better fit population cultural and religious norms”.
The study recommends that countries with predominately Catholic populations take religion into consideration when developing health promotion policies.
Cultural values
Breastfeeding among modern humans is strongly influenced by cultural values, beliefs and customs, leading to huge variations in breastfeeding practices. Northern European countries have initiation rates as high as 95 per cent, whereas just 57 per cent of Irish mothers even try breastfeeding. When they do, they often stop after a few days or weeks.
Many individual – and societal level – determinants of breastfeeding practices are known, such as maternal age, educational attainment, SES, maternal confidence, and support from the father.
Public policies, such as laws on maternity benefits, have a big influence on the decision to breastfeed.
The Health Service Breastfeeding Action Plan makes no reference to religion and very little reference to the social and cultural determinants of breastfeeding. The 31 actions in the plan refer almost exclusively to what needs to happen in maternity hospitals and units, and at primary care level.
While this is important – women need the support of health professionals – there is convincing evidence that the decision to breast-feed has little to do with health services. Women decide to breast-feed months before the baby is born based on the social and cultural determinants in their own environment. This decision is usually fixed regardless of exhortations from health professionals that “breast is best”.
Only Action 4.5 refers to cultural influences. “Establish an interagency group to address cultural barriers to breastfeeding in Ireland.” Much more needs to be done about cultural and societal determinants.
The Irish Catholic Church's attitudes towards women must be challenged. The authors of the Global Health study speculate that Protestantism promotes pragmatism and utilitarianism, making breastfeeding more likely, whereas Catholicism is less adaptable and dynamic, making breastfeeding less likely. Protestants view breasts as useful whereas Catholics believe breasts are just for sex and "lactation and sex are incompatible".
Ireland’s maternity system of care also influences breastfeeding rates. This system has now been criticised by a second international body: the Commissioner for Human Rights of the Council of Europe.
The Irish maternity system is “over-medicalised” and women are forced “to comply with medical decision-making about their care and treatment with which they do not agree”, the commissioner said. When childbirth is over-medicalised, women are disempowered and less likely to breast-feed.
No religion numbers
Fortunately, Ireland is becoming less Catholic and less religious. Census 2016 figures show that the percentage of the population who identified as Catholic has fallen from 84 per cent to 78 per cent. There has been a corresponding rise in the number with no religion, which grew by 74 per cent from 269,800 to 468,400. This is very good news for breastfeeding and the health of the nation’s children.
No one need fear the fact that the country is becoming less Catholic. It is perfectly possible to be a good citizen and lead a moral life without any religion by taking a human rights approach to life. Less Catholicism will mean better health all round, including for newborn babies.