For many women, breastfeeding is a difficult process, made only more difficult (and emotional) because of society's expectations that women make every effort to nurse their children. The conflict between these expectations and whether those expectations are ultimately fulfilled has a surprising and strong link to postnatal depression. In 2014, a study at Cambridge found that women's depressive levels after birth were closely tied to their intentions to breastfeed and whether they'd been able to accomplish that intention. Looking at over 10,000 new mothers across Britain, they found that women who had not intended to breastfeed and did not (or could not), were 50 percent more likely to experience postpartum depression than women who had intended and were able to breastfeed; but even more startling was the realization that women who had intended to breastfeed, but were not able to, were twice as likely as women who had not intended to breastfeed to have postpartum depression.
The broad takeaway from this at the time the study came out was that "not breastfeeding raises your risk of depression" — but that doesn't tell the whole story. What seems to matter, the research says, is what the mothers wanted to do in the first place. This was proven again in a study in 2015 from the University of Swansea, which looked at a much smaller group of women (200 in total), but found the same sort of result. All 200 women studied had begun to breastfeed, but stopped before 6 months had elapsed. Those who had planned it that way weren't at higher risk of depressive symptoms. Those who had wanted to breastfeed for longer but were unable to for varying reasons, by contrast, showed higher risks of low mood and depressive disorders. This isn't just the case in the UK, either. A study in 2014 of 458 mothers in the Kashan province of Iran found that "unsuccessful" breastfeeding mothers were 5.48 times more likely to depressive symptoms than "successful" ones. (We should remember here that "successful" is the researchers' metric; what ultimately matters, when it comes to breastfeeding, is what's right for you and your baby.)
"Success", as we define it, might be a lot harder than it looks. The National Health Service recommends that babies are breastfed for the first six months of their lives, but only a third of women meet that milestone. Not one country in the world has enough support in place for breastfeeding moms, the WHO found. And there are many things that can get in the way of breastfeeding, from breast cancer, to latching issues, to hormonal issues, to an unexplained lack of milk.
So is the relationship between breastfeeding and depressive disorders a matter of biology, culture, or both? In order to connect the dots, it's important to trace the cultural role of breastfeeding in new mothers, and why new mothers need to pay attention to what's best for them and their babies, not what society says about their bodies.