In this 2015 photo, Filipino mothers are lined up to enter a gymnasium in Manila to try to set a simultaneous breastfeeding record. 3,738 mothers attended in order to set the record. This event was used to show mothers that there is no viable substitute for a mother’s milk. (AP Phtoto/ Bullit Marquez)
Breastfeeding is when a mother provides milk to her child from her breast. The World Health Organization (WHO) defines breastfeeding as the “normal” way to provide infants with needed nutrients for healthy growth and development (“Breastfeeding”). They recommend that mothers breastfeed exclusively for the first six months of a child’s life and then still provide the child with breast milk until the child is two years old (Thomson et al. 33). Even so, in most Western countries this does not occur. For example, only 12% of mothers in the United States and only 2% of mothers in the United Kingdom are still breastfeeding exclusively by the time their child is six months old (Boyer 7).
Over the history of breastfeeding, technological advances have allowed for continual breastfeeding from the biological mother to become less necessary for infant survival. At the beginning of the 20th century, artificial infant formula was created and eventually became accepted as a breast milk substitute. In the United States, infant formula feeding was promoted by pediatricians and became the cultural norm, becoming more common than breastfeeding (Eden 29). Wet nursing, which is when an infant is breastfed by a woman who is not the biological mother, is documented as taking place in as early as 2000 BC (Eden 29). It has since developed into many human milk sharing practices in the United States, which includes the creation of human milk banks (Palmquist 278). In the 1950s, the breast pump began to be used in hospitals and by the 1990s it started to become marketed to the public for at-home use, making it possible for working women to still breastfeed their child and go back to work sooner (Boyer 7). These technologies have made it easier for working women to have children, but they have also led to backlash from organizations that promote the health benefits of breast milk (Thomson et al. 34).
The breastfeeding advocacy movement began in the 1950s, spearheaded by an international organization titled La Leche League and motivated by information on the health benefits of breastfeeding (Boyer 7). Their “breast is best” message has made a huge impact in the United States as well as many other countries. Although it is based on improving infant health, it has also led to a lot of shame and judgement of mothers (Thomson 34 et al.). The organization’s main goal is to stop women from using formula, but it has recently led to breastfeeding becoming synonymous with being a good mother in many countries (Thomson et al. 34).
Evidence has shown that using breast milk reduces the risk of allergies, ear infections and sudden infant death syndrome after birth. In the long term, breastfeeding is also linked to reducing rates of diabetes, leukemia, lymphoma, obesity, high cholesterol and asthma in children. For mothers, it is known to reduce rates of breast cancer and osteoporosis as well as working as a natural birth control, which can be beneficial for mothers in undeveloped countries where contraceptives are less accessible (Boyer 7). That being said, breastfeeding is not an option for all women due to lactation failures, but there is also evidence to say that lactation failures are usually due to a lack of lactation specialists in the hospital that know how to correctly guide the mother to breastfeed. It has been found that about 2 to 5 percent of women actually have physical impediments that make them unable to breastfeed their children (Barston 37). Although this percentage is low, women are often not told that there is a chance that they will not be able to breastfeed their child (Barston 35).
While there are potentially more health benefits to breastfeeding, in Western countries, heathy children very often are raised using formula. As one mother declared after switching to feed her child formula, “the prospect of a future filled with more ear infections or the loss of a few IQ points seemed tolerable when balanced against the constant misery making up our present” (Barston 76). Breastfeeding can be painful for the mother as well as difficult, requiring a lot of lactation consultation that often is not available in all hospitals (Barston 35). In some cases, formula can even be healthier for the child because sometimes breastfeeding difficulties can limit the amount of milk the child receives as well as sometimes not providing the healthiest kind of milk (Barston 75). As a consequence, the “breast is best” message is not true for all women.
Advocacy for breastfeeding is especially intense for developing countries. Infant formula often includes a powder that has to be mixed with water, which can be dangerous and even lead to infant death in areas where there is a lack of clean water (“Infant Mortality Rate”). In the 1970s, the Nestlé Corporation was criticized for distributing free infant formula in developing countries. In this instance, the women did not realize exclusively using formula would stop their breast milk production and as a result, they were then forced to continue using the formula. Unfortunately, the women often could not afford to buy more formula, so they tried to extend their supply by watering it down. This led to malnutrition, starvation and infections in these children (“Infant Mortality Rate”). Today, the WHO lists on their website that malnutrition, which they say is almost always a result of “inappropriate feeding practices”, is responsible for one-third of deaths in children under five. They add that “in infancy, no gift is more precious than breastfeeding” (“Promoting proper feeding”).
