Karen Gregory reviews the 20th anniversary edition of The Politics of Breastfeeding by Gabrielle Palmer
Why has artificial feeding become the norm in many parts of the world? Why are worldwide sales of bottles and artificial feeding products still rising, and what are the health implications of this trend? How has breastfeeding become so damaged and who is better off as a result? Are mothers more equal, healthier and happier because they have been ‘freed’ from the tyranny of breastfeeding? Or are the real beneficiaries the multinational corporations that profit from the baby food market? In The Politics of Breastfeeding, Gabrielle Palmer seeks to answer some of these questions through a wide-ranging examination of the place of breastfeeding in today’s society. Encompassing discussions on the mechanics of breastfeeding, HIV and Aids, birth practices, fertility, wet nursing, economic developments since the industrial revolution and ecology, Palmer’s key message is that the decline in breastfeeding can be explained within an economic system which values its destruction in the name of profit.
The first edition of the book was published more than 20 years ago, in 1988. In the preface to this third edition, Palmer surveys the changes in feeding practices over the past two decades and concludes that we now have a far greater knowledge about the positive effects of breastfeeding, but the baby food industry continues to engage in ever more aggressive marketing of their products and the spread of misinformation about breastfeeding.
This has had particularly tragic consequences in the developing world. The figures she quotes are shocking. The global value of baby food sales is projected to reach $20.2 billion annually, of which two thirds will come from infant formula sales. Yet, throughout the world, three thousand babies a day die from infections triggered by the use of risky products such as bottles and artificial milks.
There are many reasons why artificial feeding is particularly dangerous in the developing world. Often there is limited or no access to clean, fresh water or fuel to boil it. Artificial milk takes up a large percentage of income and many are unable to read the instructions on the packets, either through illiteracy or because the instructions are in the wrong language. The damaging effects of artificial feeding in developing countries are well recognised and concerted efforts have been made to control the activities of the baby-food manufacturers. These have included adopting standards, such as the International Code of Marketing of Breastmilk Substitutes, which aim to promote breastfeeding and limit some of the misinformation promulgated by the baby-food industry. But Palmer shows how the industry simply ignores, circumvents and flouts this code. Over and over they have engaged in aggressive marketing strategies, media manipulation and attempts to influence government policy. One is left with the impression of a highly unethical industry cynically pushing its products throughout the world with little regard to the tragic human consequences.
What about babies in the West? Palmer argues that the advances in medical care and living standards in Europe and North America have mitigated many of the harmful effects of artificial feeding we see in the developing world. Nevertheless, she goes on to list a raft of risks associated with a lack of breastfeeding, including a greater likelihood of the baby suffering diarrhea and respiratory infections, meningitis, ear, urinary tract and blood infections, an increased likelihood of dying of SIDS, overweight and obesity, high blood cholesterol and asthma.
For a mother, the longer she breastfeeds the lower her risk of breast and ovarian cancer, bone disease and hip fractures. What does this mean in financial terms? Palmer quotes research by UNICEF, the National Chldbirth Trust, Save the Children UK and the UK Natinal Breastfeeding Awareness Group which showed that if all British babies were breastfed for three months, the NHS would save £50 million a year in the treatment of just one disease – gastroenteritis – and 400 deaths from breast cancer might be prevented.
The danger of listing these effects is that information about their likelihood and the difference in outcomes between formula and breastfed babies is difficult to come by. Hanna Rosin recently argued the case against breastfeeding, stressing that the actual health benefits were far smaller than popular literature claims.
The debate for and against breastfeeding often becomes highly emotionally charged; however a key issue I would like to draw out of the book is less around whether women should breastfeed and more to do with the ways their choices are being undermined by misinformation and lack of support, at the same time as pressure is put on them by health professionals to breastfeed. This causes real suffering to thousands of women who attempt to breastfeed but find themselves running into difficulties.
One of the strengths of Palmer’s argument lies not in a discussion of what women ought to do or which feeding method is ‘best’, but in illuminating the way in which women’s confidence in their bodies and ability to breastfeed has been eroded. This can be attributed in no small part to the marketing tactics used by infant food manufacturers. These can be subtle and therefore more insidious. For example, advertisements for formulas to use “when breastfeeding fails” help to put the idea in women’s mind that failure is a possibility in the first place. One of the many examples in the books is a Cow and Gate leaflet from 2006 showing a half-laughing, half-grimacing woman holding a baby exclaiming “I’m thinking of getting a t-shirt made – Danger! Sore boobs!” Messages like this help to subtly undercut women’s confidence by portraying breastfeeding as something that is difficult or painful. For too many women in the West this is indeed the case, but not because this is an experience intrinsic to breastfeeding. As Palmer explains, women often experience breastfeeding as difficult and painful for several reasons. Firstly, many are given inadequate, misleading or actively counterproductive information, often by the very health professionals who are supposed to help them.
