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Another issue with the new guidelines is that they don’t discuss maternal mental health but include the statement that “medical contraindications to breastfeeding are rare.” This, even though one in seven women can develop postpartum depression and some mothers experience a phenomenon called D-MER — dysphoric milk ejection reflex — which is “characterized by dysphoria starting shortly before ejection of milk and progressing for several minutes.”

“In my clinical practice, feeding and sleep deprivation — which, of course, are connected — are two of the biggest triggers for moms’ anxiety and mood disturbances,” Dr. Pooja Lakshmin, a psychiatrist specializing in women’s mental health, told me in an email. “I worry that the lack of centering of mothers’ mental health continues to reinforce a narrative that in order to be ‘good’ moms, women must sacrifice their own emotional and mental well-being for the sake of their families, when, in fact, the data supports the opposite. Prioritizing moms’ mental health positively impacts the whole family.”

But the most glaring problem with the new policy statement may be its seeming disregard for the lived financial realities of so many families. In a technical report published alongside its new guidelines, the organization suggests that pediatricians should not give out free formula at their offices because it provides “mixed messaging to families about the importance of exclusive breastfeeding.” This runs counter to one recommendation cited during the formula shortage: that parents should call their pediatricians to help find formula.

Mothers who are beneficiaries of the Special Supplemental Nutrition Program for Women, Infants and Children, colloquially known as WIC, need government help to afford formula. WIC recipients often find that they still need extra supplies to feed their babies for the full month and struggle to afford them even when there isn’t a shortage, potentially relying on a diaper bank that stocks formula to fill the gap. Considering the frayed state of the American social safety net, any guidance that might encourage cutting off a source of free formula seems painfully out of touch.

The tone of a lot of breastfeeding literature carries an implication that if mothers just had enough education about how to nurse and about the advertised benefits of breastfeeding, more of them would fall in line with the recommendations and would embrace exclusive breastfeeding instead of feeding their babies any formula at all. And I don’t doubt that many American moms need more comprehensive information about and support for breastfeeding — which they should absolutely have available, free.

But in a country where, as of last March, only 23 percent of civilian workers had access to paid family leave, three months of paid leave is considered generous and on-site child care has been described as “extremely rare,” even for Fortune 100 companies, I don’t think a lack of education is the main barrier. It’s that for a lot of moms, exclusive, prolonged breastfeeding is quite difficult to accomplish.

 

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