Our friend Jennifer Block wrote this wonderful article for babble.com in response to the recent Atlantic Magazine’s article, “The Case Against Breastfeeding.”
The worldwide “Baby Friendly Hospital Initiative” is a great campaign — get the baby skin-to-skin with mom first thing after birth, leave them be for an hour to start nursing, and basically phase out the nursery. A centerpiece of the initiative is to ban formula companies from giving out free samples in maternity wards. But perhaps calling it “baby friendly” was a bad idea. Perhaps it sends the message that breastfeeding is somehow not “mother friendly.”
That’s essentially what Hannah Rosin argues in an article in this month’s Atlantic, “The Case Against Breastfeeding.” (Babble ran a similarly critical piece by Marjorie Ingall a few years back; it’s still one of the “most viewed” articles). Rosin is a contributing editor and mother of three children, all of whom she breastfed, and the youngest of whom she is still breastfeeding, she has said — the several thousand words denouncing its health benefits notwithstanding — “because it’s nice.”
Rosin’s case against breastfeeding isn’t so much that it’s a pain, like housework. It’s that it is holding women back,”stuck at home,” like housework. She actually compares breastfeeding for the full year recommended by the American Academy of Pediatrics to the vacuum cleaner of Betty Friedan’s day, a symbol of domestic imprisonment. “It was not the vacuum that was keeping me and my twenty-first-century sisters down,” Rosin writes of her epiphany, “but another sucking sound.”
“Epidemiological research always has confidence limits,” Labbok explains to me. Sure, if you scan a handful of studies, you’ll notice that one might show a strong association, one might show no association; that maybe three out of twenty achieve statistical significance. “But those who understand epidemiology go in and sort out the predominant evidence, and that’s accepted science.”
Rosin quotes a review article from 1984 but doesn’t cite the most recent and comprehensive epidemiological review of the literature, published in 2007, which surveyed 9,000 studies. This report is upfront about the limitations of studying breastfeeding (namely that it is impossible to conduct a randomized controlled trial — you can’t tell women how to feed their babies — and thus it is nearly impossible to prove causation) but nevertheless concludes, “A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers,” and goes on to name a dozen. There are some relationships that remain unclear, such as whether breastfeeding makes babies smarter or moms shed pregnancy pounds more quickly. But the thrust of the evidence is clear: breastfeeding is optimal. The full review, commissioned by the famously cautious U.S. Agency for Healthcare Research and Quality, is 186 pages long. Labbok tells me that based on this, AHRQ put out a clinical guidance, which they only do when they are “fully convinced” by the scientific data.
Rosin is right that the individual risk of formula-feeding her children may be relatively small, but public health is about the collective, and among a population the risks of not breastfeeding are significant. For example, formula fed babies will have more severe diarrhea and respiratory infections. One could argue that such consequences aren’t a huge deal if they are born into families with good access to health care (like Rosin and her friends). But however treatable these ailments, they become more serious among poor families in the U.S., and it’s clear that in non-industrialized countries they cause babies to die. That’s why the group Save the Children calls breastfeeding “one of the most effective interventions for newborn survival.”
That said, public health initiatives have been known to overstate risk and play on fear in an effort to affect behavioral change. And breastfeeding PSAs have shamelessly sunk to playing the bad mother card (see ad that likens formula-feeding to riding a mechanical bull while pregnant). No, formula is not poison. It is a life-saving intervention when needed, much like the C-section. A satisfactory substitute. The problem is that it should never have come to be seen as equivalent to normal physiology, the superiority of which is really quite breathtaking when you think about it.
A woman’s body goes through profound physical and hormonal changes to grow and birth a baby, but also to continue growing that baby after it is born. Some even call breastfeeding the “fourth trimester.” Physiology ensures that the baby will eat. And not just that she will eat, but that she will eat what she needs to eat, when she needs to eat, how she needs to eat. “Your body is capable of producing this amazing, perfect food,” writes author and cartoonist Kate Evans in a delightful new book, The Food of Love: Your Formula for Successful Breastfeeding (Soft Skull Press).