Many health professionals and so-called childcare experts still recommend practices such as spacing feedings according to a set routine and limiting the amount of time on each breast. These work to sabotage breastfeeding by interrupting the supply and demand principle. ‘Top-ups’ – additional bottles of artificial milk – also have a negative impact. Each time a baby is topped up the mother’s breasts will produce less milk as they are not being stimulated, leading to a vicious circle of dwindling supply necessitating further top-ups. This can make a mother question whether she is making enough milk or believe her milk has ‘dried up’. Problems such as poor attachment and limiting time at the breast can lead to a reduced supply and painful conditions such as sore nipples, engorgement and mastitis – an inflammation of the breast. My own experience is that we still have a long way to go before women are given adequate advice on starting breastfeeding and what to do when problems are encountered.
Like many women, I absorbed the mantra ‘breast is best’ and decided I would breastfeed. Incidentally, Palmer is critical of this type of language, arguing it normalises artificial feeding and presents breastfeeding as an added extra as opposed to being the normal way to feed a baby. But like many women I knew little about breastfeeding other than it was what you ‘should’ do if you were a ‘good’ mother. My experience was not a positive one. I had continuing problems with sore, cracked nipples and mastitis over the first few weeks due to my daughter having a condition called a tongue tie which hadn’t been picked up by the hospital, midwife or health visitor. The ‘breastmates’ support group I was advised to attend ran only sporadically and not in the school holidays. Eventually the tongue tie was diagnosed by a lactation consultant who I contacted via the internet. She allowed us to travel sixty miles to her NHS clinic where my daughter had a simple procedure to snip her tongue and we were finally pain free. I later found out that tongue tie is relatively common but because it rarely interferes with bottle feeding, many midwifes are no longer trained to spot it.
Experiences like mine are far from unique. No wonder breastfeeding has the reputation of being difficult and painful when women are sabotaged from the beginning by inadequate or counterproductive ‘support’ from the medical profession and so-called childcare experts.
Of course, help to learn to breastfeed would be largely unnecessary if breastfeeding were the norm in our society. We would then learn how to breastfeed in the same way women do in other parts of the world: by seeing it carried out in practice. As Palmer points out, whilst breastfeeding may be normal for babies it is not innate but learned. Where there is no opportunity to see others breastfeed, combined with inadequate or counterproductive information and support, we are setting women up to fail. If we had the basic knowledge needed to breastfeed successfully, including the opportunity to observe other women feeding their babies and toddlers, large amounts of specialist support wouldn’t be needed. Palmer mentions talking to women in areas where breastfeeding was the norm who simply couldn’t understand how a woman could not know how to feed her baby.
It is worth reiterating the statistics on breastfeeding. According to the Department of Health’s 2005 infant feeding survey, 78% of women in England breastfed their babies at birth. By six weeks the figure was down to 50% and by six months to 26%. It should be noted that the survey defined initiation rates as including all babies who were initially put to the breast once at birth even if they then did not go on to be breastfed at all. The number of babies who are exclusively breastfed for the first six months as recommended by the World Health Organization is much lower. A recent article in the Independent on Sunday quoted a figure of 7%.
Why do so many women initiate breastfeeding but then stop? Do some women never want to breastfeed in the first place, but feel pressured by health professionals? How many women are told ‘breast is best’ and then left alone to get on with it? How many feel incredibly guilty or like failures if they experience problems breastfeeding? How can we let so many women suffer because of the hypocrisy of a government which pushes the ‘breast is best’ message but doesn’t fund adequate support for women?
The Politics of Breastfeeding has made me very angry at the cynical way in which the baby-food industry has marketed their products and the collusion of the medical profession in this. We should not forget that babies are still dying because of their products in the developing world. But they have done a great disservice to women in the developed world, too. By undermining our confidence in our bodies, which were designed to feed babies, they have stolen what should be a natural and healthy relationship from too many women and their children and replaced it with something that is all too often difficult, stressful and mars the early weeks and months. I do not believe in telling women what they should or shouldn’t do with their bodies. But I do believe that it’s time for feminists to start demanding some changes for women and their babies: firstly, that the marketing activities of the milk manufacturers, in all parts of the world, are reigned in; secondly, that all women are able to access unbiased information about infant feeding, free from pressure to choose one method or the other; and that those who wish to breastfeed are properly supported not only by the relevant health professionals but by society at large. It would be nice to think that eventually this level of support will no longer be needed in the future. Sadly, Palmer first wrote her book more than 20 years ago and in the interim nothing much has changed. Where will we be in another 20 years?