‘Breast is Best’: the worst kind of hectoring
Two new books explode the pseudoscientific idea that bottle-feeding is evil, and reveal what a poisonous impact the pro-breast lobby has had.
Last summer, New York City mayor Michael Bloomberg’s administration instituted a new set of guidelines for city hospitals, which were aimed at encouraging women to breastfeed. The measures included banning complimentary diaper bags with formula samples that were traditionally distributed to new mothers, and instructing nurses to ‘remind’ women why breastfeeding is superior before giving them infant formula.
If Bloomberg’s policy wonks expected warm, fuzzy accolades for their efforts, they were wrong. What they got was white-hot rage from women fed up with hearing that their decision to feed their babies with infant formula was ‘second best’. Within a day of launching the new guidelines, the mayor’s press office took over handling enquiries from the Department of Health, and officials’ bleating protestations started appearing in the comments of even the most obscure mommy blogs: ‘We read your blog post with interest and want to address some inaccuracies…’
The interesting point here is not the relentless obnoxiousness of the Bloomberg administration in its quest to transform New Yorkers from their sassy food-loving selves into svelte, cycling locavores. No, it’s the reaction to a policy intended to promote breastfeeding – the one health initiative for which, in the words of the Department of Health, ‘there is overwhelming evidence – supported by national and international health organisations’. The evidence for the superiority of breastfeeding was supposed to be unassailable, uncontroversial, incontrovertible – end of story. But it’s not – and it won’t ever be again, as two new books on the subject, Suzanne Barston’s Bottled Up and Zoe Kleinman’s Birth, Boobs and Bad Advice, reveal.
These authors are by no means the first to question the pro-breastfeeding campaign. Joan Wolf of the University of Texas shook up the debate when she published her earth-scorching critique, Is Breast Best?, in 2010, and many other distinguished academics, including spiked contributor Ellie Lee, have challenged the consensus about breastfeeding. The difference is that Barston and Kleinman, both journalists, are writing as mothers and for mothers; mothers who feel they were sold a bill of goods when it comes to infant feeding. And when it comes to the claims for breastfeeding, they absolutely were.
Consider the contradictions. Breastfeeding is natural, but doesn’t come naturally and apparently requires an army of experts, breastfeeding-friendly hospital policies and ‘continuous support’ to make it happen. Breast milk is ‘best’ for babies – unless your baby can’t tolerate your breast milk or is actually allergic to it. (Yes, it happens.) Breastfeeding is a wonderful bonding experience, unless you and your baby dislike it so much you begin to dread each meal. Studies show that breastfeeding will make your baby smarter, healthier and thinner – at least if you ignore pesky details like statistical significance, the distinction between causation and correlation, and confounding factors like the meaning and impact of the decision to breastfeed versus the biological effects of breast milk itself.
Until recently, the experiences of women like Barston, Kleinman and the others whose stories they share might have become the fodder for ‘momoirs’, those funny and sometimes sad expositions of the gap between the ideals of motherhood and the reality. The fact that they didn’t is largely due to a breakdown of the consensus about breastfeeding at the hands of breastfeeding advocates themselves. The watershed moment that made both these books possible came in 2003 when the US Department of Health and the Human Services Office of Women’s Health brought out a series of pro-breastfeeding ads that stretched credulity.
Their campaign featured a series of ads with heavily pregnant women engaged in incongruously dangerous activities. The most controversial of these showed a woman riding a mechanical bull with the caption: ‘You wouldn’t take risks before your baby is born, why start after? Breastfeed exclusively for six months.’
It was so blatantly calculated to play on parents’ fears and to exploit the implied dangers of formula feeding. The campaign was so over the top that it drew criticism from individual mothers, doctors and even the executive committee of the American Academy of Pediatrics. It also drew the attention of a number of academics interested in the question of risk. As they investigated the claims for breastfeeding, it began to dawn on many of them that the Breast is Best campaign – not just this particular series of ads, but all of it – had inflated the benefits of breastfeeding while exaggerating the risks of formula feeding beyond all proportion. Furthermore, the obsession with breastfeeding seemed to sideline the needs of individual mothers and babies in favour of an ideal that, even for women who breastfed successfully, bore little relationship to reality. Seen in this light, it became clear that the Breast is Best campaign was not really about infant feeding at all, but rather about motherhood itself.