That kind of talk may sound frothy, but it is true. And what’s truly amazing is how the milk actually shapeshifts to meet the baby’s needs. Fresh out of the womb the baby gets antibody- and nutrient-rich colostrum, which primes the gut and immune system for life on the outside. Women who give birth prematurely actually produce more colostrum for a longer period of time — the body knows; mother and newborn may be separate but they are still very much in sync. The immunoglobulins within the milk actually change depending on the pathogens the mother is exposed to. A feed itself is dynamic, with the foremilk more hydrating than the creamy hind milk. “There simply isn’t any question that something is lost if you don’t breastfeed,” says Labbok.
Physiology — if we respect it, if we support it — keeps mother and baby physically linked in the immediate postpartum so that breastfeeding can be established. The umbilical cord, left intact, ensures this proximity (modern obstetrics routinely cuts it, but science continues to refute this standard practice). In fact, if born under optimal conditions, babies instinctively reach for their mother’s breast and start sucking away.
But the majority of U.S. maternity wards are not “baby friendly,” let alone mother friendly. Physiological childbirth itself isn’t supported, and thus part of the reason women find breastfeeding so difficult is because they are recovering from C-sections, or their babies’ esophageal tracts have been preemptively suctioned, and irritated, or they’ve been induced too early and can’t breathe on their own; and the cord was cut and the baby has been whisked away rather than getting the recommended immediate skin-to-skin contact, and many hospitals still routinely give formula rather than facilitating a breastfeed within the recommended first half hour; and most obstetricians don’t get involved, and most pediatricians don’t either, and nurses are busy, and lactation consultants are disparaged and cut out from insurance reimbursement, and here’s where the dissonance begins.
We tell women that breast is best, we tell them to breastfeed exclusively for the first six months, we even tell them it will raise their kid’s IQ (and we should give that a rest), and then we send them home with formula samples, or with a baby whose throat is too sore to suckle, or a mom whose milk is delayed because of surgery, and we don’t teach technique, and we are offended when a woman breastfeeds in public, so we make her feel housebound, and we don’t give a mother and her partner paid leave, and we send her to go back to a workplace without on-site childcare, and so her only alternative to formula is to plug her nipples into a machine, and if she’s lucky she gets periodic breaks and a “non-bathroom lactation room” in which to pump, and if she’s not she gets a toilet, and so on and so forth.
It’s no wonder women are ready to burn their nursing bras.
But it’s not that these public health recommendations are grounded in some return-to-the-1950s conspiracy, as Rosin suggests; they’re grounded in physiology. And science is validating the physiology of the mother-baby dyad — that is, both are healthier when they remain close to each other during the first several months postpartum. It’s not simply the milk that’s inimitable; it’s the mothering. (Indeed, “We actually don’t know if feeding infants human milk has the same benefits as breastfeeding,” says Labbok.) And mothering is something that our culture does not value enough to support. It is this dissonance between physiology and culture that has women so frustrated, and feminists like Rosin grasping at the bottle as a proxy for equality.
But is that really what we want? Powder rather than real power? In a brilliant New Yorker piece about the rise of the breast pump, Jill Lepore questions the direction of breastfeeding advocacy, which seems to be settling on the pump as a compromise to this conflict, with tax incentives for businesses with “Mother’s Rooms” in which babies are explicitly not welcome (”pump stations,” Lepore calls them) and Baby-Friendly hospitals sending women home with manual plastic pumps, and the president of the National Organization for Women calling for more “corporate lactation” programs. “It appears no longer within the realm of the imaginable that . . . ‘breastfeeding-friendly’ could mean making it possible for women and their babies to be together,” writes Lepore. “When did ‘women’s rights’ turn into ‘the right to work’?”
What a great question. Why did American feminism evolve in such a way that we think of biology as destiny, and that destiny as a prison? Why are we so willing to surrender the parts and processes that makes us female rather than demanding that society support them? We’ve broken down doors and cracked glass ceilings, when what we need to do is redesign the building.
