Supporting Mothers
HomeAbout DoulasServicesTestimonialsBirth StoriesResourcesResearchContact Me
Breastfeeding Paper

America’s Confliction with Breastfeeding
Lily Ostle
The Anthropology of Reproduction 2006

            From the moment a woman knows she is pregnant, the concept of interconnection becomes inescapable.  Everything the woman ingests is shared with the fetus growing inside of her womb, for good and ill.  The relationship of hormones exchanged between mother and child is reciprocal; the emotional state of the mother affects the child, and the child’s hormonal impetus creates contractions in the mother’s uterus.  The coveted ideals of individuality and autonomy in American society become inadequate and incongruent with the unique stages of interdependence experienced by mother and child.  The three chronological stages of physiological interconnection for mother and child are pregnancy, birth, and breastfeeding (Blum 1993).  Therefore, in a society which highly prizes autonomy and individuality, the mother and child pair is considered naturally deviant and suspiciously devoted.  The spiritual, mental and emotional experiences the pair feels are, to a great extent, constructed to be congruent with the technocratic model.  The symbolism of technology’s use throughout the stages is to separate the fetus/neonate from the mother, thereby restructuring the relationship to fit into cultural ideals. 

Currently, the possibility for fetuses to be “grown” outside female bodies is the science-fiction dream of strange bedfellows, such as anti-natalist feminists, medical researchers, and bioethicists.  Therefore, pregnancy is still necessarily embodied.  The inevitability of pregnancy representing an anomaly to individuality is promptly reorganized during the birth process in American hospitals.  The current high rate of surgical and technological intervention transfers the authoritative role in birth to doctors instead of women, and separates neonates into an individuated patient role.  Only within the last fifteen years have some hospital facilities recognized the importance of the mother and child to not only share a room, but also spend “quality” time together after the birth (Davis-Floyd 1992).  The post-partum period, which many women experience as depression, is also the time breastfeeding is either successfully or ineffectively initiated.  Infants must be fed to survive, so naturally women produce colostrum and milk after giving birth.  This third stage represents the apex of cultural intervention into the biological necessities of life.  Technology’s insidious use throughout pregnancy and birth simply prepares mothers to hand over essential aspects of their maternal role to bottles, formula, doctors and corporations.  The element of choice elucidates the presence of a culturally appropriate norm which conflicts with the best interests of the interconnected mother and child pair.  Bottle feeding gives mothers the choice to reestablish their biological independence from the stages of reproduction, which reorganizes their previous deviant liminality to fit cultural expectations of individuality.  Breastfeeding, as the most socially visible and contested stage of the intense interdependence of mother and child, blurs the lines of nature and culture, as well as subverts American ideals of individuality and autonomy. 

Originally, women did not have a choice whether to breastfeed or not; children depended on the maternal body’s ability to create nourishment.  Women most likely breastfed all of their biological children for 99 percent of human history.  The “luxury” of handing off infants to other mothers was most likely not practiced in foraging societies, unless the death of a mother had occurred, based on the nursing mother’s need for increased caloric consumption.  The practice of hiring another woman to breastfeed infants, to be a wet nurse, most likely started with agricultural civilization and the stratification of society.  The first documentation of wet nursing is found in the ancient civilizations of Mesopotamia, Egypt, and Greece, which continued into the eighteenth century in Europe (Deloache and Gottlieb 2000).  Wet nursing exploited the bodies of poor or slave women to benefit wealthy white women in Europe.  Although, whether the female elite actually benefited from this disjunction, between the nature of pregnancy and birth and the cultural importance of not breastfeeding, could be questioned. The parallel between low status women’s bodies of the past and technology’s roles today points to how much culture can shape what is perceived as natural.

For American women, breastfeeding was the norm until the 1940s which heralded the pervasive cultural switch to medicalized birth and scientific motherhood, as represented by hospital birth and bottle feeding for upper class women (Blum 1993).  Child rearing became a science which needed to be supervised by male doctors.  Bottle feeding was the preferred method because of its measurability and commoditization.  The scientific mother would spend a considerable amount of time each day preparing formula and calculating total daily milk volume, as well as sterilizing bottles, nipples, and bottle caps (Weiner 1994).  The negative affects of the technological switch on the overall health of infants have been hard to prove.  The conflicting reports of infant health, in comparing breast versus bottle feeding, are a result of the annual four billion dollar infant formula industry providing the largest portion of research grants, scholarly conferences, advice pamphlets, and hospital consultations (Blum 1993).  The resurgence, essentiality, and prestige of medicalized pregnancy and birth practices in the United States correspond with the current drop in breastfeeding, after a rise was initiated with the feminism movement of 1970s (Blum 1993). 

