Breastfeeding on demand: A cross-cultural perspective
© 2008 - 2014 Gwen Dewar, Ph.D., all rights reserved
Breastfeeding on demand—-also known as feeding “on cue" and
“baby-led" feeding—-is about responding flexibly to your baby’s hunger
cues. It means initiating feedings when the baby requests them, and
continuing each feeding session until the baby is satisfied.
cross-cultural, and clinical research suggests that babies were
designed to feed on cue. For details, see my article on
the scientific evidence for breastfeeding on demand.
Here I provide an overview of the benefits of breastfeeding on demand,
and focus on the ways that new moms can cope with frequent,
Women living in Westernized,
industrial societies face special problems that can make demand feeding
more difficult. I discuss how babies are breastfed in other cultures and
suggest how Western moms can
apply these lessons to their own lives.
Why is breastfeeding on demand a good idea?
Breast milk production is keyed to the frequency of suckling. The
more a baby nurses, the more milk a breast produces. If a baby suckles
less frequently, milk production slows. For this reason, breastfeeding
on demand is the ideal way to keep a mother’s milk production in sync
with her baby’s needs.
In the first days of a baby’s life, cue
feeding helps establish an adequate milk supply. It also helps newborns
regain their birth weight more quickly. Moreover:
• Women’s breasts vary in the amount of milk they can produce at one feeding
• The caloric content of milk may vary by time of day and mother’s diet
• Babies vary in their ability to extract milk efficiently
• Babies also vary in their stomach capacities
on demand permits babies to cope with the quirks of their particular
situation. When babies are forced to adopt a rigid, timed schedule, some
babies have difficulty getting enough to eat. In addition, lactation
consultants often note that babies who are left to cry for access to the
breast--even for a few minutes--may become unsettled and upset. This
makes it hard for them to latch on correctly, decreasing the efficiency
of their feeds.
For these reasons, baby-led breastfeeding is now recommended by:
• The World Health Organization
• The American Academy of Pediatrics
• La Leche League
The new pediatric recommendations seem inspired largely by concerns
about milk production and early growth. But there may be other
considerations. Breastfeeding soothes and reduces pain (Shah et al
2006). It provides babies with skin-to-skin contact—-a practice that
promotes mother-infant attachment (Moore et al 2007) and helps regulate a
baby’s body temperature and blood glucose levels (Anderson et al 2003).
Skin-to-skin contact is also associated with higher rates of head
growth in preterm infants (Rojas 2003).
Babies show signs of
reduced stress while breastfeeding, and Kerstin Uvnas Moberg, an eminent
physiologist and endocrinologist (MD, PhD), believes that breastfeeding
bouts may boost babies’ levels of oxytocin—the “cuddle" hormone (Uvnas
As I note in this blog post, there is even evidence that rigid, scheduled feedings contribute to modest lags in cognitive development (Iacovou and Sevilla 2013). Why that might be -- energy shortfalls, stress, or other factors -- isn't yet clear.
But all this suggests that breastfeeding on demand may help babies regulate more than their caloric intake.
How often--on average--do babies feed?
As noted above, babies vary—both as individuals and across cultures.
Hunter-gatherer babies nurse very frequently—-twice an hour or more. In
the West, mothers who identify themselves as “baby-led" feeders may not
nurse more than once every two hours. This disparity has led some
researchers to question whether “breastfeeding on demand" means the same
But regardless of the culture you live
in, it seems clear that most babies need very frequent feedings only
during the first weeks of life. When older, Western babies are permitted
to determine their own feeding times, they usually settle into a
routine of feeding sessions spaced several hours apart.
Coping with exhaustion
New mothers get precious little sleep and may find breastfeeding on
demand to be exhausting. To a large degree, this is a transitory
problem. As newborns mature, they are able to consume more milk at a
feeding. They also become more “tuned in" to the rhythms of daily life.
For these reasons, babies require fewer feedings overall-—and fewer
night feedings—-as time goes by.
But knowing that your life will
improve 4-6 weeks after birth doesn’t make the newborn phase less
exhausting. And I think it’s fair to say that Western mothers face
special problems that make breastfeeding more difficult. Here I review
some of the cultural practices that help non-Western mothers establish
and maintain breastfeeding on demand. These practices suggest ways that
Western moms can make breastfeeding on demand easier.
Non-Western practices that support breastfeeding on demand
No punch clock
Our hunter-gatherer ancestors didn’t keep strict schedules. Neither
have most people throughout human history. People have always had work
to do, but they didn’t have clocks and their work-days varied according
to the season and the tasks they had to perform. The idea of reporting
to work each day at precisely the same time—and putting in the same,
inflexible hours—is associated with Western industrialization.
moms forced to keep a rigid schedule, restricting their sleep to certain
night hours, adhere to strict deadlines and appointments, will obviously
find it harder to make time for breastfeeding on demand.
Flexible sleep schedules
The Western model of sleep—-that you lie down at the same time each
night and sleep for 7-8 continuous hours—-is another cross-cultural
oddity. Anthropologists and historians have documented a very different
pattern of sleep in other cultures (Worthman and Melby 2002; Ekirch).