In addition to shame for not breastfeeding, there is also evidence tied to shame for public breastfeeding in mothers because it violates “feminine modesty” (Thomson et al. 34). In the United States, 43 states have passed legislation to allow breastfeeding in any public or private location, but only 23 states have laws that protect breastfeeding in the workplace. In the United Kingdom, breastfeeding in public is allowed but only until the infant is six months old (Boyer 7). The inability to breastfeed at work further limits working women’s ability to breastfeed their children, leading them to have to turn to either a breast pump, milk sharing, or formula, all of which have their negative consequences. While public breastfeeding is normally shamed due to a conservative call for modesty, Pope Francis supported public breastfeeding earlier this year.
In this 2016 photo, two Argentinian women breastfeed at a demonstration in support of public breastfeeding. This rally occurred after a woman was forced to leave a public park because she refused to stop breastfeeding her child. (AP Photo/Agustin Marcarian)
As mentioned above, the breast pump made a big impact on breastfeeding especially for working women. The breast pump allows women to be away from their child for more than just a few hours so they can attend work because as mentioned above, many states do not allow breastfeeding at work. In addition, breast pumps can relieve swollen breasts as well as allow the partner to also feed the child. In the United States, 77 percent of women use a breast pump at some point while they are breastfeeding (Boyer 8). Despite all its benefits, the breast pump still draws criticism, specifically from the La Leche League, for not providing the psychological benefits from traditional breastfeeding. They take the stance that the physical connection is important for a baby’s development (Boyer 9).
Human milk sharing as an infant feeding process is also growing in the United Sates. Human milk sharing is when a woman donates breast milk directly to a family in order to feed an infant (Palmquist 278). This process often occurs online. It has drawn criticism because there are many potential health risks involved with feeding an infant someone’s milk that is not screened by a health professional (Palmquist 278). Even so, milk sharing has become common among middle-class, college educated white women in the United States (Palmquist 279). In addition, human milk banks have begun to emerge in larger cities (Carroll 1). This article provides more information about human milk banks.
To provide information on who in most likely to breastfeed, among white, black and Hispanic women in the United States, white women are most likely to continue to breastfeed over a period of a year, although Hispanic and white women are equally as likely to initiate breastfeeding. African American women are significantly less likely to initiate as well as sustain breastfeeding than white or Hispanic women (“Morbidity and Mortality”). Socioeconomically, wealth is positively correlated with likeliness to breastfeed. For example, in a survey conducted by the CDC, 70.7 percent of women below the poverty level initiated breastfeeding while 90.1 percent of wealthy women initiated breastfeeding. Women of a higher education level are also more likely to breastfeed (“Morbidity and Mortality”).
Connections to Politics of Health
Breast pumps and formula could be described as the medicalization of breastfeeding. These are an example of medicalization because they require medical interference in something that occurs without any medical assistance, breastfeeding (Conrad 3). In fact, mothers who do not breastfeed their children the traditional way are often criticized because it is perceived that they are depriving their child of natural nutrients (Thomson et al. 34). This criticism of the medicalization of breastfeeding, as well as the stigma tied to breastfeeding, can also be linked to Metzl’s argument in “Why Against Health?” As he puts it,
“When we see a woman bottle feeding an infant and reflexively say, ‘breastfeeding is better for the child’s health,’ when what we mean is that the woman must be a bad parent. In these and other instances, appealing to health allowed for a set of moral assumptions that are allowed to fly stealthily under the radar. And the definition of our own health depends in part on our value judgements about others” (Metzl 2).
Healthy children can be raised through formula but the “breast is best” campaign is used as a way to judge and shame women into what they think is the healthiest way to raise a child, which is exactly what Metzl is arguing against in his piece.
The judgement mentioned above has led to milk sharing practices which in turn have led to many problems with informed consent. While these milk sharing practices do not involve clinical trials as in Fisher’s piece on informed consent, they do involve a vulnerable population being taken advantage of, a key aspect of Fisher’s piece. In the case of breastfeeding, these mothers who are unable to provide breast milk themselves either due to work demands or lactation problems are an example of a ready-to-consent population because they are desperate to provide their children with breast milk because of the supposed health benefits and the judgement involved with using formula (Fisher 195). As a result, they get milk from women without being given their complete health background. This, in turn, has led to families getting milk from women that have alcohol problems or are using drugs or eating foods that are not safe for an infant (Palmquist 278). These milk banks are taking advantage of these mother’s vulnerability and not allowing them to give informed consent (Fisher 195).
