How Breastfeeding Became a Moral Imperative - and Why That’s a Problem

By Julie Brownley, MD, PhD

Founder, Psychiatry for Women

Reproductive Psychiatry

As a reproductive psychiatrist, I spend a lot of my days sitting with postpartum women who are trying, desperately, to do everything “right.”

They are waking themselves up every 2–3 hours to pump.They are tracking ounces like it’s a full-time job. They are crying in the middle of the night because their body isn’t cooperating.

And almost every one of them, at some point, says a version of the same thing:

“I feel like I’m failing my baby.”

Not because they’re neglecting their child. Not because their baby isn’t fed. Because they’re not breastfeeding the way they were told they should.

Where This All Started (and where it went off track)

The push for breastfeeding did not come out of nowhere. In developing parts of the world where clean water isn’t reliable, formula feeding can be dangerous. In those settings, breastfeeding is not just beneficial - it is life-saving.

There was also a very real and necessary backlash against unethical formula marketing.

So public health did what public health does:it simplified the message.

Breast is best.

And then… we never really unsimplified it.

The Data Is Not as Clean as We Pretend

Here’s the part that almost never gets said out loud.

Most of the breastfeeding research people quote is observational. Which means it shows correlation, not causation.

Women who breastfeed, on average, tend to have:

• more resources

• more time

• more support

• higher education

So yes, their children often do better on paper.

But when you look at studies that compare siblings in the same family — one breastfed, one not — many of those long-term differences shrink dramatically or disappear.

That’s not fringe data. That’s about as close as we get to a real-world control.

It doesn’t mean breastfeeding has no benefits.

It does mean we’ve been telling a much cleaner, more absolute story than the data actually supports.

Meanwhile, Back in Real Life

Here’s what I actually see:

Women who are:

• profoundly sleep deprived

• anxious, wired, and spiraling

• developing or worsening depression

• becoming obsessive about feeding, pumping, output

All while being told, implicitly or explicitly, to push through.

Because stopping feels like failure.

Because no one wants to be the person who says,“this isn’t working — and that’s okay.”

The Part We’ve Been Ignoring

We have built an entire narrative around optimizing the baby. And quietly minimized the person keeping that baby alive. Let me say this as clearly as I can:

If a mother is not well, her baby is not well.

Not in a theoretical sense. In a very real, day-to-day, developmental sense. We cannot talk about “what’s best for the baby” while ignoring the stability of the mother. That’s not evidence-based care. That’s tunnel vision.

When Breastfeeding Actually Makes Sense

Breastfeeding can be a great option when:

• it’s physically manageable

• it’s emotionally sustainable

• it’s not costing the mother her stability

• it actually feels okay (or at least neutral)

In some settings, it’s clearly the safest choice.

And for some women, it’s deeply meaningful.

When It Doesn’t

When breastfeeding starts to cost a mother:

• her sleep

• her mental health

• her sense of self

• her ability to function

we need to stop pretending the answer is always “try harder.” At that point, the risk–benefit equation has changed. And continuing is not automatically the more “virtuous” or better choice.

The Culture We’ve Created (and no one wants to own)

We have created a system where:

• Lactation consultants are in the room within hours of delivery

• Women are expected to perform, immediately, in one of the most vulnerable states of their lives

• Success is narrowly defined

• Struggle is internalized as failure

And then we act surprised when women feel ashamed. We’ve taken something that should be one option among many and turned it into a referendum on motherhood.

A Quick Reality Check

We will feed toddlers ultra-processed snacks without blinking.

We will accept wildly imperfect diets as “normal.”

But somehow, a bottle of formula - a safe, regulated, nutritionally complete option - is where the line gets drawn?

That deserves at least a raised eyebrow.

A More Honest Framework

Breastfeeding is not a moral obligation. It is not a measure of maternal worth. It is not more important than a mother’s mental health. And it is not universally superior in the way it is often presented.

It is one option.

A good one when it works.

A bad one when it doesn’t.

What Actually Matters

A fed baby.

A mother who is stable, sleeping, and able to function.

A home environment that is not driven by anxiety, guilt, or exhaustion.

That’s the foundation.

Everything else is secondary.

Final Thought

We don’t need to swing to the other extreme and be “anti-breastfeeding.” But we do need to be honest about the tradeoffs.

Because right now, too many women are paying a price no one warned them about in the name of doing what’s “best.”

And that’s not a system I’m interested in quietly supporting.

If You’re Sitting There Thinking “This Is Me”

If you’re exhausted, overwhelmed, and quietly wondering why this feels so much harder than it’s “supposed” to — you are not doing anything wrong.

You are responding to a system that has not fully accounted for you.

At Psychiatry for Women, this is the work we do every day — helping women navigate postpartum mental health, sleep, and feeding decisions without shame or unrealistic expectations.

If you're interested in taking a deep dive into the beautifully designed research study, “Is Breast Truly Best?”, you can read the full study here.

About the Author

Julie Brownley, MD, PhD is a psychiatrist specializing in women’s mental health and the founder of Psychiatry for Women. She spends much of her time working with postpartum women navigating anxiety, depression, sleep disruption, and the very real pressures of early motherhood.

Her work focuses on helping women make decisions that are grounded in both evidence and lived reality - not pressure, guilt, or one-size-fits-all expectations.

Learn more at www.psychiatryforwomen.org/about-us