Breastfeeding: The Basics, the History, and Barriers in the Modern Day.

IMPORTANCE: The scientific benefits of breastfeeding for the parent and baby are clear, but the goal is often simplified to "breast is best." Patients' decisions to breastfeed are more nuanced than this approach implies, and it is essential for providers to understand other factors that contribute to this complex decision. OBJECTIVE: We reviewed the current literature of the health benefits of breastfeeding, local and global breastfeeding trends and current disparities, and the historical, political, and social factors that influence a patient's decision to breastfeed. EVIDENCE ACQUISITION: Original research articles, review articles, and guidelines on breastfeeding were reviewed. RESULTS: Rates of breastfeeding have increased in the United States and globally after public health interventions, but significant disparities persist. Numerous factors influence a patient's decision to breastfeed including the medical benefits, formula marketing campaigns, historical connections to slavery and oppression, limited societal support for working parents, mental or physical health concerns, previous sexual abuse or trauma, gender identity, and others. CONCLUSIONS AND RELEVANCE: Understanding both the medical importance of breastfeeding and the various other factors that influence a patient's decision or ability to breastfeed is essential for counseling patients before delivery. Providers have a responsibility to navigate this complex conversation with patients to empower them to make an informed decision that works for them.

Duke Scholars

Author Jeffrey Adam Kuller Obstetrics and Gynecology, Maternal Fetal Medicine

Author Sarah K. Dotters-Katz Obstetrics and Gynecology, Maternal Fetal Medicine