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Doctors must support women who choose not to breastfeed, new U.S. guidelines say

When women make an informed decision not to breastfeed, health professionals need to respect and support them, says the American College of Obstetricians and Gynecologists.

Doctors and other health-care professionals must support the decision of women who choose not to breastfeed, according to new guidelines released Monday by the American College of Obstetricians and Gynecologists (ACOG).

The guidelines recommend exclusive breastfeeding for at least the first six months of an infant's life. They also state that anyone providing obstetric care should be able to provide guidance, support and knowledge about breastfeeding and complications that often arise. But when women make an informed decision not to breastfeed, health professionals need to respect and support them, the college says.

"We need to be advocates for the patient, not the cause," said Dr. Alison Stuebe, lead author of the new position paper and medical director of lactation services at University of North Carolina Health Care. "Our obligation is to make sure she has the information to make an informed decision."

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The subject of breastfeeding has become increasingly politicized in recent years, with many women experiencing guilt and shame if they choose not to breastfeed or have problems continuing breastfeeding.

The previous ACOG guidelines focused on helping support women so they could choose breastfeeding. The new policy echoes those important points, but there is a marked shift with the inclusion of the message that health-care workers should recognize that only a mother is "uniquely qualified to decide whether exclusive breastfeeding, mixed feeding or formula feeding is optimal for her and her infant."

Joint guidelines by Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada recommend exclusive breastfeeding. While they mention that some women may not be able to breastfeed, they don't discuss the importance of supporting women, regardless of their feeding choices.

Dr. Catherine Pound, member of the Canadian Paediatric Society's nutrition and gastroenterology committee, said the new U.S. guidelines are in line with the message they are trying to deliver in Canada.

"I think what it's trying to get at is this underlying problem there, that people are feeling forced to breastfeed," she said.

A big part of the problem is that health-care professionals encourage women to breastfeed, but are unable to provide sufficient education or support because they haven't been trained to do so.

"We as health professionals tell them [to breastfeed] … and then guilt them if they're not, yet we can't help them," Pound said. "And that's unfair to women."

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Stuebe said it's important for more people to understand the obstacles that continue to prevent some women from breastfeeding. For instance, although Canada has a generous leave program for new mothers, statistics show that women with lower levels of education and income are less likely to breastfeed.

According to Health Canada, more than 90 per cent of women who completed postsecondary education in Canada initiated breastfeeding, compared with 76.5 per cent of those who had not completed high school. While those numbers may appear high, they steadily drop. By six months of age, only about 25 per cent of all Canadian mothers are still exclusively breastfeeding.

Kimberley Felker, nurse manager for the special care nursery at St. Joseph's Healthcare Hamilton, said rather than passing judgment, the health-care system needs to find better ways to make breastfeeding more accessible to Canadian women. She says the focus should be in helping all women make an informed decision.

"We need to remove the pressure," Felker said. "We don't want people to feel guilty about it."

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About the Author

Carly Weeks has been a journalist with The Globe and Mail since 2007.  She has reported on everything from federal politics to the high levels of sodium in the Canadian diet. More


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