'Hey, Mom, Can I Nurse Now?'
Some Women Breast-Feed Children Well Past Infancy

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By Rebecca R. Kahlenberg
Special to The Washington Post
Tuesday, May 27, 2003; Page C09

The benefits of breast-feeding infants are widely acknowledged, and the percentage of mothers who nurse their newborns at birth has climbed to about 70 percent. But although experts say many of those benefits continue for mothers and babies beyond age 1, the number of nursing moms in America who engage in "extended breast-feeding" -- breast-feeding a baby for more than 12 months -- drops to under 20 percent.

Marianne Vakiener, a full-time mom who lives in Fairfax, nursed her son until age 3 and her daughter until age 5, but not without opposition.

"With my son, my husband started to ask, 'When are you going to be done?' because sometimes when he was feeling amorous, I was feeling wiped out and not interested."

An older generation may not provide much support either. Deborah Tobin, a nurse and lactation consultant in Springfield who facilitates a weekly breast-feeding moms' group at Inova Fairfax hospital, says, "Parents and in-laws often ask moms in that tone that seems critical: 'Are you still breast-feeding that baby?' "

Despite these pressures, a 2000 survey of mothers conducted by the Ross Products Division of Abbott Laboratories shows that 17.6 percent of infants were still breast-fed at 1 year, a big jump from 7.5 percent in 1980 and 6.2 percent in 1990.

The World Health Organization recommends that women nurse for a minimum of two years. And the Illinois-based American Academy of Pediatrics (AAP) recommends that nursing continue for at least a year and for as long thereafter as mother and baby want to do it, according to its most recent policy statement, written in 1997.

"There was good evidence that nursing beyond a year has health benefits to babies and mothers," says Lawrence Gartner, chair of the AAP's Executive Committee, of the section on breast-feeding. Specifically, for the baby, the benefits are nutritional, immunological and developmental. For the mother, they include a possibly lower rate of premenopausal breast cancer. Nursing also can calm an agitated toddler.

Some studies suggest that if babies were left to wean naturally, the normal weaning age for modern humans would be between 2 1/2 and 7 years, says Katherine Dettwyler, a noted anthropologist and author who has been conducting research on culture and breast-feeding since 1981. And 2001 UNICEF statistics show that in several countries there are high percentages of children who are breast-fed at 20 to 23 months, specifically Benin, 64.3 percent; India, 68.9 percent; Iran, 41 percent; Ethiopia, 76.6 percent; and Nepal, 87.7 percent.

The reasons the United States has not kept pace with other nations go beyond husbands and disapproving relatives. Desire for sleep is another factor. June Fusner, a pediatrician in private practice in Kensington, says some babies and toddlers who are nursed wake up more frequently than usual at night, leading to exhausted and stressed parents. Additionally, some babies lose interest in nursing around age 1 because they are getting more calories from table food, she says.

Another consideration is intimacy issues. "The high levels of the hormone prolactin and low estrogen that are typical in breast-feeding women can cause low libido," says Sheryl A. Ross, a gynecologist in private practice in Santa Monica, Calif.

Women planning to return to work after a maternity leave sometimes stop nursing because they believe it will be hard to keep it up logistically. However. the opposite may be true with toddlers. They typically do not need to be nursed during the day, so mothers don't have to pump milk at work. Preschoolers can usually go overnight or even a few days without nursing, so a mother could take a business trip. And nursing can provide a reassuring sense of security and peace for both the mom and toddler, says Gale Pryor, author of "Nursing Mother, Working Mother" (Harvard Common Press).

There is also an image problem for employed women who discuss extended breast-feeding at work, says Pryor, a freelance writer and editor in Massachusetts. "Extended breast-feeding is often equated with an earthy image of motherhood that is incompatible with the image of a committed professional. Bring up a nursing toddler at a business meeting and I guarantee you get some raised eyebrows," she says.

Experts say the biggest reason for weaning by age 12 months is that extended breast-feeding is not well accepted in mainstream American culture. Many people think young children become too old to breast-feed when they reach certain milestones, such as being able to walk or talk or when they are big enough to wear shoes, says Mary Lofton, spokeswoman for La Leche League International, a breast-feeding support group based in Illinois. Some are put off by a child who is old enough to ask, "Can I nurse now, Mom?"

Breasts are considered sex objects in the United States and are thus supposed to be covered up in public. Dia Michaels, a District mother of three and president of Platypus Media, which publishes books for families, teachers and parenting professionals, says: "Breasts are used to sell everything from beer to cars these days, and so Americans are terrified of seeing breast-feeding in public." She notes that some people act horrified when they see her nursing her 4-year-old and that she has heard comments ranging from "That's not allowed here" to "That's disgusting" to "Isn't she too old for that?" when she nurses her daughter in restaurants, parks, or on airplanes and the Metro.

Even in child-friendly environments, women are often criticized for breast-feeding. Jolene Ivey, a Cheverly mother of five boys, remembers nursing her third son, who was then around 1, at the neighborhood pool in 1996. A lifeguard informed her that she had to move away from the pool. "She said nursing him there was a health violation because food is prohibited in the pool, as if I had a Coke," she says.

Ivey, one of the founders of Mocha Moms, a support group for at-home mothers of color, contacted the health department, which led to a policy change. Breast-feeding is now allowed there anytime. Ivey also recalls the time she was nursing her 1 1/2-year-old son while she was volunteering at an elementary school. The principal approached her in the hallway and asked her not to nurse there because someone had complained. "The older the child, the harder it is to do in public," Ivey says.

Still, some observers believe attitudes toward extended breast-feeding are slowly changing. "I did talk shows on it in the '80s and it was like a shock topic, but in the past 10 years, there is slightly more acceptance," says Peggy O'Mara, publisher and editor of Mothering magazine, based in Santa Fe, N.M.

Ross, the gynecologist, says there is a huge trend to nurse today, and for women "it's kind of like bragging rights to say I nursed for 'X' amount of time."

Policymakers are encouraging longer-term breast-feeding as well. The Department of Health and Human Services, through the U.S. Breastfeeding Committee established in 1998, has set a breast-feeding goal of 25 percent of women nursing their 1-year-olds by 2010. And Rep. Carolyn B. Maloney (D-N.Y.) plans to introduce legislation this spring that would ensure that women cannot lose their jobs, or face harassment or discrimination, for breast-feeding or expressing milk on the job, and it would provide tax incentives for employers who promote lactation at work. "In many workplaces, people get a break to smoke a cigarette or have a candy bar but not to nurse or pump milk for a child," Maloney says.

Ultimately, society will achieve a greater comfort level with the concept of breast-feeding older babies and toddlers when women feel confident and proud rather than embarrassed or apologetic about it. "As long as women do it in bathrooms and behind closed doors and out of sight, it won't become normal," says Michaels, who has breast-fed her three children for a total of 12 years.

Today's mothers make their own decisions about how long to breast-feed. But if they have strong support networks of friends, relatives or fellow moms, along with cultural and legal support for breast-feeding in public and private, they are more likely to continue beyond infancy. Years later, those who did continue tend to look back fondly on their nursing years. Says Vakiener, the Fairfax mom who nursed her daughter till age 5: "I'm really glad I nursed as long as I did because it led to a parenting style that respected my children's needs instead of imposing a developmental calendar on them."