The often ignored and little studied beneficial biological affects of breastfeeding for mothers include faster contraction of the uterus, burning of body fat, protection from breast cancer, lower rates of osteoporosis, less urinary tract infections, and somewhat reduced fertility (Blum 1993; Baldwin and Friedman 1999).  One study has indicated that if mothers breastfed all their children the first two years, breast cancer rates in the United States could decrease by 25 percent (Baldwin and Friedman 1999).  Said another way, researchers have found that mothers who breastfeed for six months, or more, decrease their risk of breast cancer by 50 percent (Meltz 2004).  The biological benefits babies receive from breastfeeding include reduced incidences of infections, allergies, Crohn’s disease, celiac disease, childhood cancers, meningitis, childhood-onset diabetes, as well as mortality and morbidity during the first year (Lawrence 2002).  The immunities of the mother, which are passed on to the child through colostrum and breast milk, are the reason for the remarkable reductions in childhood diseases; by giving infants healthier and stronger immune systems (Meltz 2004). The less discussed benefits for both mother and child are those related to bonding and connection, perhaps since such ideas are not supported by the Western tradition of independence.  The inevitability of strong bonds between a mother and her children are mediated through multiple avenues and technologies throughout pregnancy and birth.  Once the child is born, institutions are eager to replace close family members’ connections and authority.  The hospital continuously gives the mother this subconscious ideal through the standardized procedures of separating mother and child, dictating when the pair may go home, and failing to provide a place for the father to stay with his family in the hospital, if the father is part of the family (Davis-Floyd 1992). 

Even if breastfeeding is actively encouraged in the hospital setting, which is becoming the case more and more since the American Academy of Pediatrics recommended the use of breastfeeding exclusively the first six months, most women do not, cannot, or will not continue for very long after they leave the hospital (Lawrence 2002).  Unlike other cultural interventions into the stages of interdependence, like Cesarean rates, the exact percentage of mothers who breastfeed nationally is not known.  Studies of certain populations have found that many more women start breastfeeding than continue for the entire first year of the child’s life (Lawrence 2002).  Specifically, one study in 2002 found that 70 percent of white mothers were initiating breastfeeding in the hospital, but that only 17 percent still were nursing exclusively by six months (Meltz 2004).  African-American mothers in the same study started out with 27.5 percent nursing in the hospital, and by six months only 9.5 percent were still breastfeeding exclusively.  The prestige of the technocratic model has been linked to the extreme differential at initiation of nursing between minorities and dominant white culture, in addition to the many other impediments (Meltz 2004).

There are a myriad of reasons why women either never start breastfeeding or stop soon after starting.  Some women find the use of breasts by their children to be incongruous with the breasts’ former status of being sexual objects; while others believe that their milk is inherently insufficient.  The belief that women’s milk may not be adequate or even harmful for children exists, based on the research done by infant formula companies concerning nutritional health and environmental toxins (Aluwalia, Morrow and Hsia 2005).  Since breast milk is produced on a supply-demand basis, mothers who are unable to breastfeed often enough in the hospital will lose the ability to produce enough milk.  Other mothers find that when they return to work, there is no convenient way to continue to breastfeed, and therefore switch to formulas and bottles.  The mothers who continue to breastfeed after returning to work may also experience supply-demand issues if they are not allowed enough break time throughout the day to express milk (Weiner 1994).  Some mothers feel a great deal of pain with the initial stages of the infant learning to suckle and opt for the bottle instead.  Mothers who have had a Cesarean delivery cannot breastfeed in the usual position of the infant across the abdomen, as a result of experiencing major abdominal surgery.  These mothers must hold their infants tucked under their armpits, which is a more awkward position and may result in less women continuing to breastfeed.  This technocratic intervention scenario shows how the birth outcome can influence women’s ability and desire to breastfeed.

In addition, some women who hold the ideal of shared-parenting have opted not to breastfeed on the basis of the exclusion and resentment of their male partners (Blum 1993).  In the case of partners resenting the interconnection of the mother and child pair, the idea of equality gets conflated with sameness.  Equal parenting does not literally necessitate the same treatment of the child by both mother and father; instead the focus on equal time and energy spent parenting is required.  Since breastfeeding is visible to others outside of the mother and child pair, it is important to recognize that the beliefs of family members may either support or contradict the ideal of “the breast is best”, which in turn affects the choices of mothers.  The grandparents may have conflicting sources of authoritative knowledge as a result of the generational difference, which may lead them to idealize the “tradition” of scientific motherhood in place of respecting their children’s differing parenting styles. 

