Thursday, April 7, 2011

Book Review: The Politics of Breastfeeding

The Politics of Breastfeeding: When Breasts are Bad for BusinessThe Politics of Breastfeeding: When Breasts are Bad for Business by Gabrielle Palmer

I was excited to read this book when it arrived from inter-library loan. I found myself rather frustrated by the first half of the book, though. In fact, on quite a few occasions, I wanted to throw it against a wall! (I didn't; that would not be the proper way to treat a book, especially one from inter-library loan.)

Thankfully, I persevered, because much of the second half of the book was quite interesting.

I have nursed my children for 14 months, 13 months, 17 months and 8 months (and counting on that last one). I nurse on demand, cannot reliably say how often or how long my children nurse, tend to night-wean my children after they day-wean, and have never started solids or other food before five and a half months. I have also experienced my share of problems while breastfeeding. First Son literally did not nurse until he was nearly a week old. A lactation consultant showed us exercises to teach him how to nurse. I have suffered mild and severe cases of mastitis (the cause of my most recent hospital stay). I have read a lot on nursing, follow a breastfeeding blog and am surrounded by friends who nurse their children long past a year.

Just to be clear: Ms. Palmer and I agree on many points. We did so before I read her book.

The Politics of Breastfeeding: When Breasts are Bad for Business is a call to arms. The author repeatedly blames the nefarious deeds of men, the Church, businesses, and governments for undermining women's right to breastfeed, ability to breastfeed and choice to breastfeed. I think some of her points are valid and others...well, a little extreme.
Despite the illusion of equality, and despite improvements since 1990, the majority of women are economically dependent on men. The unpaid housewife might joke about being a salve, but it is true. She works for the welfare of her husband and his household for no monetary reward and her status in the world is usually lower than his, often in her own eyes. She is dependent on his whim or that of his family. The fact that some men (and their families) behave decently does not negate the unequal power structure.
I suppose I dislike this quote because I am economically dependent on my husband, but it seems like I could just as easily say he is working to allow me to live my life as I like. I don't sit around all day eating bon-bons, but I'm also not answering to the whim of contemporary cubicle-life.

It seems to me Ms. Palmer thinks we should have remained hunter-gatherer societies. I didn't copy out any quotes (and my copy has been returned), but she repeatedly points out how much better women's lives were in hunter-gatherer societies, how much better they are for the environment and how they really knew how men and women should live as equals. I was not convinced we should throw off modern society and basic agriculture. She also seems to be against monogamy, as it encourages women to stop breastfeeding in order to discourage their husbands from seeking out other women, presumably women who are not breastfeeding. In polygamous societies, the husbands have other wives, so it's apparently less of a concern. Again, I'm not convinced.

The author is also anti-Catholic. Every once in a while she'll mention that a few nuns or clergymen did something noble in the fight for protecting infants living in poverty, but mostly she condemns the Catholic Church as part of the vast conspiracy against women's ability to breastfeed their babies.
For several hundred years before the eighteenth century, Roman Catholic doctrine advised wet nursing "to provide for the frailty of the husband by paying the conjugal due."
I can't say for certain she's incorrect in this statement, though I know it does not fit with current Church teaching. (See here for one example.) I noticed, too, her source was not a church document or even a statement from a local parish priest; it was a history book. That's not the worst she says about the Catholic Church. I won't quote any more on the subject.

Ms. Palmer makes a great deal of the contraceptive tendency of extended breastfeeding, implying that all women would space their children four years apart if only they would nurse each child for long periods of time. (She does admit that increased calories might decrease the spacing, though she doesn't necessarily think those extra calories are otherwise beneficial.) I found it hard to read repeatedly about how poor women in developing countries do not have access to contraception and abortion services (and therefore suffer increased risks of death and illness with closely spaced pregnancies because they are not allowed to breastfeed). Not everyone who reads this blog would feel the same way. I fully support women being able to decrease their fertility with extended breastfeeding.

Now on to what I did like about the book.

