Barriers to Breastfeeding

Special attention should be given to barriers to breastfeeding for all women especially African American and other minority women.  Below are several barriers to breastfeeding that where identified in focus group findings.

  • Embarrassment
  • Lack of social support
  • Worried about not enough milk
  • Lack of support at work or school
  • Worried about having to eat well
  • Lack of information

Studies show that mothers who receive advice, information and encouragement from their physicians to breastfeed are more likely to breastfeed than those who do not receive such advice. The American Academy of Pediatrics Policy Statement outlines physicians’ roles in the promotion and protection of breastfeeding. View it on the web by accessing

Maternity Care Practices Survey done by the CDC conveys that a mother’s ability to successfully breastfeed her baby is strongly affected by the practices and policies of the hospital that she delivers her baby.  Previous CDC research shows that women who are subjected to the best possible in hospital breastfeeding practices are eight times as likely to continue breastfeeding for at least six weeks compared to women who have a less favorable in-hospital experience.  Postponing the initial breastfeeding experience beyond the first hour of life, giving supplementary feedings in addition to breastfeeding and feeding the baby on a specific schedule all appear to strongly interfere with the successful initiation of breastfeeding. DeGirolamo AM, Grummer-Strawn LM, Fein S. Maternity Care Practices:  Implications for Breastfeeding.  Birth. 2001, 28: 94-100.

Studies show that returning to work after having a baby is a major barrier to mothers who want to breastfeed. Moms worry that their employer may not be supportive and provide break time that they would need to pump. They usually have questions about how to pump, how to store milk and how their co-workers will react when they need to take break time to pump.

There is now a well-researched program distributed by the Department of Health and Human Services and the Maternal Child Health Bureau to help these mothers make an informed decision.  The program is called “The Business Case for Breastfeeding”. Georgia was one of 10 states that received funding through the Georgia Breastfeeding Coalition to help implement this program. This funding was to train trainers to offer technical assistance to businesses wanting to start a lactation program.

The Business Case for Breastfeeding includes comprehensive resource kits that target breastfeeding mothers, employers, human resource personnel and others.  The kits or booklets help support a mother’s decision to continue breastfeeding after returning to work.  The program was developed in a train-the-trainer format to assist breastfeeding educators and breastfeeding coalition members to provide information and support to local business and their employers.  The goal is to increase awareness of the economic benefits of breastfeeding, increase the number of employers that provide a worksite breastfeeding support program and provide models for implementing a worksite breastfeeding support program. The information provided focuses on a company’s return on investment (ROI) in employee retention, productivity, decrease in absenteeism and job loyalty.

These resource kits are available free of charge from the US Department of Health and Human Services but it is recommended that employers receive information through those that have been trained to provide technical assistance in their implementation.  For more information and a free copy of the brochures go to or

Maternal Outcomes

  Breastfeeding is associated with a reduced risk of:

  •  Type 2 diabetes
  •   Breast cancer
  •   Ovarian cancer

Early cessation/not breastfeeding is associated with an increased risk of:

  •  Postpartum depression 

Infant Outcomes

  Breastfeeding is associated with a reduced risk of:

  • Sudden infant death syndrome (SIDS)
  • Obesity
  • Type 1 and 2 diabetes
  •  Childhood leukemia
  •   Asthma
  •  Acute otitis media
  •  Non-specific gastroenteritis
  • Severe lower respiratory tract infections
  •  Atopic dermatitis
  • Necrotizing entercolitis (NEC)​

Benefits of Breastfeeding

Breastfeeding, Maternal & Infant Health Outcomes in Developed Countries –

AHRQ Review Summary April 2007

Screened >9,000  abstracts 

Comprehensive, systematic review of studies conducted in developed countries

43 primary studies on infant health outcomes

29 systematic reviews or meta-analyses covering approx. 400 individual studies

43 primary studies on maternal health outcomes

Breastfeeding, Maternal & Infant Health Outcomes in Developed Countries –

AHRQ Review Summary April 2007

Breastfeeding for Greater Than 6 Months Reduces Diabetes Risk

A 30-Year CARDIA Study in JAMA Intern Med. 2018 found that breastfeeding for a longer duration, six months or more, was associated with a graded 25% to 47% decreased incidence of later-life diabetes, according to the study by Erica P. Gunderson, PhD, MPH, MS of Kaiser Permanente Northern California, and colleagues. They conducted a multicenter, prospective cohort study involving 1,238 black and white women, who were followed for 30 years. The researchers accounted for biochemical measures before pregnancy, demographic and clinical risk factors, weight gain, and lifestyle factors.

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Breastfeeding Benefits & Barriers

Aggressive Breast Cancer Reduced with Breastfeeding

Boston University’s Sloan Epidemiology Center has found one reason that African American women have a higher risk of developing more aggressive breast cancers.  The study was published in Cancer Epidemiology, Biomarkers & Prevention.  The 14 year study found that giving birth to 2 or more children was associated with an increased risk of certain aggressive cancers, but only among women who had not breastfed. There was a 50 % increase of estrogen and progesterone receptor negative (ER-/PR) cancers in these women who did not breastfeed. The conclusion is that breastfeeding can reduce risk of developing the aggressive, difficult-to-treat breast cancers that disproportionally affect African American women.  The study was supported by the National Cancer Institute of the National Institutes of Health.

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