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.