eeanne - with regard to why NHS, WHO etc promote the "breast is best" message - firstly, the WHO's responsibility is for disseminating best practice on health interventions around the world. In low and middle income countries, BF is genuinely life saving. The WHO's remit and lookout in many areas is often prioritised towards those countries (not the richer ones) because the poorer countries do not have their own technical and scientific expertise to the same degree as richer countries - so they look to WHO to provide the coordination and direction. This does to some extent, for certain guidelines and recommendations mean that WHO takes more seriously the needs of countries where there is a greater health burden or need and lesser scientific expertise of its own. for BF, the effects of BF in terms of protection for child and infant health are far greater in those poorer countries. Therefore WHO has a very strong mandate to provide v strong impetus for the protection of BF in its guidelines.
for NHS, the strength of the case is on a different level to that for WHO. But as I previously explained, the case still looks good on paper. URTIs and diarrhoea account for tens of thousands of A and E admissions for infants every year and probably many times more GP appointments. BFing can reduce the risk of those events by a decent margin - maybe 40, 50, 60% depending on length and exclusivity. So on a "health resource use" level, promoting BF for the health service is a slam dunk.
When you look at it from the perspective of the individual family, it's very very different. Because individual families also look at the "work needed" for a single person to do the task of something that can only be done by a single person (the mother). And how this fits into their own needs, priorities and personal situations. And how that plays off against the benefit; for outcomes that, when push comes to shove, in a rich country setting are just not that serious (and most under 1s get an URTI or a case of diarrhoea within the first year anyway).
Meaning these messages get lost in translation. Also the issue I made above, that the implementation of breastfeeding support is not a science-driven thing. We have very little evidence for what actually works in eg, fixing a painful nipple or helping a mother to increase supply. (other than feeding lots, but a heck of a lot of mums who say they weren't making enough milk, have been feeding like crazy and are almost at the point of collapse as a result). Hence -- the mess that we are in.
The way out IMHO is to admit that BF for many mums is not working well, to be prepared to do scientific research to understand better for whom it isn't working and WHY and to develop new approaches which will fix those problems for mothers.
Saying "only 2% of mothers can't breastfeed, you either didn't try hard enough or didn't get the right support" is a horrible thing for a mum to hear who genuinely had problems and spent her entire life on Kellymom and seeing IBCLCs or BF support groups and still wasn't able to make it work.