People who live without artificial light get more sleep overall. And
people rarely consolidate their sleep into one long interval. Instead,
they sleep for shorter intervals at different times throughout the day
For instance, hunter-gatherers—-like the !Kung san of
South Africa and Efe of Central Africa—-have no fixed bed- and
wake-times, and people tend to nap opportunistically (Worthman and Melby
This opportunistic sleep style may be the norm for our
species. And it is certainly more descriptive of how babies sleep than
is the Western model.
Like the “punch clock," the Western model
of sleep puts parents at a great disadvantage. Western sleep schedules
are relatively inflexible. If you miss the chance to sleep during the
allotted hours, you are out of luck. Rigid scheduling prevents sleepless
parents from making up lost sleep. This makes breastfeeding on demand
more difficult, particularly in the early weeks when babies require
Other peculiar characteristics of Western culture are solitary
sleeping and the practice of leaving babies to sleep in cribs or cots.
When babies and mothers sleep apart, night feedings become very
disruptive. Typically, both mother and baby become fully aroused from
their sleep, making it difficult for them to resume sleeping when the
feed is over.
But in most non-Western cultures, people sleep with others (Worthman and Melby 2002). Infants are not left alone.
a recent cross-cultural review of child care practices in
non-industrialized societies, researchers found that babies shared beds
with parents in 23 out of 26 societies surveyed (Severn Nelson et al
2000). An earlier, more extensive analysis of 90 cultures found no cases
where mothers and infants slept in separate rooms (Barry and Paxton
When mothers and babies sleep together, breastfeeding on
demand becomes much less disruptive to maternal sleep. This is
particularly true when moms and babies sleep in the same bed. The baby
awakens at night, and is fed right there—in bed—while both parties are
lying down. The nursing couple need never wake all the way up (McKenna
and Bernshaw 1995).
Westerners tend to “park" their babies in cribs, bouncers, car seats
or playpens for much of the day. In the rest of the world, these
practices are uncommon. Cross-cultural surveys reveal that most babies
are held or carried throughout the day (Barry and Paxton 1971; Severn
Nelson et al 2000). In hunter-gatherer societies-—and in societies found
in warm climates-—“baby wearing" is further distinguished by
skin-to-skin contact (Konner 2006).
As a result, mothers have
more opportunities to “read" their babies’ cues, and babies are always
close to the breast. In some cases, babies have easy access to the naked
breast, permitting babies to begin feeding on their own.
Unless they buy it, Western moms with infants receive relatively
little help. New moms are frequently isolated from their extended
families, and they lack close relationships with their neighbors. As a
result, they may be cut-off from easy access to
• Breastfeeding advice
• Child-rearing advice
• Impromptu and emergency childcare
means more stress and more work—and more difficulty breastfeeding on
demand. By contrast, women living in hunter-gatherer groups—-and other,
non-industrial societies—-receive substantial amounts of help. In one
hunter-gatherer society (the Efe of Central Africa) this help extends so
far as to include women who provide supplemental breastfeeding to other
women’s newborns (Tronick et al 1987)! For more details, see this
article about non-maternal helpers.
In a wide range of places, from Southeast Asia (Jambunathan 1995), to
China (Raven et al 2007), to Morocco (Westermark 1926), mothers may
spend the first 30-40 days weeks with their newborn in postpartum
seclusion. During this time, mothers are excused (if not downright
forbidden) from doing most work except for breastfeeding. Friends or
relatives (usually the mother’s mother or mother-in-law) help with
housework and food preparation.
Postpartum seclusion isn’t
necessarily a picnic. Cultures may impose rituals and taboos that
mothers may find restrictive (Leung et al 2005). But the help mothers
receive probably makes breastfeeding on demand less difficult.
Acceptance of public breastfeeding
For Western moms, breastfeeding on demand is particularly difficult
when they leave home. Many Westerners are uncomfortable around
breastfeeding, and few public places provide space for mothers to
The problem seems to stem from Western
sexual attitudes. Westerners may take it for granted that the breast is
an object of erotic interest. Breastfeeding therefore seems a bit
risqué. But there is nothing natural about this association. In most
cultures, breasts are viewed in terms of their primary function: organs
for expressing milk. In one cross-cultural study, breasts were
considered sexy in only 13 out of 190 cultures surveyed (Ford and Beach
Anthropologist Katherine A. Dettwyler argues that American
attitudes toward breastfeeding are heavily influenced by the notion of
the “sexy" breast. In her excellent paper, “Beauty and the breast: The
cultural context of breastfeeding in the United States (Dettwyler 1999),
Dettwyler contrasts American attitudes with those of several
non-Western cultures. In places like Mali or Nepal, women’s breasts are
not sexualized, and women nurse their babies in public whenever the baby
is ready to feed. There is nothing sexual—and nothing embarrassing or
Breastfeeding on demand: Making it work
Western attitudes and cultural practices may not be particularly
supportive of breastfeeding on demand. But understanding how
breastfeeding works in the non-Western world suggests ways that Western
mothers can better cope. See these
tips for improving your breastfeeding experience.
References: Breastfeeding on demand
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Content last modified 2/2014