I think women in the United States are often lulled into complacency regarding formula-feeding our infants. I do not want to insinuate that women should not be able to choose to feed their children with formula, but it does seem likely that we view formula as nearly equal to breastfeeding. In fact, it seems almost wrong to me as I type that sentence, to hint that we may be harming our children with formula, even though we all know "Breast is best."
Messages about the 'benefits' of breastfeeding imply that artificial feeding is normal and safe, and that breastfeeding is a bonus. It is not like that. Artificial feeding is risky.
She goes on to point out (and I'm afraid I could not find the quote for it) that, all else being equal, even here in the United States, a formula-fed infant is six times more likely to die than a breastfed infant. I'm very disappointed I didn't properly mark that for myself so I could check her notes on it as the difference seems astounding to me. Also, 27%  American babies do not breastfeed at all, not even for a few days. I could not believe this number, either, but it seemed to be supported by a few other sources I checked.

She mentions the recent melamine scandal. Even without such tragedies, Ms. Palmer questions the safety of many of the ingredients in formula. We all like to think everything's been tested and is safe, but in fact a great many chemicals (remember BPA?) are allowed, unregulated, even in formula intended for infants. I find this disturbing. Of course, our children are bombarded with chemicals every moment of their life, even in the womb. We simply can't protect them from everything at every moment.

I found her history of the development of formula and formula companies fascinating, and fairly reliable as she quoted objective documents along the way. (She has extensive end notes, which is always a positive feature of a book for me.)
The manufacturers of artificial milks have argued that their products kept children alive for all the mothers who could not breastfeed and that there was a 'demand'. These companies were part of the same industrialising society which created the conditions that made women lose confidence in breastfeeding, ensuring that their products would be needed.
She produces documentation of relationships between doctors and formula companies showing that while doctors were not necessarily trained in how to support breastfeeding, they are receiving compensation from formula companies, either directly or indirectly by encouraging more doctor visits. (Not to mention all the increased visits when formula-fed infants have more ear infections and gastrointestinal infections.)

I was interested in her argument that just the hint that breastfeeding would not be successful is enough to cause some of the very problems the companies can then sell a product to "solve." Having suffered through breastfeeding problems of my own, I have to admit: it's not easy. There were a lot of times it would have been easier in the moment to quit. Even now, looking back, I'm not quite sure what kept me going, especially with First Son's difficulties. I can understand how a woman less determined would turn to formula with thanksgiving in such moments.
A hundred years ago most US babies were breastfed and most artificial feeding was done by rich women, or their servants. Now the class pattern is reversed. Hospital birth, company promotion and WIC have contributed much to this change.
Ms. Palmer has a hundred pages of ways modern society, industrialization and corporations have destroyed breastfeeding rates. Even if she's exaggerating some of them, the onslaught is awfully condemning: separating families from older generations, leading men and women to work outside the home, belief in the superiority of science, the medicalization of childbirth and infant care, milk subsidies that caused a great amount of excess milk to be produced seeking a market for it, lack of adequate maternity leave...really the list goes on and on.

The advertising strategies of formula companies are atrocious. Some of the quotes she pulls from company documents are revealing. We should never suppose companies are in business to help people. They are in business to make money. As Ms. Palmer points out, very few people make any money when a woman breastfeeds her baby. (Some companies, of course, make breastpumps and other such products, but Ms. Palmer contends expressed or pumped breastmilk is still inferior to nursing directly. That may be true. The Motherwear blog mentions a study here that showed that breastmilk in a bottle did not confer the same protection against obesity as non-expressed breastmilk, but she doesn't link to the study.) She also asks, if the formula companies are merely filling a need for women who cannot breastfeed, why do they need to advertise so extensively?

Some of the most convincing arguments against formula companies, though, are the struggles of families in poverty in developing nations. Without reliable access to clean water, fuel to heat water and money to buy more formula, many families are simply unable to safely feed their infants with formula. Donations of formula (from ill-meaning companies or well-meaning individuals) can interfere with an infant's nursing, decreasing a mother's supply of milk. Families are forced to stretch formula (essentially starving the baby), prepare formula with dirty water or prepare formula with water that has been insufficiently purified. It seems money would be much better spent assisting women in such situations (including disaster relief) to continue breastfeeding as long as possible.

Some of her statements at the end were rather more accommodating.
Whatever systems are devised to meet the needs of both small humans and economic structures (and there is no limit to human imagination and creativity), it is essential to consistently love and care for small children if we want adult humans to be mentally and physically healthy and resilient.
It's important to consider what's best for parents and infants, here and abroad. It seems logical to support breastfeeding with many times more resources than we have in place to support formula-feeding. I was intrigued with her idea that formula could be dispensed at a pharmacy with a doctor's prescription rather than available to one and all (and given as free samples to every mother who gives birth). I think it highly unlikely anything like that would ever happen. (Can you imagine the money formula companies would throw at Congress if a law like that were considered?)

