By Naomi Bromberg Bar-Yam, PhD
For decades, breastfeeding advocates have worked on normalizing breastfeeding: protecting the right to breastfeed in public; expanding access to lactation care; and supporting appropriate workplace policies.
Recent research and a growing body of clinical evidence indicate a new frontier for these efforts: recognizing pregnancy and breastfeeding as critical components of lifelong health, and ensuring they are fully integrated into both clinical care and health research across the life cycle. We’ll call it Normalizing Breastfeeding 2.0.
A recent New York Times article highlights how pregnancy complications such as preeclampsia, gestational hypertension, and gestational diabetes are associated with increased risks of cardiovascular disease, stroke, and metabolic conditions decades later. The article argues persuasively that pregnancy history should follow a person throughout their life and inform ongoing care.
Breastfeeding belongs in this conversation.
Breastfeeding is associated with reduced lifetime risk of breast and ovarian cancer, and it is linked to lower rates of cardiovascular disease and Type 2 diabetes. These are lifelong health effects.
Yet breastfeeding history, whether someone breastfed, for how long, and under what conditions, is rarely documented, revisited, or used to inform care outside the perinatal window.
If pregnancy is a “stress test” for future health, breastfeeding is part of the body’s recovery and adaptation. Treating either as a temporary event misses their preventive power.
Normalizing Breastfeeding 2.0, Part One: Educating Non-Perinatal Providers
Over a lifespan, most care comes from clinicians who are not perinatal specialists; rather they are primary care providers, cardiologists, endocrinologists, oncologists, and others. These providers were not trained to ask about pregnancy or breastfeeding history, or to use that information in risk assessment, early intervention, and prevention planning.
Normalizing Breastfeeding 2.0 requires:
- Teaching non-perinatal practitioners that pregnancy and breastfeeding histories are clinically relevant decades later;
- Ensuring medical records make this information visible and retrievable;
- Framing breastfeeding not as an “infant feeding choice,” but as a factor in cancer risk and metabolic and cardiovascular health.
Normalizing Breastfeeding 2.0, Part Two: Research Across the Life Course
Pregnancy has been treated as a short-term condition and breastfeeding has been treated as an infant outcome in research as well as in clinical practice.
Longitudinal, life-course studies that follow individuals over decades should include and thereby help to connect:
- Infant feeding in early life;
- Adult cardiometabolic health;
- Pregnancy complications and outcomes;
- Breastfeeding experiences;
- Health of the next generation.
We have strong evidence that breastfeeding protects the lactating mother from cardiovascular disease and diabetes. We have moderate evidence that being breastfed in infancy reduces lifetime cardiometabolic risk. What we lack is research that connects these findings across generations.
Normalizing Breastfeeding 2.0 includes ensuring that pregnancy and breastfeeding data are collected, retained, and analyzed over decades in long-term studies.
When pregnancy and breastfeeding are treated as central to lifelong health:
- Paid leave becomes preventive care;
- Lactation support becomes chronic disease prevention;
- Continuity of care becomes a public health imperative;
- Breastfeeding equity becomes health equity.
Normalizing Breastfeeding 2.0 builds on earlier advocacy work. We still need to protect breastfeeding in public, expand access to lactation care, and support families in the early months. But we also need to ensure that the lifelong health implications of pregnancy and breastfeeding are studied and practiced and that providers and patients know about them.
Normalizing Breastfeeding 2.0 incorporates clinical, scientific, and structural elements into the health care and research landscape. And it is long overdue.
Naomi Bromberg Bar-Yam, PhD, has been working in maternal and child health for over 35 years as an educator, researcher, advocate, and writer. In addition to serving on the board of Massachusetts Breastfeeding Coalition, she is past president of the Human Milk Banking Association of North America (HMBANA) and is the founding director emerita of Mothers’ Milk Bank Northeast, which provides safe donor milk to hospitals and families throughout the northeastern US. Learn more about her on her LactSpeak profile.
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