Labbok, who’s worked in some fifty countries, tells me the feminists in northern Europe have done this. “In northern Europe, women fight for the right to breastfeed,” she says. There, feminism isn’t just about “making women act more like men,” the right of women to be full citizens and the right of babies to be given best possible care are not at odds. “There’s an understanding of human rights outside the U.S. that includes the right of women to breastfeed. And that means women shouldn’t be expected to do it unless everyone is fully supporting it — her family, her society, her workplace, everybody all the way down the line to her government.” And where there is paid leave, it should be noted, there are no “mommy wars.”
In the podcast accompanying the Atlantic story, Rosin reveals her pessimism: “We are never going to be Norway,” she says, rolling her eyes. “There will never be a situation in America where women . . . will have six months time to exclusively breastfeed their children.” Really? Did we ever envision an organic garden being planted at the White House by the nation’s black first family? This is the real tragedy of the mommy wars: they drag us down where expectations are so low, where we don’t value mothers enough to fight for them. We’re making a case against ourselves.
13 Responses to “The Backlash Against Breast Is Best: Why Is Breastfeeding Under Attack?”
April 22nd, 2009 at 7:34 pm edit
Actually there ARE poisons in formula.
Formaldehyde and mercury to name a few.
There’s also MSG, hexane and other undesirables.
April 22nd, 2009 at 9:34 pm edit
That was incredibly empowering as an exclusive breastfeeder for the past 6 months.
April 22nd, 2009 at 10:52 pm edit
Love this article. I’m proud and happy to still be breastfeeding a 20 month old, and for the record, not feeling tied down in the least!
Someone should break it to Rosin that far, far away in a Northern land called CANADA, mothers get twelve months paid maternity / parental leave, with the added option of dividing that time between the parents so that each can take a portion of the paid parental leave. I was stunned to learn after having my son that American women must return to work after only six weeks (or less)!
April 22nd, 2009 at 11:40 pm edit
Amanda Bent says:
Great article. I also read both the New Yorker and Atlantic monthly articles. While I was initially irritated by Rosin’s article, after thinking it over, I agreed that the whole motherhood guilt thing does not need to be exacerbated. Still, how many low income moms feel pressured to use formula, because the are young or they are simply surrounded by idiots. While college educated women may be over pressured to breast feed by other mothers and some books, uneducated women aren’t likely to get enough pressure. It would be nice to at least see breast feeding on television once in a while. I know the medium is not the best, but come on! Every baby on network television is bottle-fed. Given how many girls use TV to find a role model, this is cause for concern.
Anyway, don’t be too hard on Rosin. I mean, women and moms are way too competitive. Many are trying to achieve other things besides being a perfect mom. Rosin certainly is. Her article is totally well founded and honest. I thought her point about it being difficult to breast feed a third child while you hear the other two killing each other in the other room was hilarious and I certainly can relate. These sort of dynamics are real, and it is not as if you are going to be producing much milk during these very common and stressful scenarios. Having the option of bottle feeding is extremely valuable, for many reasons. I find the prevalence of overblown concerns about nipple confusion and stuff like that totally ridiculous. There are women out there who like to be away from their young babies from time to time. It’s no crime. More voices are needed in the breast feeding debate.
April 23rd, 2009 at 1:29 am edit
I am constantly amazed by the ability Jennifer Block has to put into words my exact thoughts on such matters but much more eloquently than I ever could. Thank you, Jennifer, for stating what so desperately needed to be said in response to Rosin’s article! Wonderful stuff!!
April 23rd, 2009 at 9:35 am edit
Amanda - “I find the prevalence of overblown concerns about nipple confusion and stuff like that totally ridiculous.” Obviously you have never had this problem (have you even breastfed?), but it’s ridiculous that you try to dismiss real problems that other people have. You sound like the horrible lactation consultant I saw at my hospital. Shame on you.
April 23rd, 2009 at 12:00 pm edit
I have breastfeed 3 children well into toddlerhood. I believe nipple confusion and “stuff like that” to be very real. Only thng is they are not biologically normal. They are man-made problems. Caused by PEOPLE, namely health professionals. When women assume they will have problems, they will. If they are told they will have problems, they will. We must stop tearing each other down. It’s time for a revolution ladies, and I’ve got news…it’s up to us!
