Last year, during National Breastfeeding Awareness Month, I wrote about the business case for supporting “nursing mothers” at work. Two years before, just six months into my (now 3.5-year-long) journey in breastfeeding, I wrote that “[o]f all the new baby myths, one of the most harmful (in my opinion) is that breastfeeding is an easy choice.” As the mommy blog universe lights up with posts extolling the virtues of breastfeeding and those who do it this month, I feel compelled to again offer an alternate (though not contradictory) perspective on this issue that is – literally – near to my heart.
First off, let me preface this by saying, I LOVE BREASTFEEDING. Being able to nourish my children from my body, not to mention the closeness involved in the process itself, truly feels like a superpower. I am incredibly grateful that both of my babies latched within moments of being born and continued to nurse past eighteen months. Even more, I feel lucky that breastfeeding and pumping came very naturally to me. I have never had a problem with supply, my workplace is incredibly supportive of nursing mothers, and I actually enjoy my pumping breaks. Most importantly, I am fortunate to live in a country, city, and community where breastfeeding is not just tolerated, but celebrated. I have nursed my babies in the baseball stadium, in Smithsonian museums, in front of the White House, on the Metro, and just walking down the street.
Sorry if it sounds like I’m bragging, that’s not my intent. My point is, breastfeeding came very easily to me. In light of the massive public health campaign exalting the benefits of breastfeeding for babies, mothers, the environment, and humankind at large, the decision to breastfeed was a no-brainer for me.
But that’s not true for everyone. Women may not want to breastfeed for a host of reasons. For some, it is incredibly painful, or ceaselessly frustrating at a time when they should be bonding with their new baby rather than stressing about how to feed it. Women without the benefit of paid maternity leave (which is up to 80% of Americans) may need to return to jobs where they do not have the luxury of pumping. Those on medication for mental illness, chronic disease, or persistent pain may not be able to nurse and take the medication necessary to treat their condition. Then there are women who do not want to breastfeed “only” because of social pressure from their family or community. Although I fully endorse outreach and advocacy to change those social norms, I more strongly believe that those women should not be forced to ostracize themselves from those whose support they need most in their transition to motherhood.
I believe in educated choices. It is wonderful that there is so much information in the world about the benefits of breastfeeding to wear down the obstacles of stigma or tradition and to allow women to carefully weight their options. But at the end of the day, every woman should be allowed to choose how to feed her child. I believe that all the circumstances I noted above are perfectly valid reasons to opt out of breastfeeding. It does not mean those mothers do not love and want the best for their baby. To the contrary, they may have had to make a difficult choice between nursing and keeping the job they need in order to provide a stable home for the child, or staying on their anti-depressants so they can be more present for their new baby. I think “Breast is Best” is overly simplistic. My proposed baby-feeding motto is: “Support choice. Choose support.”
Some mothers do not have a choice at all. Some simply cannot produce sufficient milk. Doctors estimate that up to 15 percent of women do not produce enough milk to feed their babies. Some have nipples that make nursing nigh impossible. Some could actually harm their child by breastfeeding it. In 1998 and 1999, the World Health Organization and UNICEF issued recommendations that HIV can be transmitted through breastmilk so women with the virus should not nurse their children. As Courtney Jung describes in Lactivism, there was an immediate backlash from La Leche League and others who feared the medical recommendations would tarnish their message touting the magic of mother’s milk. Even with huge strides in antiretroviral treatment that limits transmission, the World Health Organization estimates that between 140,000 and 210,000 infants are still infected with HIV annually through breastfeeding.
Even with all of these unescapable complicating factors, the CDC’s 2016 “Breastfeeding Report Card” finds that, on average, 81% of American mothers have breastfed their children for some period of time, and on average, 51.8% are still nursing their 6-month-olds. The lowest rates of breastfeeding are in places like Louisiana, Mississippi, and West Virginia (between 52-65%, on average). These statistics are consistent with other research showing the biggest indicator of whether a new mother will breastfeed is her income level. Without paid maternity leave, many working moms, especially single mothers, cannot afford to stay home and nurse their babies, and may have jobs that do not allow for frequent pumping breaks. In Lactivism¸ Jung describes how African-American women, who have the lowest breastfeeding rates in the U.S. (and also lead the majority of single mother families), are often inundated with dumbed-down educational materials that assume they “choose” not to breastfeed out of ignorance, rather than making a difficult decision based on their life circumstances.
I fear that the campaign to de-stigmatize breastfeeding is resulting in the stigmatization of formula feeding, which limits a woman’s ability to make choices about her body and her children. The World Health Organization’s website on breastfeeding states conclusively:
Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.
(Emphasis added). That account makes it sound like if a woman cannot or chooses not to breastfeed, she is clearly abnormal, ignorant, and isolated. As described below, policies are reinforcing this message.
