I just finished reading Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn't (by Suzanne Barston from Fearless Formula Feeder) and I think every breastfeeding advocate should read it.
Why, you may ask, should breastfeeding advocates read a book that is written by someone whose main goal is to stand up for formula feeders? Well, there are several reasons:
- First, they should read it so that they can get out of the echo chamber that often exists in the breastfeeding advocacy world and get a fresh and well-researched perspective on some of the things that people in the breastfeeding community often simply accept as gospel. Perhaps some of those the whole truth and nothing but the truth, but perhaps there are other things we've just repeated so many times that they feel true even though they are not.
- Second, breastfeeding advocates should read this book to get a more comprehensive understanding of the barriers to breastfeeding -- not just the medical ones, but also the societal, psychological, and socio-economic barriers.
- Third, the book does an exceptional job of explaining why and how the choice to breastfeed or not truly is individual and personal.
That said, as I worked my way through the book, I alternated between nodding and shaking my head. In this post, I'll touch on a few of the issues that caught my attention and I'm sure I'll bring others up in future posts too.
Guilt Trips
In the introduction to her book, Barston asks:
Why are we focusing so much energy on convincing women they have to breastfeed rather than offering better help to those who want to, and working to make formula the safest and healthiest alternative that it possibly can be? All of these questions danced seductively in my head, coming together for a big Chorus Line finish, the one singular sensation question that no one seemed willing to answer: Is breastfeeding really so superior that it justifies the guilt trip we heap on all of these women, essentially scaring them into nursing?
The answer to that question, in my mind, is no. We don't need to scare anyone into nursing. We need to provide evidence based information (to help moms decide) and evidence based education and support (to help moms succeed). The problem, from my perspective, is that there is insufficient evidence based support (for breastfeeding or for formula feeding), but there is plenty of propaganda and rhetoric from both formula companies (that have HUGE budgets) and the breastfeeding advocacy community (that have very small budgets, if at all).
If I feel my voice is being drowned out (especially by deceptive corporate advertising campaigns), I'm more likely to yell. I think that is what leads to the "guilt trip" that sometimes comes from lactivists. This is one of the reasons that I support a ban on formula advertising (with appropriate enforcement of the ban). I think that if less money and effort was spent on wooing moms on both sides, it would be a much less emotionally charged issue and resources could be put towards supporting moms instead of selling to them.
Feminism and Breastfeeding
There is a difference, to me, between understanding the fact that women and men have not achieved equality in the home or in the workplace and accepting that disparity. Barston brings up examples of workplace barriers to breastfeeding and, as I've discussed on the blog, also raises the issue of inequality within couples. She quotes her friend Megan, who was exclusively breastfeeding her four month old:
I keep hearing these things about how if you're in a truly feminist, truly 'modern' marriage, then breastfeeding shouldn't lead to an unfair division of labor...and I have to say, it's a load of crap.
Personally, I don't think that creating a fair division of labour in parenting, or in relationships in general, is something that just happens by accident. Traditional gender roles, our own upbringing, wage disparity, and many other issues reinforce the woman's role as the primary parent and primary housekeeper. Assuming that there is a solution to inequality at the bottom of a can of formula is naive, in my opinion. A truly equal partnership will find a way to remain equal in the face of breastfeeding and formula will not create equality in a partnership where it didn't already exist.
The same is true of a workplace, I think. In an environment where woman are empowered and trusted, they will be able to find a way to pump at work. In an environment where women are not empowered and trusted, not being able to pump at work is likely just one of the many workplace issues they are facing.
All that to say, I don't think we should just accept the status quo. I think we should continue trying to create a society where more relationships are respectful and equal and where more workplaces trust and empower their employees. We shouldn't do this for the sake of breastfeeding, but if it allows more women to breastfeed if they want to then great. While we work on that, we need to accept that each woman will need to come to terms with her own situation and make the feeding decision that is best for her (without projecting her situation on everyone else).
