Breastfeeding, advocacy and women’s rights

In June 2015, I heard a fantastic talk by Keith Hansen, Vice President for Human Development at the World BankGroup, at the Academy of Breastfeeding Medicine summit. Hansen spoke eloquently about the importance of breastfeeding for both global health and economic development; he said, “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

I’d brought my teenage son with me to Washington, and when we met up for lunch, I shared Hansen’s quote. He responded, “If breastfeeding were invented today, there would be an outrage, because of feminism.”

It took me a few seconds to fully process this response, as I began to consider the implications of a newly-discovered practice that would require one half of the population to engage in thousands of hours of unpaid work, at all hours of the day and night, for the greater good. There would, indeed, be an outrage.

Naturalizing Breastfeeding Through Filters

Every day since 2010, I spend a couple of hours reading and responding to posts in  a Facebook group of physician women who are breastfeeding/pumping/advocating called Dr. MILK (www.drmilk.org).  And in the last 72 hours our group’s feed of 5200+ international physician mothers has exploded with dozens of deliciously gorgeous #brelfie pics of themselves nursing or pumping for their kids using the concept of the #treeOfLife breastfeeding selfie.

I completely derailed my entire Sunday evening of finishing newborn nursery charts and billing to create my own “Tree of Life” photo with dazzling filters, and I wanted to give credit to the person who came up with the idea.  So I did some serious journalistic Googling and found Cassie @keeponboobin (Instagram, Twitter) and tagged her in a series of posts of my own kids from 2012.  She wrote back in admiration of my edits (feigned blushing) and reposted my pics to her own account (as is customary in social media etiquette).  I asked her to be interviewed for this blog to explain how this viral campaign came to be and how it has changed the landscape of women fearlessly posting bare-breasted nursing photos.

The very FIRST tree of life pic!

The following are excerpts from our dialogue of her inadvertent campaign to #naturalizeBreastfeeding and give women confidence to share with the world their pride in making milk for their children.

How did this Tree of Life concept unfold?

“After celebrating my 12 month anniversary of nursing my daughter, I wanted to commemorate with a nursing photo that I could hang on the wall. I had recently learned about how breast milk was considered a living organism and that having fascinated me, I chose to try and incorporate that into our photo. We had a rough beginning when we started nursing, so this was something that was truly special to me. I came up with the idea to use Photoshop and create a flower, with the vines going from my breast to her brain. A metaphor for her ‘blossoming’ into this beautiful child. While nursing her one day, I took a photo of her on my cell phone and decided to play around with it, kinda work out the idea I had come up. “

“I was able to add a flower to the photo but didn’t really like the way it looked. That is when I decided to try a tree instead. I gave it a kind of artsy look through the app’s many filters they offer and just fell in love with it. I had originally intended to take a professional photo with my camera and do this all on the computer but I really loved what I had created.”

Is it really about sexualizing breasts? Or is it about rape culture?

A guy friend once informed me that breastfeeding breasts aren’t sexy. Sure, there might be the odd dreamboat (thank you, Brad Pitt) who will publicly announce his preference for the breeding female form, but my friend explains: “Breastfeeding breasts aren’t sexy. No one thinks they are sexy! They are generally overfirm, or oblong, with a giant nipple and a BABY attached to the end!” (He also has lots of very warm and supportive opinions of breastfeeding women) Let’s repeat that: “A baby is attached to it;” and that baby probably just pooped itself.

This struck me as essentially true, so it got me thinking: what’s the deal with the worry that this cultural myth of “breasts are for sex, not feeding” undermines women’s ability to feel comfortable with breastfeeding in public? What’s up with the leagues of women telling us they feel over-sexualized while breastfeeding? Or, at least, the leagues of lactation consultants and breastfeeding advocates worrying about it? In fact, it seems important to point out that breastfeeding women aren’t walking around complaining that they feel too sexy. In fact, one of the main reasons teen moms will give for not breastfeeding is that it isn’t sexy. Not to mention the common misconception that breastfeeding causes one’s breasts to become prematurely saggy. Saggy…real sexy. So, if we, as breastfeeding advocates, are not getting this directly from moms, where does it come from?

I #March4Nutrition to make #breastfeeding a right, not a privilege

I #March4Nutrition because breastfeeding is a powerful predictor of health and wellbeing for mothers and infants — and yet, too many families face barriers that prevent them from achieving their own breastfeeding goals.

Families who want to breastfeed navigate a veritable minefield of “Booby Traps.” Many maternity providers have minimal training in lactation support, and providers may not ask about breastfeeding during prenatal care — or spend only seconds on the topic — missing the opportunity to address concerns and provide guidance.  Parents are inundated with misleading materials from infant formula manufacturers, promising that their product is “designed to be like breast milk” or will magically convince fussy babies to sleep through the night. Indeed, in a study, mothers looking at formula advertisements voiced concerns that their milk didn’t have added vitamins, so perhaps it would be healthier to formula feed.

