The importance of breastfeeding — for both baby and mama's health — is well-known. Much of what happens to a breastfeeding woman's body during the period where she's lactating has positive effects in the long run: Women who breastfeed for longer have lower risks of cardiovascular disease, diabetes, high cholesterol and hypertension, for example. But when it comes to the relationship between breastfeeding and maternal mental health, things become a bit murkier — not only because there's less research on the subject, but because of the societal pressures about breastfeeding and its complicated relationship with "ideal" motherhood. The mental health effects of breastfeeding are linked in a surprising way with social pressure, and it's an important feminist issue.
The relationship between breastfeeding and mental health medications, in particular, is a complex one. Most doctors recommend against breastfeeding while on antidepressants or antipsychotics, because clinical drugs aren't tested on pregnant women or new mothers, and because the medications themselves can pass to the babies through milk. (Under medical supervision, women with mental illness can take medications while breastfeeding, but it has to be carefully monitored.)
Aside from that certainty, however, there are more complex issues — like a link between not breastfeeding and depression that goes beyond biology into culture and motherhood itself.
The Surprising Link Between Breastfeeding And Depression
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.
What's Happening Behind The Scenes?
Women are overwhelmingly told that breastfeeding is their "natural" duty to their kids, for many of the health benefits outlined above. It can seem as if this has been the norm for a very long time: witness Renaissance paintings of the breastfeeding Virgin Mary. And yet it's easy to forget that, for the early part of the 20th century, the advent of safe, nutritious formulas made breastfeeding unfashionable, and it only started regaining ground in the 1970s as doctors and the natural birth movement started to advocate for it again — and this gave rise to the hugely problematic "ideal" mother. Staff Writer Emily Wax-Thibodeaux wrote in the Washington Post in 2014 about her experience with what she jokingly called "breast-feeding nazis," who insisted that she needed to breastfeed her infant son despite the fact that, after having a double mastectomy, that was actually impossible. While breastfeeding does provide benefits to kids and parents, the impact of feeling like a 'failure' if breastfeeding isn't feasible, for whatever reason, seems to have a crushing effect on women's mental health.
Social pressure can cause this shame that can ultimately lead to mental health issues, but psychology itself may also play a role. "A mother's pre-natal mental state, pregnancy and birth experience can all result in stress and trauma — all of which can influence how a mother feels about breastfeeding," notes Shereen Fisher, chief executive of the Breastfeeding Network, in an article on their website. The researchers behind the 2014 study also note that other elements, like the mothers' personalities, might have played a role in how likely they were to develop depression.
Another possible factor is biological. Breastfeeding appears to help women cope with stress factors a little better, and seems to produce better metabolic responses to pressure and worry; a study of breastfeeding mothers in 2015 found that they had lower cortisol levels (the stress hormone) in their saliva up to six months postpartum than non-breastfeeding mothers. But a theory advanced in the International Breastfeeding Journal in 2007 went further. It suggested that there's a link between breastfeeding's role in reducing inflammation levels and depression. The reasoning is that depressive disorders are associated with increased levels of bodily inflammation, and that inflammatory symptoms may actually help cause mood disorders. When women breastfeed, their inflammation levels naturally drop, which may contribute to better mood outcomes.
Understanding the biological and societal factors behind the link between depression and difficulty breastfeeding is a big deal — and a feminist issue. Women's bodies and women's issues garner a significant portion of medical attention, but the wider picture needs to be understood too: that breastfeeding and its place as the "ultra-maternal" mode du jour are another way of policing women's bodies and making parts of female experience ultimately less-than by putting them up for public debate. The implications for women's mental health are serious and need to be explored more deeply, and women who are struggling need to be given more professional support.