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How Breast Became Best When It Actually Isn’t

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*** Editor’s note: This guest post is by Ranjini (Rini) Ghosh, health and breastfeeding policy researcher, PhD student, and mom ***

World Breastfeeding Week is upon us. Cue the breastfeeding advocates staging “nurse-ins” and everyone from moms on social media to medical experts in the mainstream media telling us that “breast is best,”and worse, making the so-called choice about how to feed your baby, a moral one. It’s not that I think breastfeeding isn’t good. It totally is. It’s just not always right for all parents and all babies. So, how did breastfeeding evolve from being a totally good and valid choice to being “best” and something that all moms are expected to do? The answer, my friends, is found in culture, not science.

Breastfeeding is good. It is a nutritious, balanced, completed food for our babies… most of the time. I say most of the time because the first part of that sentence does not acknowledge the many pit falls of breastfeeding: insufficient production (15 percent or more of mothers cannot make enough milk to exclusively breastfeed), delayed onset of lactation (affects nearly 22 percent of new mothers), nutritionally incomplete milk (yes, some mothers make skim milk). So, while breastfeeding can come easily to many women, that is not true for a significant percentage of the population. For them and their babies, breast is decidedly *not* best.

And yet, although we have used our scientific knowledge and expertise to create a perfectly balanced and nutritious formula akin to breast milk, which allows us to side step many of the pitfalls mentioned above, and allows mothers the freedom to exercise their bodily agency and choose an equally good, nutritious option for their babies, society continues to vilify formula.

From the 1977 edition of the Womanly Art of Breastfeeding, La Leche League. Illustrated by Joy Sidor

The outcomes of breastfed and formula-fed babies are observationally identical. The seminal flaw found in much of breastfeeding research is one confounding factor. Most of the studies which find discernible differences in intelligence and health outcomes do not control for socio-economic status. If there is one thing that *actually* impacts all of those outcomes, especially in a country like the U.S. where income inequality is rampant and omnipresent, it’s money. Much has been written about the science of breastfeeding vs formula feeding already so I don’t want to rehash it here but I’ll just say this, the science is clear – Fed is Best.

Today’s post though is not about the science, it’s about society. It’s a post directed to those of us (including me), who have felt the immensely powerful guilt and shame of watching our breasts droop, fail us when they were supposed to be engorged with milk, and leave our babies hungry when they were supposed to magically squirt all that “liquid gold” into their hungry mouths. But mothering (or parenting) isn’t just about breastfeeding; it’s about so many other decisions. So, why am I made to feel that my motherhood is hinged on the single act of breastfeeding?

Much research has been done about the placement of breastfeeding in the discussion of motherhood as a “moral” value which results into us mothers also aligning our infant feeding choices with morality.[1] Good mothers breastfeed. This notion is not only informed by religious imagery and an appeal to nature (La Leche League’s usage of Eve as an example of the quintessential breastfeeding mother)[2] but also by the patriarchal one-dimensional approach to the public and private lives of women. Virtues assigned to women are traditionally those that are generally incompatible with a woman’s participation in the public sphere. This imagery thus relegated her to the private sphere during the industrial revolution.[3]

The public/private sphere discourse didn’t apply to women of colour and/or working class women since the vision of the “virtuous” woman wasn’t compatible with the image of a working class woman,[4] and ultimately, breastfeeding was only for those who could afford to maintain their position in the private sphere – “privileged mothers”.[5] In her book At the Breast, Linda Blum notes that breast-feeding as part of a pattern of idealized motherhood has been described as a “class-enhancing project” for (in the United States) white middle-class women. And so, over time breastfeeding came to be associated with whiteness and class. Even today, rich, white women are more likely to exclusively breastfeed for much longer – a significant and hard to control for confounding factor in much of the breastfeeding research out there.

With the creation of formula, we found a technological advancement meant to step in only when a mother suffers from “insufficient milk syndrome” and was thus failing their “natural” abilities. Framed in this paradigm, formula should therefore never be an option or a choice – itis only meant to be a technological, “artificial” solution to an infant’s feeding needs when a mother’s body fails to do what is natural; make what is best for the infant – breast milk.

So, when a mother preemptively chooses to feed her baby formula, she is charged with being a “poor mother” who sacrifices her baby’s health in favor of convenience and personal preference.[6]  E. Lee has examined the context of infant feeding in Great Britain, where while breastfeeding has achieved a heightened level of socio-cultural approval, formula feeding has been increasingly portrayed as “risky”.[7]

The moral equivalence of breastfeeding and motherhood is not only a value portrayed ubiquitously through social marketing[8] but there is ample academic literature which pushes the natural fallacy and makes the argument for “natural” feeding as being an intrinsic component of motherhood. Moreover if what is “natural” is also believed to be “free” (it’s really not – a woman’s time is not worthless dammit![9]) then why wouldn’t mothers breastfeed?

