Authors: Meghan Etsey, Rhea Manohar MPH, Brianna Clark DO – On behalf of AMWA Gender Equity Task Force
While breastfeeding has long been considered beneficial, since the 1990s it has been championed as the gold standard of infant nutrition by leading pediatricians and health advocacy groups alike. The benefits are undeniable: breast milk, also known as human milk or lactation, provides optimal nutrition, strengthens the infant’s immune system, supports cognitive development, and fosters maternal-infant bonding. Additionally, breastfeeding provides maternal benefits including reduced risk of breast and ovarian cancers, a form of postpartum birth control, and reduced risk of postpartum depression and anxiety (Chowdhury et al., 2015; Yuen et al., 2022). Beyond the health benefits, also cost-effective and readily available. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods for up to two years or more (World Health Organization 2022).
Throughout ancient societies, breastfeeding was considered the standard method of infant feeding. In wealthier families, this often included the use of wet nurses—sometimes hired, but in many cases, enslaved women were coerced into breastfeeding the children of their enslavers. While this arrangement enabled extended breastfeeding and allowed elite women to resume their social roles, it was rooted in systems of exploitation and oppression that dehumanized the women forced into this labor (Knight, 2024). With the Industrial Revolution, women entering the workforce began relying on early forms of formula or alternative feeding arrangements to nourish their children. By the mid-20th century, formula feeding had become mainstream in many Western countries—marketed as modern, scientific, and even superior to breast milk (Wolf, 2021). To combat the aggressive and often lack of evidence-based marketing by formula companies, the WHO and UNICEF launched the “Breast is Best” campaign in the 1970s. This was further reinforced by the 1991 Baby-Friendly Hospital Initiative and the consensus by pediatric and public health organizations to promote breastfeeding benefits on mother and child (World Health Organization).
Breastfeeding offers numerous well-documented health benefits for both infants and mothers. For infants, breast milk provides optimal nutrition with the right balance of nutrients and antibodies that help protect against infections, allergies, and chronic diseases later in life. Breastfed babies have lower risks of respiratory and gastrointestinal illnesses, and evidence suggests cognitive benefits as well. For mothers, breastfeeding supports postpartum recovery by promoting uterine contraction, reducing bleeding, and lowering the risk of certain cancers such as breast and ovarian cancer (Roghair, 2024). Additionally, breastfeeding fosters bonding between mother and child and can support maternal mental health (Modak, 2024). While efforts focused on increasing education and awareness of the benefits of breastfeeding for infants and mothers are incredibly important and beneficial, personal decisions around feeding are rarely so clear-cut.
In today’s society, feeding choices have become a larger part of the public discourse. Mothers who breastfeed, especially in public, are often shamed or sexualized. They’re told to cover up or leave public spaces, despite laws in many countries protecting their right to nurse in public. This stigma disproportionately affects Black, Indigenous, and other women of color, who are statistically less likely to breastfeed due to historical traumas, systemic racism, and lack of culturally competent support (Robinson et al., 2019). Additionally, women from minority populations, such as African American and indigenous, may receive decreased breastfeeding support that is culturally sensitive which reduces initiation and duration rates (Centers for Disease Control and Prevention, 2021; Robinson et al., 2019).
While breastfeeding and alternative breastfeeding options, such as lactation banks, continue to be the recommended practice for infant nutrition, providing empathy for mothers who rely on bottles or formula is still important. Notably, mothers who rely on bottles or formula—whether temporarily or long-term—often face stigma and judgment. The internalized stigma and perception of judgement or inadequacy from other parents may lead to negative feelings of self-worth among these mothers. In turn, this may exacerbate mental health challenges, including post-partum depression, that affect new mothers (Bresnahan et al., 2020). At the same time, the commercial marketing of formula and bottle-feeding products frequently exploits parental fears, using messaging that implies mothers are not “enough” on their own. This dynamic underscores the urgent need for culturally appropriate, evidence-based lactation support that empowers rather than shames.
Breastfeeding should not be physically or emotionally painful, yet many parents face challenges such as pain, low milk supply, or inadequate guidance without proper support systems (Louis-Jacques et al., 2021). Research on human lactation remains surprisingly limited—especially compared to what we know about managing low milk supply in dairy cattle—leaving critical gaps in care and understanding.
Inadequate workplace protections compound these challenges. Many new parents, especially younger or early-career individuals, have little control over their work environments and are rarely afforded adequate paid leave or private (Patel et. al., 2023). These inequities—when layered with age-related stigma—can discourage young parents from seeking help for breastfeeding difficulties or related mental health concerns. Notably, the Providing Urgent Maternal Protections for Nursing Mothers (PUMP Act) has helped close some of the gaps in workplace inequities for nursing mothers, including a legal right to pumping breaks and private spaces to pump (U.S. Breastfeeding Committee, n.d.). To foster healthier outcomes, we must shift away from shame-based narratives and toward structural support systems that affirm parental autonomy, provide accurate lactation education, and recognize breastfeeding as a public health and workplace equity issue.
Yes, breastfeeding offers significant health benefits for both infants and mothers—but feeding decisions are often shaped by broader social determinants of health, including access to healthcare, paid leave, workplace accommodations, and community support. These structural factors—not personal choice alone—play a pivotal role in whether and how long a parent is able to breastfeed.
Access to safe, donor human milk can be lifesaving for vulnerable infants when breastfeeding isn’t possible. Milk banks, like those supported in states such as Ohio, serve as a critical public health resource—especially for premature or medically fragile babies. Yet awareness and access remain unequal, with lower-resourced communities facing disproportionate barriers.
Healthcare professionals must advocate not only for evidence-based lactation education but also for systemic policies that address inequities. This includes expanding culturally sensitive lactation support, improving access to donor milk, and ensuring policies like paid family leave are equitably implemented. Supporting infant feeding through this lens means recognizing that breast milk is not just a personal decision—it’s also a public health equity issue.
References
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About the Authors
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Rhea Manohar is a third year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology, Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed and implemented hands-on workshops to further reproductive health issues and bolstered medical students’ abilities to navigate physician-patient communication. Prior to medical school, she was a research associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also a member of the Gender Equity Task Force and Reproductive Health Coalition within the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.
Dr. Brianna Clark is a proud osteopathic physician. She has completed fellowships in Breastfeeding Medicine at the University of Rochester Lessons in Lactation Advanced Curriculum ( LILAC) and Climate Health Equity Fellowship ( CHEF) through the National Medical Association ( NMA). She spends her spare time thinking about innovative ways to provide equitable health care to all and create sustainable advocacy.