At birth, too few families receive evidence-based maternity care that gets infant feeding off to an optimal start. For example, putting a baby skin-to-skin for the first hour of life increases breastfeeding duration by as much as 6 weeks — yet 28% of US hospitals do not provide such care to most women.  Skin-to-skin is one of the World Health Organization Ten Steps to Successful Breastfeeding. Hospitals that implement all ten can be designated as “Baby Friendly” – but currently, only 11.5% of US maternity centers meet that standard. It’s worth noting that we are making progress — just 2.9% of hospitals were Baby Friendly in 2007 — but 88% of families are still hobbled at the starting gates when they start their breastfeeding journey.

Reports on breastfeeding sibling study are vastly overstated

A recent analysis of breastfeeding’s effects on child health is making headlines that some of the benefits of breastfeeding have been overstated.

The authors examined behavioral assessments of children born between 1978 and 2006. When they compared breastfed children with formula-fed children, they found that the breastfed kids were healthier and smarter, as many other studies have previously reported. However, they then looked at families in which only some of the children had been breastfed, and they found that whether or not siblings were breastfed did not significantly affect their health outcomes. The authors argue that this proves that a child’s family – not infant feeding – is what really determines long-term child health, and breastfeeding doesn’t really matter.

The biggest problem with this conclusion is that the study ignored anything that happened in these families before their children reached the age of 4, disregarding well-established links between ear infections, pneumonia, vomiting and diarrhea and the amount of human milk a baby receives. There’s strong biological evidence for these relationships, because formula lacks the antibodies and other immune factors in breast milk that block bacteria from binding to the infant gut and airway. For preterm infants, formula exposure raises rates of necrotizing enterocolitis, a devastating and often deadline complication of prematurity. And evidence continues to mount that formula feeding increases risk of Sudden Infant Death Syndrome. Furthermore, mothers who don’t breastfeed face higher rates of breast cancer, ovarian cancer, diabetes, high blood pressure and heart attacks. None of these outcomes were addressed by the recent sibling study. The paper’s authors note they were interested in longer-term outcomes in childhood, but that’s been lost in the news coverage, which has effectively thrown out the breastfeeding mom and baby with the bath water.

Emotional (!) responses to breastfeeding promotion and formula marketing

Is anyone besides me endlessly fascinated by how emotional we all become about infant feeding?  It’s such a big part of mothering, & I would submit that we get emotional about our kids because they are so precious to us.  (As my 10-year-old would say, well, duh.)

In response to my rant about the formula company putting my name on their advertising rag last week,  a friend I hadn’t heard from in years sent me a lovely private message saying that the “tangle over breastfeeding” left adoptive moms feeling ignored and left out.  “(W)hen (my kids) were babies, I often felt badgered and belittled by the insistence that breast milk was best… We were, after all, feeding our kids.”

I tried to apologize for leaving adoptive moms out of the discussion.

I tried to sum up the public health perspective:  that human babies do best with human milk, and that, in the US at least, we feel we are still working to overcome  decades of cultural “belittling” of breastfeeding —  summed up by Jayne’s comment that  “(t)he only reason breastfeeding is seen as so much harder is because our culture and often our medical professionals totally undermine it.”.

And (rhetorically, perhaps) I asked whether there is a way for the public health community to avoid hurting feelings while still counteracting the cultural forces of formula marketing, back-to-work pressures, and just plain undervaluing women in general.

Perhaps there is some explanation, if not an actual answer, in the State of the World’s Mothers 2011 report.  (For those who haven’t already heard, the US comes in at #31 among 43 developed countries surveyed.)

And I think the US Surgeon General’s Call to Action to Support Breastfeeding (full statement here)  is an important start toward improving our situation in this country, beyond the simple repetitive  “breast is best” message that seems to have so hurt and angered my friend.

Happy Mother’s Day to all of us!   Love your kids, nurture them … feed them.  It’s what we do.

Kimberly Lee is a neonatologist and member of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

What does feminism have to do with breastfeeding?

At first blush, most people would say, “Nothing at all.” After all, the conventional wisdom is that breastfeeding is a maternal duty that forces women to eschew their career aspirations to fulfill some ideal of motherhood, while feminism is about liberating women from exactly those constraints. Case closed. Or is it?

I’ve had to good fortune to think a lot about breastfeeding and feminism in the past few weeks, in preparation for a fascinating discussion on NPR’s  The State of Things. Paige Hall Smith,  Director of Center for Women’s Health and Wellness at University of North Carolina at Greensboro, set up the discussion beautifully: for the most part, “Feminist advocacy doesn’t consider breastfeeding, and breastfeeding advocacy doesn’t consider the context of women’s lives.”