What is Extended Breastfeeding?
…& what are the barriers?
“Extended Breastfeeding” is a term that doesn’t exactly have a solid definition. In the United States, it’s typically referring to breastfeeding beyond one year. But, I think that the definition of it is not as important as the way in which we think about nursing children beyond the baby stage.
Extended breastfeeding—although endorsed by the World Health Organization (WHO) & even the American Academy of Pediatrics (AAP) in so far as formally recommending it as standard practice in the United States in 2022—is not embraced. Well, at least not in the United States.
Don’t get it twisted, this is not any fault of parents. It’s much deeper than that. Without promotion, protection, & support of breastfeeding beyond one year, it is very challenging for most families to meet these formal goals set forth by the WHO & AAP. Sixty percent of mothers don’t breastfeed for as long as they intend to. As per the CDC, how long a mother breastfeeds her baby (duration) is influenced by many factors. These include (but are not limited to):
Mother’s concern about taking medications while breastfeeding
Cultural norms & lack of family support
Unsupportive hospital practices & policies
Unequal pay
Other healthcare inequities
Accidental weaning
The factors I circled are examples of systemic barriers—structural obstacles that prevent certain folks from being able to achieve an end goal. These systemic barriers play a huge role in undermining extended breastfeeding for many families. For example, a parent may not be able to breastfeed for an extended period of time if they cannot afford to be at home with the child or need to have more than one job. Other examples include healthcare providers pushing practices like sleep training during infancy (which leads to night weaning… which is weaning) or pushing folks to switch to cow’s milk when they disclose that they are still breastfeeding beyond infancy & their child(ren) eat a well-balanced diet. We need systems-level protections for families to be successful in breastfeeding for the long haul.
To make matters worse, data on extended breastfeeding (beyond 1 year) is scant. Therefore, there is virtually no weaning data specifically available for this category of nursers. Very few people nurse to 2 yrs or beyond. Likely due to this lack of data, there are no supports for this group of breastfeeding parents when it comes to empowering them to continue beyond infancy, nor information to help them figure out how to stop. We need to push for more research in extended breastfeeding.
We also need to do our best to educate the public on the known benefits of breastfeeding. For example, it is widely known that there are many health benefits for the breastfeeding parent, including reduced risk of breast cancer, ovarian cancer, diabetes, & high blood pressure. There may also be an association of prolonged breastfeeding with reduced maternal fertility & increased birth spacing, although the physiologic mechanisms underpinning this effect are unclear. This can have benefits for the mother's health to recover fully between babies. Without folks accepting the importance of breastfeeding for the health of children, parents—& even the economy—I fear we will never have enough promotion of the practice to push for the protections & support we need.
But, I think that cultural influences play an even bigger role in making any meaningful progress in extended breastfeeding rates. One study by Thompson (2020) confirms a societal influence on extended breastfeeding practices. They found that many women perceived a shift in approval for continued breastfeeding as their child transitioned from “baby” to “toddler,” which led to “concealment” & “reluctance” of seeking professional support. It’s no wonder breastfeeding parents feel this way—I see how the public engages with breastfeeding content online. Parents are bullied if they nurse their children in public. Parents are shamed if they disclose they’re breastfeeding a child who also eats solids or can drink from a cup. Parents are blamed for their children’s sleep issues because of how they feed them. Parents are called “sick” for breastfeeding. As a society, we claim that we want to be healthier, but we do not support folks who are doing their best to provide their children with the nutrition, immune support, & emotional regulation that they need. We need to do better as a community for our families.
While I do not have all the answers, I need you to know that there are many parents out there breastfeeding beyond 12mo—just like you. You can breastfeed as long as it works for your family, & you can wean on your terms.
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