The irony is that the modern crusade for breastfeeding was begun by feminists making a political statement, fighting back against big businesses like Nestlé that were peddling formula to mothers and discouraging them from feeding their babies themselves. Formula sales are still a huge market, estimated at $3.5 billion in 2007 (concentrated in just three companies), but the breastfeeding industry is catching up fast. From nursing pillows and covers, to pumps and milk storage solutions, breastfeeding has become a big business, with the market for pumps alone expected to be worth $2.6 billion by 2020. Critiquing the role of formula producers in public policy and public education dates back almost a century (see Dr. Cicely Williams’s “Milk and Murder” of 1939, declaring “misguided propaganda on infant feeding should be regarded as murder”). However, companies with a financial interest in breastfeeding have also been accused of pushing their interests under the guise of public health advocacy.
The reality is that policies are increasingly boosting one industry and restraining the other, supposedly to advance general health and wellbeing. Formula, which just thirty years ago was hailed as a savior for women who could not or chose not to breastfeed, is now demonized. To earn the coveted “Baby-Friendly Hospital” designation, maternity wards must ensure that “[e]xclusive breast milk feeding shall be the feeding method expected from birth to discharge.” Hospitals in my area proudly advertise that they provide “human milk substitutes” to newborns only when ordered via a doctor’s prescription stating that it is medically necessary.
On the other end of the spectrum, in early 2014, the United Arab Emirates passed a law mandating that all women breastfeed their babies for two full years; their husbands could sue if they did not. Other policies are less dramatic, but still have widespread consequences. The federal Women, Infants and Children (WIC) program gives mothers who breastfeed better quality food, for twice as long, compared to mothers who use formula. What is even more worrisome, WIC prioritizes breastfeeding mothers as the first recipients of its finite funds, even if some formula-using mothers are medically unable to breastfeed. Less controversially, the Affordable Care Act (i.e. “Obama Care”) requires health insurers to cover the cost of double electric breast pumps and mandates that employers provide pumping breaks. WIC’s website boasts that “2 out of 3 WIC moms initiate breastfeeding.” Quite frankly, I am surprised the proportion is not even higher given these skewed incentives. But that reinforces my point that breastfeeding is not always a feasible option for some women. They should not be penalized for feeding their babies in the way that is best for their bodies and lives.
I am concerned that breastfeeding has become a moral issue, not unlike smoking. Whereas lighting up in public was once “cool,” now smokers are isolated and ostracized because of the massive public education campaign emphasizing the serious health consequences that extend beyond the smokers themselves. Formula was once hailed as a scientific advance that provided critical nutrients to infants while leaving well-off mothers free to live their lives. Now it is seen as a threat to the “natural” process of breastfeeding and its accompanying health benefits for mothers and children. Nursing mothers feel morally superior to their formula-feeding peers, and those who must resort to “human milk substitute” are shamed at a time when they most need non-judgmental support. The big difference between smoking and formula-feeding, of course, is that one has a clear, direct, far-reaching negative impact on health, while the other is posited to be mildly less beneficial for some children than the alternative. In fact, recent studies increasingly show little or no proven health benefits to breastfeeding.
Personally, I have found breastfeeding to be empowering, rewarding, and enjoyable. I have never been subject to any kind of negative treatment for nursing in public; to the contrary, I am regularly congratulated for my efforts, as if I am making some great sacrifice for my child and humankind. I initially bought into the hype and cried – yes, cried – when I spilled a few ounces of “liquid gold.” Not, it all seems a bit silly to me. I still nurse my 18-month-old daughter, but not because I believe it will protect her from germs or make her smarter. I like the closeness, and the sense that I am literally nurturing her growth (in other words, I have continued breastfeeding mainly for purely selfish reasons). If nursing became painful or inconvenient (as when I became pregnant with my daughter while still nursing my 18-month-old son), I would gradually wean her and try not to feel too guilty about it.
Unfortunately, many women find breastfeeding discouraging, draining, painful, and/or a luxury of time that they simply cannot afford. The inescapable “Breast is Best” propaganda and disapproval (no matter how subtle) of doctors and other moms must be devastating. Lactivists have indeed begun to reverse the stigma against breastfeeding, and that stigma is now falling squarely on those women who choose – for whatever reason – not to breastfeed. I believe that mothers need to support each other unconditionally. We all love and want the best for our children, and that common purpose should unite us, not divide us over the issue of what/how we feed them.
Earlier this month new neighbors moved in across the street with a one-week-old baby. I thought it might be nice to bring over some lactation cookies with a note offering some move-in assistance. But first, I had my husband casually ask the new dad if his wife was breastfeeding. It turns out that she can’t nurse her baby because she has Lyme disease. So I sent over a bottle of red wine instead. Support Choice. Choose support.