In fact the moralizing of breast milk as the only natural and good option is so pervasive that it has influenced how researchers study the outcomes of infant feeding methods and how that research is disseminated to the public. Jules Law, argues that underlying the popularly cited benefits of breastfeeding are assumptions of the relative value of social arrangements that are conventionally associated with formula or breast milk. These assumptions affect the way maternal health and infant health literature is worded, presented and published.[10]

In her book Is Breast Best? author Joan Wolf goes a step further and shows us how in addition to research being designed problematically the existing research is not understood, disseminated and reported on properly. Amazingly, physicians are more likely to base their practice on “opinion” pieces as opposed to research conducted with robust scientific method. Moreover, a substantial number of abstracts are incongruent with the actual findings of the article itself. Wolf presents an abstract which misquotes the correlational findings of breastfeeding research as causal outcomes – a mistake even the most lay researchers should know better to avoid. Further exacerbating the understanding of breastfeeding outcomes is the fact that the media tends to overestimate and highlight the superiority of breastfeeding over formula even when the primary source makes no such claim.[11]

So, when racism, sexism, and classism play such strong roles in informing the way we view breastfeeding as the moral “choice”, and that choice is further bolstered by poor understanding, dissemination and reporting of actual research, it should not be a surprise that the “Breast is Best” trope continues to thrive.

Is breastfeeding good? Yes. Is formula also good? Yes. But is either choice *actually* best? Which should you choose? In a world where we have options, and a time in history when women have (and should have) the ability to make choices about how they use their bodies, pursue careers, and raise their children, the answer, it seems, depends entirely on you.

Image credits: The Womanly Art of Breastfeeding; Steph Montgomery, all rights reserved
References:
[1] Elizabeth Murphy, “‘Breast Is Best’: Infant Feeding Decisions and Maternal Deviance,” Sociology of Health & Illness 21, no. 2 (n.d.): 187–208, https://doi.org/10.1111/1467-9566.00149.
[2] Rachel Muers, “The Ethics of Breast-Feeding: A Feminist Theological Exploration,” Journal of Feminist Studies in Religion 26, no. 1 (June 13, 2010): 7–24.
[3] Christina G. Bobel, “Bounded Liberation: A Focused Study of La Leche League International,” Gender and Society 15, no. 1 (2001): 130–51.
[4] Barbara Katz Rothman, Recreating Motherhood: Ideology and Technology in a Patriarchal Society, 1st ed. (New York: Norton, 1989).
[5] Orit Avishai, “Managing The Lactating Body: The Breast-Feeding Project and Privileged Motherhood,” Qualitative Sociology 30, no. 2 (June 1, 2007): 135–52, https://doi.org/10.1007/s11133-006-9054-5.
[6] Murphy, “‘Breast Is Best.’”
[7] Dr Ellie J. Lee, “Infant Feeding in Risk Society,” Health, Risk & Society 9, no. 3 (September 1, 2007): 295–309, https://doi.org/10.1080/13698570701488910.
[8] Manuela Schmidt, “Social Marketing and Breastfeeding: A Literature Review,” Global Journal of Health Science 5, no. 3 (May 2013): 82–94, https://doi.org/10.5539/gjhs.v5n3p82.
[9] Phyllis L. F. Rippeyoung and Mary C. Noonan, “Is Breastfeeding Truly Cost Free? Income Consequences of Breastfeeding for Women,” American Sociological Review 77, no. 2 (April 1, 2012): 244–67, https://doi.org/10.1177/0003122411435477.
[10] Jules Law, “The Politics of Breastfeeding: Assessing Risk, Dividing Labor,” Signs 25, no. 2 (2000): 407–50.

[11] Joan B. Wolf, Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood, Biopolitics (New York, N.Y.) (New York: New York University Press, 2011).

 

Ranjini (Rini) Ghosh is an Adjunct Lecturer and PhD student at Northeastern University. Her dissertation research explores the gap between the science and policies that push the “Breast is Best” message in the healthcare system and the impact that the Baby Friendly Hospital Initiative has on mothers. She lives in Massachusetts with her husband, dog, and a rambunctious toddler who was fed both breast and science milk.

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