Deciding Which is the Better Fit The practice of breastfeeding has been around since the time of the Ancient Egyptians and Grecians. (History and Culture, 2020) Over the few millennia since then, practices with breastfeeding have evolved and advanced alongside mankind. While the technology and technique surrounding breastfeeding may have changed drastically throughout the existence of humanity, the benefits, risks, and challenges of breastfeeding have not. One problem that has developed over time, however, is the great debate over mothers breastfeeding their babies the standard six month recommended period or for an extended time frame, up to two years.
There is no doubt that breast milk is beneficial for infants; it contains extremely important nutrients for their development and nutrition and helps strengthen their immune system (American Academy of Pediatrics [AAP], 2016).
It is not just beneficial for the baby, though; according to Borra, Iacovou, and Sevilla (2015) there have been several studies correlating breastfeeding to a lowered risk of post-partum depression, and, according to the National Health Service (2017), breastfeeding lowers a mother’s risk of ovarian and breast cancer (as cited in Nurmi, 2020).
What is up for debate, however, is if there are any specific benefits, risks, or challenges for mother and baby that women who choose to breastfeed may experience if they decide to extend the amount of time they breastfeed.
When it comes to standard breastfeeding, there are many sources to choose from that support it. The World Health Organization (WHO) recommends that women practice exclusive breastfeeding for the first six months of life, specifically: “…No other food or liquids are provided, including water.” (World Health Organization [WHO], n.d.).
According to WHO (n.d.), breastmilk provides all the nutrients an infant requires for the first six months of life, and continues to provide up to half, and then one third, of the nutritional needs of the child from six to twelve months and twelve to twenty-four months respectively. The American Academy of Pediatrics also recommends breastfeeding as the sole source of nutrition for the first six months of life (AAP, n.d.).
While nutritional value alone is a large benefit for infants, many studies have shown other, more long-term, advantages to breastfeeding. A couple examples are breastfeeding being linked to a lower risk of obstructive sleep apnea syndrome in children who were breastfed at least three to five months (Xu et al., 2020), and breastfed children have a reduced change of childhood obesity. (Umer et al., 2015 as cited in Umer et al., 2019). The latter discovery was supported by another study performed by Houle, Rochat, Newell, Stein, and Bland (2019), however, their data suggested that extending breastfeeding into the six to eleven-month range or even over twelve months shows an even more significant decrease in the likelihood of childhood obesity in children between the ages of seven and eleven. The extended provision of breast milk was, however, paired with complementary foods appropriate for the age of the infants (Houle et al., 2019). Another similar study that endorses extended breastfeeding also reported the use of complementary feeding alongside breast milk; the study performed by Moss and Yeaton (2014) also looked at a lowered risk of childhood obesity, however their approach involved delaying the introduction of solid foods until at least four months and the continuation of breastfeeding alongside solid foods. For mothers, studies have found that women who breastfeed have a lowered risk of “developing type two diabetes, rheumatoid arthritis, and high blood pressure,” though more research on the subject is needed (Nurmi, 2020). This is not, however, specifically associated with extended breastfeeding but instead just the act of breastfeeding itself. While extended breastfeeding does have some benefits, there is little evidence that it is more favorable than standard breastfeeding for infants or mothers.
When it comes to risks concerning breastfeeding, there are more risks for mother and baby to not partake in breastfeeding than to breastfeed. According to Steube (2009), infants who are not breastfed have an increased risk of infectious morbidity, sudden infant death syndrome (SIDS), type one and two diabetes, and leukemia. For mothers, not breastfeeding is associated with heightened risks of heart attack, ovarian and breast cancer, retained weight gain from pregnancy, and type two diabetes (Staube, 2009). Very few risks are associated with breastfeeding, and those that are could generally be avoidable. One such risk is childhood anemia in children who were exclusively breastfed in Africa for more than six months (Buck et al., 2019). According to Buck et al. (2019), hemoglobin levels in these children were not the result of a low socioeconomic status or food insecurity, but there was an inverse correlation concerning when breastfeeding was ceased. However, it is suggested that this risk of anemia could be avoided as long as the infant is provided age-appropriate complementary foods (Buck et al., 2019). Thus, there is less of a risk both for the infant and mother to partake in breastfeeding than to abstain, and if fed correctly, the infant should be at no risk if the mother chooses to extend the time she breastfeeds.
Every mother who breastfeeds faces challenges, whether physical, emotional, or social. The obstacles she may face will likely continue for the length of time she breastfeeds, regardless if it is for the standard six months or an extended time. These challenges are often the biggest factors in a woman ceasing breastfeeding earlier than is recommended. Physical challenges that many mothers face include sore nipples, breast infections, leaking milk, and too much or too little milk (Nurmi, 2020). Having twins often makes the already formidable transition into motherhood even more strenuous and is a more physical reason some mothers choose to not breastfeed (Breastfeeding Coalition Tasmania [BCT], 2015). Another physical difficulty is the postpartum fatigue many mothers experience (Fata & Atan, 2018). According to Fata and Atan (2018), postpartum fatigue is “…One of the most commonly cited reasons for early weaning in breastfeeding.” Extending the time of breastfeeding could exacerbate the difficulties a mother faces, such as raising the likelihood of the development of a breast infection like mastitis. Emotional difficulties many mothers may face is lack of personal or family support as well as feeling embarrassed about breastfeeding in public, a daunting task for many mothers (BCT, 2015). One other large emotional dilemma many women deal with is the perception that the infant does not like or is not tolerating breast milk (Hendaus, Alhammadi, Khan, Osman, & Hammad, 2018). This could lead to the mother forgoing breastfeeding and choosing the easier option of formula. There is little to suggest that extended breastfeeding has its own emotional challenges aside from the possibility of increased embarrassment about public feedings as the child ages. While many new mothers may know to expect them, social challenges are still never easy to deal with. Breastfeeding women may face social criticism for choosing to breastfeed in public (BCT, 2015). This seems to especially be a problem once the child is older and considered more of a toddler; according to Newman and Williamson (2018), women who breastfed for longer than six months in the East of England were on the receiving end of verbal and nonverbal criticism when they breastfed in public. Even without a woman being subjected to this kind of problem, just the thought of being on the receiving end of another person’s rude comments could dissuade a woman from breastfeeding her child for longer than six months. While the most hard-hit women are those who breastfeed past six months, all women who breastfeed may be criticized socially (Newman & Williamson, 2018).
It is true that breastfeeding has its ups and downs, but the benefits certainly outweigh the risks and challenges the practice may pose. When considering the aforementioned dilemma between standard and extended breastfeeding, there is little evidence arguing which method of breastfeeding is better for the mother and child. Overall, as long as a mother administers complementary foods to her infant alongside breastmilk once the child is over the age of six months so to avoid previously stated problems like anemia, (Buck et al., 2019) she should continue to breastfeed for as long as she and the infant are comfortable. Every mother is different and has unique preferences, therefore there is no “better” length of time one may choose to breastfeed.
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