A common theme used by both advocates and opponents of breastfeeding focuses on the sensual and intimate aspects of the mother and child bond.  Children receive more than nourishment from their mother’s breast milk, they also take in the positive hormones which are produced by mothers during breastfeeding.  One hormone released is oxytocin, known as the attachment hormone since it is also produced in orgasm (Meltz 2004).  The fact that women experience the same hormonal state as an orgasm horrifies some who liken this experience to incest.  Although others who have discovered that the birth experience can also involve sexual pleasure, may not be as surprised (Davis-Floyd 1992).  Hegemonic American culture’s discomfort with public breast feeding also encompasses this issue of sexuality.  Breasts are essentialized to male-centric sexual objects instead of respected for their multipurpose life-sustaining abilities (Blum 1993).  As can be found in many patriarchal interpretations, to be a woman and sexual is conceived as threatening to social order.  Not to mention, the idea of a sexual mother being the opposite of the most idealized and impossible form of womanhood in the dominant Christian tradition, the virgin mother.

Public breastfeeding is the circumstance in which patriarchal cultural baggage collides with internalized female surveillance.  Personal reservations and doubts about breastfeeding can combine with general public disapproval to create tense or embarrassing situations which may deter mothers from continuing breastfeeding, or severely inhibit mothers’ movements in public.  The strong cultural taboo against exposed breasts, nipples and areolas in public leads to many curious, condemning, and uncomfortable stares.  In the worst case scenario, those who feel offended by the sight of breastfeeding may feel the need to confront the mother.  The mothers who feel certain in their philosophical/spiritual choice to breastfeed often find multiple strategies for dealing with the social censure.  Some nursing mothers retreat to women’s lounges, dressing rooms, bathrooms, cars and under blankets; while others would rather stay in the public eye in order to spread social understanding and awareness (Pugliese 2000).  The women who decide to not self-segregate may seek advice on how to deal with confrontational situations in public, one possible scenario is:

You can’t do that here.

-Please show me a copy of the regulation against feeding my baby.

You have to do that in the bathroom.

-I thought it was against health regulations to serve food in a restroom.

Wouldn’t you be more comfortable elsewhere?

-I’m fine here.  Thank you for your concern (Pugliese 2000).

 

Public breastfeeding makes the personal choice of interdependence a social activity subject to all the cultural scrutiny and misconceptions of motherhood.  As the example above implies, mothers need to be aware that social stigma does not change the right to feed their children in public.  Along the same lines, mothers who made the decision to not breastfeed may be especially offended or affronted by other mother’s public breastfeeding.  In social situations, these mothers may be the first to criticize and question.  Those who confront nursing mothers most likely do not understand the personal significance of her decision to not only subvert the ideal of individuality, but also make public the constructed idea of what is natural. 

As a result of public disapproval of breastfeeding, many states in America have passed legislation to reassert women’s right to choose how to feed their children in public.  In the 1990s, legislation was enacted in nearly one-third of the United States (Baldwin and Friedman 1999).  This fact points out an interesting conflict between public opinion and United States law.  The goal of breastfeeding legislation is to help change negative social attitudes; to support the rights of women (Baldwin and Friedman 1999).  Posed as an inherent natural right, public breastfeeding seems logically appropriate; but placed within the context of cultural beliefs about women and ‘indecent exposure’, the opposite judgment is found.  Women’s right to nurse in public in Washington States is supported by the exemption of breastfeeding from the indecent exposure definition (Baldwin and Friedman 1999).  The most progressive legislation language centers on ending discrimination and segregation of nursing women.  For example, New York created a new law under the civil rights act to not only encourage breastfeeding, but also give women a legal process to defend the right (Baldwin and Friedman 1999).  The fact that legislation is needed points out American patriarchal double standards for gendered behavior that are most often hidden behind equality rhetoric.  Numerous cases throughout the country have repeatedly reasserted the rights of breastfeeding working mothers in schools, offices, and federal positions, but little attention has been paid to lower income women’s same rights. 

The notion of women’s constitutional rights illuminates the simultaneous separation and blurring of nature and culture which occurs in reference to breastfeeding.  The strange phenomenon of passing legislation on a natural biological act is exemplified in comparison to the lack of legislation protecting the “natural” right to procreate, for example.  A sample of the language which has been used in legislation is:

Breastfeeding is an important and basic act of nurture which must be encouraged in the interests of maternal and child health.  A woman has the right to breastfeed in any location, public or private, where she has the right to be with her child irrespective of whether the nipple/areola is exposed during or incidental to breastfeeding (Baldwin and Friedman 1999).