This crack in the breastfeeding consensus set the stage for Barston and Kleinman, because it posed a reasonable and rational alternative to the monolithic commitment to breastfeeding. It also created a great deal of righteous indignation among women, both because they had been treated like failures by healthcare workers, other mothers and even nosey strangers simply because they decided to formula feed, and because – this is where the rage became visceral – most had bought into it themselves. They had blamed themselves and felt frightened for their children and often gone through a sort of living hell, for essentially no real reason at all.
Barston and Kleinman’s books are both products of this breakdown of consensus and part of its evolution into a different way of looking at the problem; and though they cover much of the same ground, each has something slightly different to tell us about the problem.
Kleinman’s Birth, Boobs and Bad Advice is informative and validates the experiences of any woman who has fallen foul of the breastfeeding lobby. Mainly, though, it is wickedly funny at the expense of healthcare workers. Kleinman is extremely critical of the spotty nature of support for mothers in the UK, and midwives in particular. This may surprise American readers who are often assured that the key to increasing rates of breastfeeding in the US lies in providing new mothers with environments rendered nursing-friendly by virtue of the presence of British-style lactation consultants and qualified midwives. In reality, Kleinman shows that their presence seemed to have almost the opposite effect for her and for many of the other women interviewed for the book.
The problem didn’t seem to be the midwives themselves. Some were sympathetic, some were not, and some seem destined for some special circle of hell. But the main thing is that somehow the desire to promote breastfeeding seemed to blind them to the needs of the women and babies they were supposed to be helping. Virtually every new mother Kleinman interviews had some nightmare encounter with a midwife, including one woman whose midwife insisted that spending time with her husband in a hospice (he died a few days after their child was born) was ‘no excuse’ for not breastfeeding. One of the midwives Kleinman saw insisted that her son wouldn’t latch on because ‘You haven’t cooked this one properly’.
In the end, though, Kleinman begrudgingly admits that midwives are probably not the main problem. ‘I am also learning’, she writes in her conclusion, ‘that as a parent, everything you do is up for grabs to be judged by others. Vaccinations, sleep arrangements, clothing, haircuts… perhaps the breastfeeding issue hurts so much because it’s a brutal baptism of fire.’
Barston takes a slightly different approach in Bottled Up. She begins with the astute observation: ‘Whether as a matter of necessity or preference, the way we feed our infants has become the defining moment of parenthood. Breast is not only best; it is the yardstick by which our parenting prowess is measured.’ To offer real answers to mothers for whom breastfeeding is not working, the reason Barston wrote her book, will require not just an interrogation of the science of infant feeding and risk, she says, but also asking the question of why science has come to dominate questions of personal choice.
The result is a compelling and occasionally moving book that spends as much time exploring the roots of America’s obsession with breastfeeding as with the breastfeeding itself. Barston has a gift for expressing difficult concepts, such as the confounding factors that complicate the study of the effects of breast milk, in an accessible way. In one of my favorite examples, she happens to notice that a lot of people who work for the Transport Security Administration (TSA) seem angry. ‘One might suppose’, she quips, ‘that working for the TSA turns you into an angry person. This isn’t necessarily the case. Maybe angry people are attracted to jobs at the TSA, or maybe the person in charge of hiring TSA staff has a sick sense of humour. These are confounding factors, variables that are related to the variable being studied, which can either hide a true effect or imply a false one.’
Reading Bottled Up, I found myself thinking that it should be required reading for all new parents, regardless of how they feed their infant, just because it does such a great job of interrogating the scientism that has come to permeate every child-rearing decision.
The one thing missing from both these accounts is a more thoroughgoing critique of the support offered to new mothers. Kleinman points out that midwives aren’t much help to formula-feeding mothers because they (incredibly) do not always know basic things about mixing it. Barston is rightly critical of the one-size-fits-all approach to infant feeding that leaves mothers who can’t breastfeed out in the cold.
These are valid criticisms and in some ways the obvious response is to demand more support and proper support for formula-feeding mums. And yet, it may be that what we should really be doing is questioning the need for expert advice at all. We should question it because, as much as the mechanics of breastfeeding take some getting used to and formula does need to be mixed correctly, neither is rocket science. What’s difficult is the frenzied atmosphere learning these basic skills now takes place in.
How, then, would women learn how to feed their babies? The best answer may be simply to rely on the kindness of strangers and on other, experienced mothers with no political or moral stake in how infants are actually fed.
Nancy McDermott is a writer and mother based in New York.