In some ways, the breastfeeding situation in our country is similar to the education situation. Vast amounts of money are dependent on the status quo. Supporting local decision making on a grand scale (like homeschooling and breastfeeding) threatens the livelihoods of some very large companies.
Every woman has the right to make decisions about her body. Any coercion to breastfeed is not just morally unacceptable, it is impractical; in the end only a woman and her baby can make breastfeeding happen. A woman has the right not to breastfeed, but she must be fully informed of the effects on her child and herself. [emphasis mine]
It seems clear to me, not just from this book but from other reading and research I have done, that formula is a far inferior choice to breastfeeding. There are many reasons a woman or a family may choose to give formula to their child, and they should have access to safe, nutritious baby food. I question, though, whether most women in the United States are fully aware of all the facts. I'm quite sure I don't know all the facts. It's very difficult to find an objective study, one that has not been compromised by grants from formula-producing companies. Sometimes I find it just as hard to believe the pro-breastfeeding sites because I feel like they exaggerate the benefits as well.

I could write more and more on this topic, but eventually I have to stop. I have other things I want to do with my life. I will leave you with a few links to sites I've visited recently or found while thinking about this book.
Now, off to nurse my baby! (Just kidding; he's already asleep.)


    1. It sounds like she's got it turned around a bit {said the woman who hasn't actually read the book}. It's not so much a war on breastfeeding as that we've built a culture into which breastfeeding doesn't neatly fit. The funny thing to me is that she attacks "economically dependent" women, as, in my experience, they are the ones most like to...breastfeed! Plus, that is the only holdover from the times when the culture was hospitable to nursing.

      I did not make enough milk for my babies. I apparently have insufficient glandular tissue. I nursed my children until they screamed at me {for not having a fast enough flow}. This mean 6 months, 7 months, 4 months, and 9 months, respectively. I had to supplement with formula for most of them, though occasionally I was given donor milk which I happily fed them. I agreed that human milk is far superior to formula, but I must say I was grateful to have something to feed my babies when things went wrong for me.

    2. Brandy, I think she'd agree that our culture is not breastfeeding-friendly. While she'd blame the formula companies (and complicit medical staff) for some of that, I think she'd probably agree that some of the effects on breastfeeding were secondary rather than intended.

      I think it's absolutely true that being able to stay home with a baby makes all the difference in breastfeeding. Back when the US tried it's breastfeeding awareness campaign (squashed by the formula companies, according to Ms. Palmer), I told Kansas Dad I thought the best way to increase rates at 1 year was to pay women for one year of maternity leave. I pumped while working full time for First Son and there's nothing fun or convenient about it, even in a company that was willing to let me work part-time from home and gave me as much time as I needed at work for pumping.

      I remembered you supplemented and I have other friends who have as well. That's why I was intrigued at the prescription option. We could have safe, reliable, nutritious food for babies who needed it when breastfeeding wasn't an option. I also think it would be nice to funnel some of those formula-advertising-dollars to supporting the growing network of milk banks.

      Not that it's going to happen.

    3. Interesting review and topic in general. I could rant but I think I'll refrain. You've said a lot of what i htink..

      I think another reason why breastfeeding is often avoided or frowned upon is the continual sexualization of women/breasts. The general public who think it is icky or immodest for a woman to breastfeed her baby when and where she pleases. This irks me to no end as I see it becoming more and more prevalent. I am not going to deny my baby the opportunity to eat when he or she needs to simply because it may make others feel awkward. I believe that this is their problem and not mine. I'm not going to be in your face about it, but my goodness if my baby needs to eat then they will eat, and I'm not going to do gymnastics trying to feed him or her under a blanket or wrap while they kick and squirm and to get out. Just let me feed my baby. Your average teenage girl has more hanging out simply walking around the mall than I do when I breastfeed. And now I'm ranting and I said I wouldn't. Just another angle to consider...

    4. Monica, Ms. Palmer does discuss that very issue in the book. I didn't mention it here on the blog because my review was already long enough. Also, to be honest, I haven't experienced those situations myself. I've nursed just about everywhere in New York City, here in Kansas and while traveling in all sorts of other places and most of the time receive no comments or looks other than those from mothers who seem to know what it's like.


    Comments make me happy; thanks for speaking up!