On Tits & Tyrannies: We're Asking the Wrong Questions About Breastfeeding
Several months ago, someone asked a question during a discussion of autonomy and dignity in reproductive health that gave me pause.
What about breastfeeding? It seems as though it is being shoved down everyone’s throats. And now the Mayor wants hospitals to stop giving out formula samples, and the subways have ads promoting breastfeeding, when not everyone can or wants to. It’s shaming.
The speaker, a professor, was livid – her voice quavered like she was on the verge of tears. She didn’t elaborate further, but it was clear that she was having a strong personal reaction to the public health campaign. Like many parenting decisions, whether or not one breastfeeds and whether or not they are supported in that decision can feel deeply significant. Most of us who are raising children have at some point felt the sting of judgment of our parenting. And, no doubt, the increased scrutiny of parenting by state authorities is a destructive force in our society.
But are the public health campaigns in support of breastfeeding bullying parents? Are these campaigns, and the professional and lay lactation consultants who carry them out, promoting a guilt-ridden tyranny of the breast?
Shame and stigma have should have no place in our conversations about people’s reproductive decisions. At the same time, as with analyzing any form of oppression, it’s important to keep clear distinctions between the individual and the systemic.*
Much of the criticism of the promotion of breastfeeding centers on experiences that occur on the individual level. For instance:
Someone on a parenting forum says that parents who formula feed may as well give their babies poison because formulas contain ingredients in jet fuel (yes, this happens)
Someone gives a parent a dirty look or says something nasty when they pull out a bottle to feed their child in a public place
Someone makes a sanctimonious comment about how they just don’t know how someone can bond with their baby if they don’t breastfeed
Someone felt immense sadness and shame after attempting to breastfeed and being unable to
Someone felt exhausted, ignored, or “like a dairy cow” after taking great efforts to start or maintain a breastfeeding relationship, perhaps at the urging of medical professionals
These experiences on the individual level can break out into the internalized (private beliefs that people have, including beliefs about themselves and other people), and the interpersonal (interactions between two people, when private beliefs influence public actions).
What individuals feel and believe, and what individuals say or how they treat other individuals, absolutely matter. But these individual interactions, even in the aggregate, don’t create the cultural context in which we exist. Our cultural context is determined by policies and practices on the systemic level. The systemic level includes the institutional (what happens in institutions and places of power, such as schools, workplaces, and correctional facilities) and the structural (what happens among institutions and across society, including the compounding effects of history, culture, and ideology). On balance, these policies and practices do not favor breastfeeding parents, and point to inaccessibility of breastfeeding for certain populations. For instance:
Workplace protections for breastfeeding parents – including sufficient parental leave to establish a breastfeeding relationship and time to pump upon return to work – lag behind other nations. Only recently did the Affordable Care Act amend the Fair Labor Standards Act to require non-bathroom space to pump and unpaid breaks to do so. This provision does not apply to businesses with fewer than 50 employees.
Though nearly every state has a law permitting breastfeeding people to nurse in public places where they are otherwise permitted to be, most of these laws lack any form of enforcement mechanism.
While the rate of initiation of breastfeeding has rebounded from historic low points and is now approximately 79%, it varies widely across states, with high-poverty states having lower rates of breastfeeding initiation and even lower rates of breastfeeding at 6 and 12 months.
Breastfeeding rates among women of color, specifically Black and Native women, are lower than those of white women.
People in correctional facilities – including pretrial detainees – are routinely denied equipment to pump breast milk to save for their infant or to relieve pain.
Child welfare authorities intervene against parents who seek to breastfeed while receiving opioid treatment for pain or addiction, even when medical personnel are encouraging fostering a nursing relationship, and even though research suggests that nursing can reduce or eliminate the need for treatment of neonatal abstinence syndrome.
Is “breast is best” the best possible slogan? No. Is it okay for people to snark or snipe at parents who feed their babies formula? Never. But focusing almost exclusively on the individual to shut down attempts to provide support to breastfeeding parents lets the systemic problems – and they are significant – persist. Casting infant feeding as just another front in the so-called “mommy wars” (interpersonal ideological clashes from which no actual parents benefit), we lose sight of some important truths:
It is not a zero-sum game. Encouraging one infant feeding option does not necessarily come at the expense of people who choose another. If we want to achieve reproductive justice, we need to be able to hold complex realities and provide support for multiple options. We can encourage health-promoting behaviors without devaluing people who engage in other behaviors. We can provide the support that people need to overcome institutional and cultural barriers without invalidating the people whose choices have institutional support.
There are reasons to want to breastfeed that have nothing to do with research or evidence – especially for people of color. Recently, there have been various claims that the touted benefits of breastfeeding are oversold: it doesn’t always make people lose weight quickly, the immune system benefits are marginal, promised IQ points never materialize. But maybe there are things that matter more. Promoting health and parent-infant bonding in communities of color is a radical act of resistance. Native activists are doing inspiring work, supporting breastfeeding as “the first sacred food”: asserting food sovereignty and reclaiming cultural practices. When it comes to tyrannies, the policy throughout US history that Native women are unfit to parent and the removal of their children by force likely ranks higher and cuts deeper than the suggestion that infant formula is something less-than-best. Similarly, under slavery and other forms of servitude, Black women’s breast milk was treated as property of the master and nourished white babies, even at the expense of their own infants. Even today, for-profit groups urge Black women to sell their milk (at a smaller profit, of course), leading Black breastfeeding collectives to question their motives. “Natural” is socially constructed and highly commodified, but there is value in ancestral cultural practices, especially for people whose culture has been targeted for eradication, and for whom every possible health advantage is crucial in closing the gap.
We should maintain healthy skepticism of corporate motives. Some commentators claim that banning hospitals from providing free take-home formula samples further disadvantages low-income women. Corporations don’t offer samples out of kindness. They know that once the breastfeeding relationship is disrupted, a baby will have to be fed with formula until they are weaned. They also know that women are most likely to use the formula they see in the hospital, and stand to gain WIC dollars from low-income women (for breastfeeding folks on WIC, those dollars go to nutritious foods for the parent, who passes the nutrition on to the baby). These are the same corporations that have been slapped with lawsuits for misleading claims in the US and have been subject to decades-long boycotts for undermining breastfeeding in countries where a lack of clean water can make formula feeding deadly.**
We should not let injustice beget injustice. One frequently cited reason for opposing efforts to encourage breastfeeding is that low-wage workers very rarely have jobs that permit them to pump milk, or money for equipment to do so. But should worker-unfriendly policies dictate how we feed infants? Workplace constraints create an illusion of choice and obscure the real problem, which is that everyone should have the security to transition between care work and work in the market economy as their family’s needs change, and the support to continue to meet those needs.
There has been significant improvement in the rates of breastfeeding, but there is still a way to go until breastfeeding assistance is freely available for as long as it is needed, racial disparities are eliminated, and workers have space and time for feeding or pumping. I’ll be ready to have the conversation about World Breastfeeding Week being oppressive to people who can’t or don’t breastfeed when everyone has the support they need to breastfeed successfully if they want to. That day hasn’t arrived.
* Here I acknowledge an enormous debt to the work of Race Forward for articulating this analysis with respect to racism, from which I draw heavily. I highly recommend their report, and the accompanying overview by the ever-impressive Jay Smooth.
** This is all said with the understanding that corporations are increasingly attempting to capitalize off of breastfeeding, offering lines of milk extraction and storage products. But these corporations (we’ll call them Big Boob), create products that are not strictly necessary.