When Lucy Hayes's son Gus was born almost four years ago in Mozambique, while she was working for an aid agency, the Irishwoman didn't think twice about breastfeeding her newborn. Both locals and expatriates alike nursed their babies and no one batted an eyelid when Hayes breastfed her son.
All of this changed when Gus was nine months old and Hayes left the poverty-stricken country to settle back in Ireland, where she began to notice negative attitudes when she fed her child in public.
"At my sister's wedding, a friend of our mother asked 'what are you doing still breastfeeding?'," said Hayes, while nursing her 10-month-old daughter Lara at her home in Brittas Bay, Co Wicklow. "Whenever I have had these comments, they've come from people of my parents' generation or their friends. Even my mother, who breastfed me, said it was time that the baby stopped breastfeeding.
"I'm more conscious of doing it here than in Mozambique. You don't see many women breastfeeding in public, so I'm always asking myself if I'm being discreet enough or wondering what that middle-aged man sitting beside me in the café is thinking about it."
Hayes's experiences epitomise just how divisive breastfeeding is in Ireland and why breastfeeding rates are the lowest in Europe and remain among some of the lowest in the entire world. Newstalk presenter Dil Wickremasinghe was even the target of some abuse this week when she breastfed her boy Phoenix live on TV3.
Just 56pc of mothers breastfeed newborns in Irish hospitals, a proportion that slumps to 42pc within a day, according to a survey of 2,500 mothers published this week.
One third of the women who do try breastfeeding give up the practice within a fortnight, the study, carried out by Trinity College Dublin's school of nursing and midwifery, found. By the time their babies are three to four months old, only 16pc of Irish women are feeding their infants breastmilk only, a figure that dwindles to just 2.4pc when their babies are aged between six and seven months old. The World Health Organisation recommends that infants be exclusively breastfed until they are six months old and that the breastfeeding continues to some extent by the time a child is two years old.
Indeed, Irish mothers are less likely to start breastfeeding than women of any other nationality giving birth here. More than 80pc of Polish mums and 64.5pc of British women opt for breastfeeding in Irish maternity hospitals.
Foreign women have been shoring up Ireland's dismal rate of breastfeeding since a wave of immigration from Eastern Europe over the last decade. While rates have gradually increased since the 1980s, the majority of Irish women still opt for formula over breastmilk, despite all the evidence showing a mother's milk protects babies from a raft of chronic conditions in later life, such as obesity, high cholesterol, high blood pressure, diabetes, childhood asthma and childhood leukaemia. Studies have shown that breastfed infants do better on intelligence and behaviour tests into adulthood than formula-fed babies.
Irish mothers began losing the art of breastfeeding during the early 20th century, amid an explosion of international food companies promoting formula as more nutritious than breastmilk. Artificial milk was heavily advertised in print media between the 1930s and 1950s and became more fashionable among the well-off. Because it was an indicator of status, formula-feeding quickly spread through the lower classes. Bottle-feeding also gave women more freedom in the home, by outsourcing infant care to other members of the family in an era when women had many mouths to feed. As a result, women were unable to teach their own daughters how to get their babies to latch, which many women find difficult to master. Breastfeeding has now skipped at least two generations, Louise Gallagher, assistant professor of midwifery at Trinity, estimates.
"If a woman wasn't breastfed by her mother, and she doesn't have a sibling or mother-in-law who breastfed, she might be surrounded by bottle-feeding mothers who are baffled by her choice to continue breastfeeding," said Gallagher, the lead author of this week's survey.
The legacy of the Catholic church's influence on perceptions of breasts as shameful, as well as the media's portrayal of breasts as sexual objects, may also play a role in Irish women's reluctance to breastfeed in public, she added. The sight of a partly covered lactating breast in a restaurant is often seen as more offensive than a woman's chest in a revealing top on a night out. In online discussions, mothers who nurse in public places are frequently urged to go to a public toilet rather than make other diners or shoppers feel uncomfortable.
"There is something culturally ingrained in us because Irish women who live in Australia or the UK have lower rates of breastfeeding than the rest of the population," Gallagher said.
"Breasts have also become overtly sexualised so many women and men do not associate a woman's breasts as designed to feed an infant but rather are there for sexual gratification."