Breastfeeding also provides insight into scientific knowledge production, as discussed in Petryna’s piece on Chernobyl. In her piece, she states, “What we can conclude with some certainty, however, is that the processes of making scientific knowledge are inextricable from the forms of power those processes legitimate and even provide solutions for” (Petryna 10). This relates to breastfeeding because in this case, the production of scientific knowledge is giving breastfeeding advocacy groups the power to control mothers through the shame that this scientific knowledge evokes in women that are trying to have a healthy child. This scientific knowledge provides grounds for these groups to pressure and guilt women into breastfeeding when it is not always the best option for all women.
References
Barston, Suzanne. Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t. University of California Press, 2012.
Boyer, Kate. “Of Care and Commodities: Breast Milk and the New Politics of Mobile Biosubstances.” Progress in Human Geography, vol. 34, no. 1, 2009, pp. 5–20., doi:10.1177/0309132509105003.
“Breastfeeding.” World Health Organization, World Health Organization, www.who.int/topics/breastfeeding/en/.
Conrad, Peter. “The Shifting Engines of Medicalization.” Journal of Health and Social Behavior, vol. 46, no. 1, 2005, pp. 3–14. doi:10.1177/002214650504600102.
Carroll, Katherine E. “Breastmilk Donation as Care Work.” Ethnographies of Breastfeeding: Cultural Contexts and Confrontations, Dec. 2014, pp. 1–30., doi:10.5040/9781474216074.ch-011.
Eden, Aimee R. “Breastfeeding Support: From Informal Care Work to Professional Health-Care Work.” Anthropology of Work Review, vol. 38, no. 1, 2017, pp. 28–39., doi:10.1111/awr.12110.
Fisher, Jill A. “‘Ready-to-Recruit’ or ‘Ready-to-Consent’ Populations? Informed Consent and the Limits of Subject Autonomy.” Qualitative Inquiry, vol. 13, no. 6, 2007, pp. 875–894., doi:10.1177/1077800407304460.
“Infant mortality rate.” Britannica Academic, Encyclopædia Britannica, 16 Aug. 2017, academic.eb.com.proxy.library.vanderbilt.edu/levels/collegiate/article/infant-mortality-rate/605463#312252.toc.
Marcarian, Agustin. “Argentina Breastfeeding.” AP Images, Associated Press, Buenos Aires, Argentina, 23 July 2016, http://classic.apimages.com/fronts/Default.aspx?sh=14.
Marquez, Bullit. “Philippines Breastfeeding Record.” AP Images, Associated Press, Manila, Philippines, 4 May 2006. http://classic.apimages.com/fronts/Default.aspx?sh=14.
Metzl, Jonathan M. “Why Against Health?” How Health Became the New Morality, NYU Press, 2010, pp. 1–11.
“Morbidity and Mortality Weekly Report (MMWR).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 July 2017, www.cdc.gov/mmwr/volumes/66/wr/mm6627a3.htm.
Palmquist, Aunchalee E. L., and Kirsten Doehler. “Human Milk Sharing Practices in the U.S.” Maternal & Child Nutrition, vol. 12, no. 2, 2015, pp. 278–290., doi:10.1111/mcn.12221.
Petryna, Adriana. “Life Politics after Chernobyl.” Life Exposed: Biological Citizens after Chernobyl, Princeton University Press, 2013, pp. 1–33.
“Promoting Proper Feeding for Infants and Young Children.” World Health Organization, World Health Organization, www.who.int/nutrition/topics/infantfeeding/en/.
Thomson, Gill, et al. “Shame If You Do – Shame If You Don’t: Women’s Experiences of Infant Feeding.” Maternal & Child Nutrition, vol. 11, no. 1, 2014, pp. 33–46., doi:10.1111/mcn.12148.
Additional
“LLLI | Home.” La Leche League International, www.llli.org/.
Stack, Liam. “Pope Francis Reiterates Support for Breast-Feeding in Public.” The New York Times, The New York Times, 9 Jan. 2017, www.nytimes.com/2017/01/09/world/europe/pope-francis-breastfeeding-sistine-chapel.html.
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