The Breastfeeding Decline: A Global Crisis Through a Local Lens

Breastfeeding once stood as the gold standard for infant nutrition, forming the physiological and emotional blueprint for early development. Today, however, exclusive and continued breastfeeding rates are falling, a trend that many in the public health sector consider a modern epidemic.

To understand this visually: imagine breast milk as nature’s original “superfood.” If breast milk were a classroom, it would teach immunity, metabolism, emotional bonding, microbiome seeding, and long-term disease prevention. Formula, while sometimes necessary and lifesaving, simply offers a narrower curriculum.

A Global Consensus: Breastfeeding Is Declining Too Soon

The evidence is clear: although many mothers initiate breastfeeding, few maintain exclusive breastfeeding through six months, the minimum standard recommended by the World Health Organization (WHO). For instance, a longitudinal cohort study from China showed that only 35.3% of mothers were exclusively breastfeeding at six weeks postpartum, with breast pain, maternal anxiety, sleep deprivation, and perceived low milk supply being strong predictors of early cessation [1].

Similarly, in Saudi Arabia, a study of over 600 women found that although 76% initiated breastfeeding, only 37% sustained exclusive breastfeeding to six months [2]. In India, although 85% of mothers stated they exclusively breastfed under 6 months, only 36.3% maintained that for the entire recommended period [3].

Even in high-income countries, the pattern persists. Many mothers discontinue breastfeeding due to a lack of postnatal support, societal pressure, work commitments, or poor access to practical breastfeeding education.

Beyond Nutrition: Evolutionary and Metabolic Implications

Breast milk is more than food, it’s a metabolic signal. As described in Röszer’s review, breast milk lipids communicate directly with an infant's thermogenic adipose tissue, helping them regulate energy, burn fat, and even avoid obesity later in life [4]. In evolutionary biology, mammals are considered “thermolipials,” meaning “warm-fat animals.” Breastfeeding and fat-burning brown adipose tissue co-evolved to help neonates survive post-birth cold exposure and support optimal energy regulation.

Formula-fed infants, by comparison, lack these bioactive lipid signals. Without these, early life fat metabolism can become dysregulated, potentially contributing to the early onset of obesity, metabolic syndrome, and poor appetite control.

Australia & New Zealand: A Local Reflection

In New Zealand and Australia, breastfeeding initiation rates are higher than in many countries, but continuation rates still drop dramatically. Aotearoa face unique cultural and socioeconomic barriers, while many express a strong desire to breastfeed, systemic issues like time pressure, return to work, and lack of culturally aligned care contribute to early weaning.

Australia shares similar patterns, despite progressive policies. The over-commercialisation of formula and insufficient support for mental health, sleep, and maternal confidence are consistently cited as drivers for discontinuation.

Conflicting Viewpoints: The Pressure Paradox

Despite the universal agreement on breastfeeding’s benefits [5,6], we must acknowledge the psychological toll placed on mothers. While health professionals promote breastfeeding for cancer prevention, metabolic health, and immunity, mothers report feeling guilt-ridden, judged, and unsupported when breastfeeding becomes unsustainable due to pain, anxiety, or sleep deprivation [1,2,3].

This is where the narrative splits: health systems emphasise breastfeeding outcomes, but mothers experience the journey, which is messy, emotional, exhausting. A more empathetic framework is needed: one that upholds breastfeeding’s value and supports women who face genuine obstacles.

A Hypothesis: What Might This Mean for Future Generations?

If the trend continues; where breastfeeding declines and formula feeding rises as the norm - future generations may see higher rates of early-onset obesity, autoimmune conditions, reduced microbiome diversity, and poorer metabolic outcomes [4,5].

Yet this must be approached with compassion. Formula feeding does not mean failure. For some, it is the most viable and safe option. But the larger issue is whether women chose it freely, or were forced there due to lack of support.

Conclusion

Breastfeeding is less about “milk” and more about flow. Of hormones, of messages, of trust. When we dam that flow prematurely, through policy failure, overmedicalisation, or social pressure, we interrupt something ancient, protective, and profound.

To change this, we must create ecosystems where breastfeeding can flourish: where mothers are supported, workplaces are flexible, and cultural stories celebrate the act, not pressure it.

Let us not just tell mothers to breastfeed - let us empower them to do so, and honour them even when they cannot.

References 

1. Wang Y, Mao K, Chu M, Lu X. Perinatal maternal factors influencing postpartum feeding practices at six weeks. BMC Pregnancy Childbirth. 2024;24:514. doi:10.1186/s12884-024-06711-9.

2. Raheel H, Tharkar S. Why mothers are not exclusively breastfeeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia. Sudan J Paediatr. 2018;18(1):28–38. doi:10.24911/SJP.2018.1.5.

3. Jain S, Thapar RK, Gupta RK. Breastfeeding and complementary feeding: Knowledge, attitude, and practices of mothers. Med J Armed Forces India. 2018;74(1):28–32. doi:10.1016/j.mjafi.2017.03.003.

4. Röszer T. Co-evolution of breast milk lipid signaling and thermogenic adipose tissue. Biomolecules. 2021;11(11):1705. doi:10.3390/biom11111705.

5. Scoccianti C, et al. Breastfeeding and cancer: European Code Against Cancer 4th edition. Cancer Epidemiol. 2015;39:S101–S106. doi:10.1016/j.canep.2014.12.007.

6. Ibrahim C, et al. Breastfeeding practices, infant formula use, complementary feeding and childhood malnutrition: An updated overview of the Eastern Mediterranean. Nutrients. 2022;14(4201). doi:10.3390/nu14194201.