There has been some talk lately about the pressure placed on women to breastfeed their babies.

Ninety-six percent of women in Australian initiate breastfeeding when their baby is born (Australian National Infant Feeding Survey, 2011), which is a cracking good statistic by world standards. It’s definitely up with the leading leaders in Northern Europe.

The well-worn promotional phrase “breast is best” may well be at least partly responsible for this excellent initiation rate, although breastfeeding advocates are well aware of a more pressing problem – that of keeping women breastfeeding.

In the first week after birth, many, many women who had planned to breastfeed either give their babies infant formula or stop breastfeeding completely. This is despite the best efforts to promote the World Health Organisation’s (and Australia’s National Health and Medical Research Council’s) recommendations that advise there are specific health benefits to babies when they receive ONLY breastmilk in the first six months of life.

The latest figures state that 15 percent of Australian babies are receiving only breastmilk just as they turn six months old.

The question of why this is happening is certainly of interest to breastfeeding advocates and researchers. There is every reason to believe that women who start to breastfeed plan to continue doing so, but as for many health behaviours, the reasons why women enact and sustain breastfeeding are extremely complex, and, I would say, intimately related to the context of their lives. This means that messages like “breast is best” have some power in people’s decision-making, but may not sustain their health behaviours over time.

More influential in the medium term for women breastfeeding their babies might be things like how much time off work a woman has after her baby is born, how supportive and knowledgeable about breastfeeding her friends, partner and family are, how much timely support she gets from health professionals if/when she has difficulties, how comfortable she is breastfeeding in public or even in front of other family members in her own home, and how much she actually enjoys the activity of breastfeeding.

Madeleine Morris’ new book, Guilt-free bottle feeding argues that women have too much pressure placed on them to breastfeed. Earlier, I assumed that 96 percent of Australian women were breastfeeding because they wanted to. It is unsurprising then, that when 96 percent of Australian women start off breastfeeding, our health system is somewhat geared towards supporting them to continue. The known health benefits to mother, baby and community of women breastfeeding might also explain the enthusiasm with which that support is offered.

As for individual guilt, it is generally unhelpful to blame those who helped you try to achieve the goals you set for yourself. Better to protest about the values of a society that purports to like the idea of breastfeeding, but doesn’t provide sufficient affordable, skilled support and education to those trying to do it.

Morris argues that there is really very little difference between breastmilk and baby formula, despite regularly stating throughout the book that of course breastmilk is the best and first choice for feeding a baby. Also confusing is her argument that women want to breastfeed because it is an activity that is inextricably linked in our society to the ideal of a good mother. Rather, the evidence we have suggests that women start and continue to breastfeed because of the health benefits it confers to babies.

There are also many women who struggle to breastfeed in public, whether because of overt comments or because they are worried about the possibility of comments being made. This situation is not likely to be reflective of a society head over heels in love with breastfeeding mothers.

The bigger question remains: if most women start off breastfeeding, why do so many start giving formula as well or stop completely?

To be honest, we don’t know enough about how best to support women to breastfeed. The Cochrane Collaboration’s review paper on support for breastfeeding women particularly mentions the lack of research examining women’s satisfaction with breastfeeding support. My doctoral research will ask women about their experience of care with lactation consultants. I will also observe lactation consultants in practice and talk to them about their work. I am excited by this opportunity to learn about women’s experiences of getting help to breastfeed. It will also be great to observe and talk with the health professionals who support women to breastfeed every day.

There is a happy ending to this story: the Cochrane review also notes that any form of breastfeeding support is most effective in populations with high breastfeeding initiation rates.