Shifting the Breaking Point
One of the most interesting questions for me is why do women give up on breastfeeding? I mean, I know the reported reasons and the unreported but documented contributing factors, but I want to know how to shift the breaking point. In her book, Barston gives the example of Norway:
Although the six-month breastfeeding rate in Norway is an impressive 80 percent, this still means that 20 percent aren’t breastfeeding to the “required” six-month mark— in a culture where, as one Norwegian woman told the New York Times, “Women who are not able to [nurse] are very, very sad. … They feel like failures if they cannot breast-feed.” If there are no social constraints, no formula advertising or hospital freebies, and women don’t have to return to work, why are 20 percent “failing”? Even within the first month, 12.9 percent of women in a large Norwegian cohort suffered from breastfeeding problems so severe that they required medical intervention. Chances are that not all of these women were suffering from primary lactation failure, but obviously there are issues here that “ideal conditions” cannot wipe out, and a significant number of women— and their babies— are suffering the consequences.
In the United States, around 47% of babies were still breastfed at 6 months (16% exclusively) and in Canada 54% were breastfed (14% exclusively), which is dismal considering that over 90% of women in Canada initiate breastfeeding. Women in Canada and the United States are bombarded by formula advertising, hospital formula freebies, formula freebies sent to their home, formula freebies in maternity and baby stores, formula ads in their doctor's office, and so on. Women in the United States have dismal maternity leave, while women in Canada have better leave options (although certainly not perfect). In Bangladesh, 64% of babies are still exclusively breastfed at 6 months and 95% of one year old babies are still being breastfed.
I don't know much about breastfeeding in Norway beyond what I read in Suzanne's book, but even the 80% that they've achieved there seems pretty impressive to me compared with what we see here in Canada and the United States. Perhaps the difference between the 50% mark being reached in Canada and the United States and the 80% reached in Norway is the creation of those "perfect conditions", while the difference between the 80% in Norway and the almost universal breastfeeding in Bangladesh is the affordability and accessibility of infant formula. If women truly do have the best support possible in Norway, but also have the option of being able to buy formula, then maybe 80% is a reasonable goal for developed countries. I think it is entirely possible that there are 20% of women who either cannot or do not want to breastfeed their babies and (in a developed world context), I think that is okay. I'd love for them to be able to be able to access human milk, if they desire, instead of just formula, but 80% sounds like a dream to me right now.
And...
The word that comes to mind more than any other when I look at the things Barston suggests in her book and compare them with things that I might suggest is "and". We need to normalize breastfeeding by having more moms breastfeed in public AND we need to stop judging moms who take out a bottle in public. We need to ensure that women in developing countries are given adequate breastfeeding education and support AND we need to ensure everyone has access to clean water in case they need or want to prepare formula. We need to be willing to "listen to the myriad of reasons that women may choose not to nurse" AND we need to realize that "just try formula" isn't a welcome or useful solution for someone who feels passionately about nursing her baby and just wants quality support.
At the end of the book, Barston talks about a woman who went through the same breastfeeding struggles that she did, but ended up being able to keep breastfeeding. Barston wrote: "Logic says that I should have found this threatening to my sense of self. I'd been frantically repeating the narrative of I had no choice but to stop breastfeeding to myself and anyone who would listen, and here was someone who had been in an eerily similar situation and persevered. What did that say about the truth I held to be self-evident?" She goes on to say that "as the conversation progressed, she told me how much breastfeeding meant to her, and how relieved she felt that she could still do it despite her son's allergies." That, in a nutshell, is why I do what I do. I want women like her to be empowered, educated, and supported if they want to keep breastfeeding. Barston, on the other hand, does what she does in the hopes that the "mom who wants so badly to quit breastfeeding and finds nothing but fear-and-guilt-inducing literature everywhere she turns" will "be able to make a truly informed decision" and "sit beside her breastfeeding friends, free from insecurity and judgment."
I think we want the same thing. I think we want women to be supported and empowered in their choices. I think our stories, our advocacy, and our approach is closer together than most people would imagine it to be. I think our slightly different yet well thought out and researched perspectives on the same situations can allow us to have the types of conversations that will move the bar forward. Thank you, Suzanne, for your book and for reading and commenting on my blog from time to time. Together, we can make a difference for both breastfeeding moms and formula feeding moms.