 

This segment’s isolation of breastfeeding to culture has many implications.  The separation of breastfeeding from a purely biological necessity to a cultural right distances nursing women from other mammalian nursing mothers.  As found in other cultures, the need to separate what is animal from what is human is essential, and fulfilled through the language which essentializes breastfeeding into a cultural practice.  The “basic act of nurture” message also points to the dominant American cultural belief which is contrary to the assertion.  Nature and culture are blurred in respect to nursing by the interconnection of mother and child, regardless of cultural attitudes.  The biological benefits for both mother and child are explicitly connected to the cultural decision to nurse.  Mothers who decide not to nurse, the majority of mothers, are supported by culture at the expense of the natural benefits, whereas mothers who breastfeed are stigmatized by culture while supporting the natural ideal.

The act of breastfeeding is seen as deviant within the context of American society which idealizes individuality, autonomy, maleness, and technology.  The need for physical and emotional connection inherent in nursing offends the individualistic model of independence and self-sustainability.  Even more compromising to autonomy than pregnancy, breastfeeding restricts women movements and decisions within a society which wishes not to be confronted with the image of publicly nursing women.  An example of such social beliefs is evident in the advertisements depicting breastfeeding mothers in dimly lit rooms and inconspicuous clothing looking away from their infants, in comparison to the colorful, active smiling mothers of bottle fed babies (Pugliese 2000).  Since breastfeeding necessarily requires the presence of both mother and child, it is not possible when women return to work within most American businesses.  Businesses are based on the standard of male workers; hence nursing women do not fit into the workplace seamlessly.  The use of bottles filled with breast milk offers the possible benefit of avoiding the use of formula, but the process of pumping and storing milk is time consuming and uncomfortable which may deter some women’s use.  Also, women must be able to afford the breast pumps, bottles, and nipples in order to consider this possibility.  The use of technology to mediate motherhood is encouraged in the place of respecting the female body’s abilities. 

With the myriad of cultural reasons against breastfeeding in mind, the call for more support for nursing mothers has long been heard.  Peer support, lactation education and intention have been shown to positively affect women’s continuation of initial breastfeeding (Ahluwalia, Morrow and Hsia 2005).  Although, the information offered in the hospital by lactation specialists ends up placing the responsibility and authority for breastfeeding on the staff instead of the mothers.  Mothers who internalize the idea of female inadequacy during their births may be more likely to transfer the same ideology to nursing; this can be dangerous to the process of beginning breastfeeding if the mothers feel absolutely powerless without someone to guide them.  Of course there are certain infant reflexes which is helpful for mothers to know in order to start the process, but the issue is that the bodily knowledge of being a mother is not valued, even by some mothers.   The idea of intention plays an essential role in determining how mothers will respond to the lactation education offered at hospitals.  The women who are absolutely against breastfeeding will be more likely to either refuse support, or only experience the negative painful aspects at the hospital which reinforces their previous misgivings about nursing (Ahluwalia, Morrow, and Hsia 2005).  One study from Canada found that between two groups of women, one with volunteer counselor support and one without, the women with support had about a 20 percent higher rate of continuing nursing at the three month mark (Lawrence 2002).  In addition, the mothers with support reported more satisfaction with their experience and planned to nurse any subsequent children (Lawrence 2002).  The importance of support points to how much stigma is placed on breastfeeding, and how hard it may be for mothers to accommodate for when entering to their post-birth lives.   

In a time before hospital lactation staff or professional doulas, the La Leche League (LLL) organized small peer group meetings for support and education.  The League was founded in 1957 with the goal of spreading the ‘womanly art of breastfeeding’ to all mothers (Weiner 1994).  These groups began emphasizing the wisdom and experience of mothers in place of the expertise of doctors, in anticipation of later feminist resistance to medicalized birth and child care (Weiner 1994).  The groups’ representation, as of the 1970s, was mainly white, middle-class, Catholic married women who could afford to be stay at home wives and mothers (Weiner 1994).  It was not until 1981 that the League even addressed the issue of working mothers, and then they advocated for mothers to postpone going back to work as long as possible (Weiner 1994).  Nevertheless, the League is second in size only to Alcoholics Anonymous among American self-help peer support groups (Blum 1993).  Critics of LLL have condemned the infant, instead of woman, focus; as well as the little room for differing perspectives about the role of motherhood. 

