More than 70 percent of American women don't follow new recommendations that they exclusively breast-feed their babies for the first six months.
Lactation experts say marketing pressure by infant formula companies, lack of social support and workplaces that don't encourage the behavior make it difficult for American mothers to meet the recommendations by the World Health Organization.
But formula companies, which have a $1 billion revenue market in the United States, disagree, saying they do recommend breast-feeding.
WHO last month called on countries to "protect, promote and support exclusive breast-feeding for six months" and to continue breast-feeding for children with supplemental foods "up to 2 years of age or beyond."
Breast Milk Is a Complete Food
Research WHO commissioned showed exclusive breast-feeding for six months, without supplemental formula, decreases diarrhea and respiratory and ear infections, and improves brain growth.
Yet only 29 percent of American women either breast-feed or give formula to their babies by the age of 6 months. The number of exclusive breast-feeders is even smaller since data in the United States is only kept on both activities, not each one separately.
While the American Academy of Pediatrics agrees with the WHO guidelines, the U.S. surgeon general says four months might be good enough.
Healthy People 2010 goals, an initiative of the U.S. Public Health Service, say the proportion of women who breast-feed for six months should increase to 50 percent by 2010, but the guidelines don't specifically define breast-feeding as exclusive or not.
La Leche League International, a mothers' advocacy group, says moms should do what they want to.
"We tell mothers that six months is what the American Academy of Pediatrics recommends for those mothers who can breast-feed, but they should do what feels right for them," says Kim Cavaliero, spokeswoman for La Leche International.
"We're happy as long as breast-feeding is an important element in the baby's life."
But exclusive breast-feeding advocates say aggressive marketing by infant formula manufacturers and social pressures make it difficult for women to give their babies what they need.
Barbara Heiser, executive director of the National Alliance of Breastfeeding Advocacy in Ellicott City, Md., says it is not surprising American mothers don't exclusively breast-feed, given how formula companies bombard them.
She says formula companies target new mothers before and after they deliver their babies. They buy lists from maternity stores and send coupons for formula to homes, she says.
Then they provide free so-called starter samples, bottles, nipples, tape measures, pens and posters to hospitals to give to the mothers, she says. After the mothers leave, the firms do follow-up surveys at home.
"These are unfair marketing techniques," says Heiser. "How can a message of exclusive breast-feeding compete against that when a mother's hormones are raging and a health-care professional offers her a product? Hospitals should not accept these products for free and should pay for formula as they do medicine and food."
The formula industry says it supports breast-feeding and that alleged pressure by the firms is not responsible for mothers using formula.
"Studies show that providing a formula sample does not alter a mother's practice," says Mardi Mountford, executive director of the International Formula Council, a trade organization for formula manufacturers in Atlanta. "Moms make up their mind to breast-feed, use formula or do both before they have a baby."
Mountford says the firms she represents discuss breast-feeding in educational material and says product labels say breast-feeding offers the best nutrition for infants.
One Area of Agreement
While they disagree on formula issues, breast-feeding advocates and Mountford agree our society is not accommodating toward breast-feeding.
"Social support is very important," Mountford says, adding that it varies among cultures. "Breast-feeding when a woman goes back to work is still very difficult in this country."
"Mothers are still embarrassed to breast-feed in public places," says Marcia Walker, a certified lactation consultant who works in the Boston area, "and most workplaces are not supportive of breast-feeding."
Walker says fewer than 30 states have laws protecting women from harassment for breast-feeding and says companies could benefit economically if they were more breast-feeding friendly, letting moms pump their milk when they need to, not when companies say it's OK.
"Firms could save money on health insurance claims and absenteeism since breast-fed babies are healthier," Walker says. "We are trying to help remove barriers to help women make the best decision for their babies."