Is breastfeeding 'normal'? Using the right language for breastfeeding.

BACKGROUND: Accurate terms aid clarity in thinking and prevent confusion. In the infant feeding field 'normal' can be ambiguous as biologically normal may not equate with culturally normal in a given time or place. Similarly, the use of the term 'intervention' is appropriate if a recommended practice is not perceived as 'normal' to that culture.

OBJECTIVE: This article explores the meaning of 'normal' in the context of infant feeding, since mothers may not perceive breastfeeding as 'normal' when this differs from the experience in communities in which it is considered unusual.

METHODS: Historical and recent sources were used to explore the effect of culture and established practice on perceptions of what is 'normal'.

DISCUSSION: Iceland and several regions of Europe are used as examples of long-term abandonment of breastfeeding during the late Medieval and Early Modern periods and the 19th century. Ireland, the United Kingdom and the United States are discussed in relation to fluctuations and declines in breastfeeding prevalence in the 20th and 21st centuries. The rôle of science and the rise of mother-support groups for breastfeeding, interventions to promote breastfeeding, and the possibility of cultural change, are also discussed.

IMPLICATIONS FOR PRACTICE: Culture influences the perception of what is 'normal' and where a culture has abandoned breastfeeding, or where it is in decline, women are unlikely to view it as the normal way to feed an infant. A more appropriate use of language is recommended, describing breastfeeding as 'biologically normal' or 'physiologically normal', as it is not always, and has not always been, culturally normal. In this context initiatives to improve breastfeeding rates can correctly be termed 'interventions'.