In addition to the support of hospital lactation staff, low income mothers now have more resources for making an informed choice about breastfeeding.  Throughout the last decade, La Leche League made a goal of reaching out to low income mothers with some success (Weiner 1994).  Also, the Supplemental Nutrition Program for Women, Infants and Children (WIC), which helps around 45 percent of all children born in the U.S., has encouraged breastfeeding to low-income women who are the least likely to initiate and continue breastfeeding (Ahluwalia, Morrow and Hsia 2005).  A study from Colorado indicated that WIC could save 9.3 million dollars a month if all their mothers breastfed instead of used formula (Baldwin and Friedman 1999).  Although with the recent cuts in funding to WIC, the continuation of these first few successes in reversing the anti-breastfeeding propaganda for low income women is unsure.  Single mothers of the lower socioeconomic brackets and ethnic minorities are the most affected by the institutionalized distrust of female bodies.  In fact, there is a strong pattern that the less education, wealth, and ethnic status women have, the less likely they are to nurse (Blum 1993).  Also, the factors which lead to “contaminated” breast milk are more prevalent for poor and minority mothers, as a result of such women being more likely exposed to toxins at work and sustained by poor nutrition.  Therefore, breastfeeding is not a widely available or free choice for most women, since social institutions and practices do not make nursing a viable option for all women (Blum 1993).  Low income and minority women are seen as a threat to core American family values by many conservative patriarchal points of view, and therefore are the last to benefit from variants to the dominant cultural hegemony as a result of their status.

Since motherhood is a social role, cultural attitudes towards both women and children profoundly affect the duties associated with the maternal role.  The ideal that women stay home with their young children is used by both traditional patriarchal conservatives and maternalist feminists (Blum 1993).  Patriarchal ideals use biology to determine that since women are the vulnerable child bearers, they necessarily belong in the home.  Maternalistic feminism celebrates the usually devalued feminine abilities of reproduction, but is also associated with treatment of gendered traits as essential or inherent to women by denying the significance of class, race, ethnicity, and sexuality (Blum 1993).  Therefore, breastfeeding has accumulated some stigma within the feminist community because of the associated biological essentialism.  Other feminists use the ideal of choice to support the notion that women have the right to choose their societal roles; one of which may be the stay-at-home mom (socioeconomic status permitting).  The desire to breakout of patriarchal definitions of woman has caused some to value the attributes commonly ascribed to man in the Western tradition.  These anti-natalist women applaud technologies which could free mothers from the confines of their biological duty of reproduction (Blum 1993).  Others find that technology does little more than reproduce patriarchal devaluation of women, and therefore have resisted the incessant intervention of technology into the three interdependent stages the mother and child pair experience. 

Unlike other technocratic issues surrounding pregnancy and birth, breastfeeding is supported by both the holistic and the medical communities.  While the medical community usually does strive to perpetuate the myth of the superiority of their technology in comparison to women’s bodies, in this case, the overwhelming scientific data has forced the medical community to accept breastfeeding.  The authoritative knowledge of the lactation experts is still kept within the hospital, which functions to maintain the devaluation of motherly knowledge.  The switch to using evidence based approaches to infant feeding may directly be a result of dedicated women forcing the issue for decades before gaining recognition.  The disparity, between authoritative proponents of breastfeeding and the actual numbers of mothers who nurse, points to how American society’s structure does not accommodate the natural process of feeding young children.  In a world designed and built by men, the needs of mothers are an inconvenience and a hindrance. 

The common denominator in the discomfort expressed by those who do not understand the need for breastfeeding is the censure of women in a patriarchal society.  This social and internalized surveillance is not turned on men’s behavior or exposure of skin; it is women who must be ever conscious of how they are perceived in public.  The confliction dominant American culture has with breastfeeding can be reduced to the inherent blurring of categories which occurs.  Nursing cannot be essentialized to only nature, only culture, only benefiting women, or only benefiting children.  The complexity of interconnection inextricably creates conflict with the patriarchal ideals of individuality and autonomy.  Women who become pregnant, experience birth, and breastfeed embody interconnection.   The natural ability to subvert the system of dominance is dangerous, and thereby incessantly devalued.  Technology’s interference helps some women to ignore the possibilities of intense interdependence, while others cope by reaching out for support.  American mothers face the challenge of balancing patriarchal societal ideals and structures with those inherent to reproduction in every decision, especially infant feeding.

Enter supporting content here