April 23rd, 2009 at 9:54 pm edit
This article still isn’t satisfying somehow.
I think what we really need is on-site daycare at every workplace. Then, women can work and take breaks to breastfeed their children.
I’m so tired of the so-called mommy wars!
April 25th, 2009 at 12:03 pm edit
Rosin compares breastfeeding to the vacuum cleaner, “tying” women down, but it sounds more like it’s the baby itself. No one is forcing women to have babies. Even if you bottle feed, you still have to take the time to nurture your infant. Yes, breastfeeding is difficult, but it is worth it. And in the scope of your and your baby’s life, it’s not an incredibly long time to be making that commitment. Plus, as a mom who routinely breastfeeds in public, the more exposure the public has, the more comfortable they will be with it. Let’s be leaders instead of complainers. That being said, I am one of the lucky ones who works part time and parents full time. I agree we need on-site daycare for those who have to go back to work during the critical first year.
April 25th, 2009 at 2:22 pm edit
Tracy-Oh puleeze. Yes, shame on me for applauding a little honesty and variation in the breast feeding debate. I breast-fed both my children until almost two. I was also happy to let my husband bottle-feed when I wasn’t there. Once a week, or something. I would have not chosen to let my first have a bottle within the first week, but after complications, she had to be in the hospital, which gave her a bottle, of coarse. I had read all the fear mongering about nipple confusion, and was really upset. However, I ended up being glad she had been introduced to a bottle right away. I mean come on. It is good to have options.
April 26th, 2009 at 2:41 am edit
Heather L. says:
I think that both articles agree that more options need to be available to women in all aspects of motherhood, but especially in the natal and post natal stages. I am one who is lucky enough to not only be able to have had my two children (daughter almost 3, son 15 months) with me in working, working at home, and normal home environments. Additionally,I have never had any problems with breast-feeding, pumping, or feeding bottles or sippie cups to them. They HATE formula, (I could get away with the canned milk and water for when I had nothing else ready and really needed a babysitter), but never had problems with pumping enough extra after baby was done to give me spare to take places or whatever. All of that being said, I don’t think that anyone can doubt the problems that people have. (By the way, before anyone gets too jealous, please know that I am ridiculously sick for the full 9 months of pregnancy. I can’t believe I’m trying for another when I think about that…eww..) Everyone’s physiology is different, as well as personality. I do think modern medicine has made us second guess many things that come naturally to a woman’s body, but my aunt had no health problems after 12 kids, my sister-in-law doesn’t dare have a 4th because of severe issues including blood clots, kidney stones and 7 months of bed rest to keep the last baby full term. A friend has an 12 year old and has had 35-40 miscarriages in her 25 years or marriage. None of that has to do with great advances in science, it’s just the way things are. Don’t tell other people what they are capable of, but encourage them when it’s not going as smoothly as desired. I believe many give up too easily on breastfeeding, but telling them everything about how “bad” bottle feeding is will ONLY make them feel guilt. And above all, be grateful (even if you’re lucky enough to not need it) for all the babies and women that ARE saved because of advances in obstetrical surgeries and the like. Oh, and one final thing about breastfeeding, I LOVE to have those times during the day to read a book and relax while the baby eats.
April 27th, 2009 at 10:53 pm edit
Sheila Stubbs says:
Artificial feeding means bottles, nipples, liners, cans or powders to buy;
something to keep the prepared milk cold;
something else to make it warm,
Something to carry it in, some place to store it all, someplace to dispose of it when you’re through… and yet people claim NURSING is cumbersome?
Breastfeeding doesn’t tie you down; it sets you free.
April 28th, 2009 at 10:10 pm edit
Some say we need daycare. I don’t buy that excuse. I know HUNDREDS of stay at home moms that choose not to breastfeed.
What we need is the government to stop paying for formula through WIC. Half of all formula in this country is purchased through our tax dollars.