This has helped make younger, less educated women decide never to breastfeed long before they ever become mothers, according to research cited by Gallagher. Indeed, the younger and poorer an Irish woman is, the less likely she is to nurse her baby. This has made breastfeeding a predominantly middle-class preserve.
Breastfeeding is embraced so much in some upper middle-class circles that it has become a measure of how well women succeed at motherhood, with mother who cannot or will not breastfeed pitted in the so-called Mommy Wars against those who evangelise about its merits. Gallagher argues that global food giants that promote "growing-up milk" for toddlers on Irish television are undermining campaigns by the department of health to encourage breastfeeding.
"There is a ban on advertising infant formula in this country, but the way companies advertise growing-up milk, it looks like infant formula," she said. "About 90pc of the women we interviewed said they had seen an ad for formula on TV, even though they hadn't. We would be concerned that this is feeding into the normalisation of formula feeding in Ireland."
Irish plants supply 15pc of the world's powdered infant formula and food companies are pushing the product in developing countries where breastfeeding had once been the cultural norm. Many Irish hospitals also offer formula for free to new mothers in maternity wards. This was apparent to Barbara Geoghegan, a 37-year-old mother from Kilcock, Co Kildare, who breastfed her three children, Ruben (5), Gracie (3) and Lucy (five months) after they were born in a Dublin hospital. When Gracie was born, "I was intrigued watching the nurses give up to 12 bottles of formula per day to each mother," she said.
When Lucy arrived in February, there was one other mother breastfeeding on the ward. "But she was very tired and sore from her Caesarean section and was advised by the midwives to top up her baby's feeds with formula, as the baby was hungry and she could get some rest. This seemed to be the recommended solution for exhaustion on the ward. Formula makes babies sleep longer as it's harder for their tiny bellies to digest. She switched to exclusively formula feeding her baby by the time she was discharged."
Geoghegan also noticed how overstretched hospital staff did not have the time to show women how to breastfeed. When her son, Ruben, was born, "a midwife would come by from time to time to check mine and the baby's temperature and other vitals, not really to help with breastfeeding. To be fair, they didn't have the time to teach me the art of breastfeeding. I was offered the chance to attend a breastfeeding class the morning after his birth but I declined. I was quite shy at the idea of exposing my breasts to a room full of strangers. It was too much, too soon; I needed one to one help but never got it."
It is encounters like this that makes Gallagher and others, including Geoffrey Shannon, the Special Rapporteur on Child Protection, question the effectiveness of the state's breastfeeding promotion strategy, drawn up in 2005.
"It suggested 12 national co-ordinators to implement breastfeeding in the community but that never happened," she said. "We pressure women into breastfeeding and then we don't adequately support them with post-natal services.
"Plus most women make the decision whether to breastfeed before ever getting pregnant so we need a national campaign that targets schools and even grandparents. We need to drive home the message that breastfeeding and formula feeding are not equal."
The Irish breastfeeding rate of newborns in hospital - much lower than in the UK and Sweden, where 81pc and 90pc of babies, respectively, are breastfed after their birth. In Norway, almost 100pc of babies are breastfed straight away, with 80pc of infants receiving breastmilk at six months of age
Women from other European Union countries are six times more likely to breastfeed than Irish women
One study from the Coombe maternity hospital found that 80pc of women who do not have a third-level level education were bottle-feeding their baby by the time they were discharged. These women accounted for two-thirds of all mothers discharged
The year the World Health Organisation warned Ireland about its low levels of breastfeeding, when former Taoiseach Charles Haughey was minister for health
Children who are breastfed for three to six months are 38pc less likely to be obese by the time they are nine years old than children who are bottle-fed
Mothers & Babies
The benefits of breastfeeding are well documented - it benefits the baby in terms of growth and immunity, and breastmilk is designed to meet all your baby's needs - yet Ireland has one of the lowest breastfeeding rates in the world. Only 50-55pc of mums will attempt to breastfeed, in comparison with the European norm of about 90pc.
Mothers & Babies
I was enjoying a rare glass of wine recently when a friend informed me that I may be better off giving up breastfeeding altogether if I was going to be drinking. She said it takes 13 hours for the alcohol to leave the system.