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Posts tagged ‘Mothercraft’

The Story of the Teeth

I was born with comically bad teeth. I have only one wisdom tooth – welded firmly to my jaw – and had multiple permanent teeth for some of my milk teeth, and none for others. (I still have two milk teeth.) That I don’t look like a caricature of a Blackadder-ish wisewoman is down entirely to my parents’ swift removal of me to a brilliant orthodontist who – with the aid of braces, plates, and two operations – gave me a decent set of teeth.

I spent rather a lot of my childhood and adolescence in pain, as my teeth and jaw were cajoled and wired into place. (I must add, though, that my parents provided me with an endless supply of sympathy, and soft, delicious things to eat, as well as plenty to read.) It was partly for this reason that I never understood the outrage that greeted the news of Martin Amis’s decision to spend around £20,000 in fixing his teeth, ending decades of persistent toothache.

Of course, much of the anger about this amount was linked to his lucrative move, in 1995, from the late Pat Kavanagh, the literary agent who helped him to build his career, to Andrew Wylie, causing an acrimonious rift with Julian Barnes, Kavanagh’s husband. Indeed, AS Byatt later apologised to him for having criticised both his dental work and his acceptance of an extraordinarily high advance negotiated by Wylie, explaining that she had had toothache at the time.

In his memoir, Experience (2000), Amis writes evocatively of the hell of toothache: that it seems to be the only manifestation of dull pain which can’t be blocked out or ignored. It demands attention. (Apparently James Joyce and Vladimir Nabokov were fellow martyrs to tooth pain. There is, clearly, a link between toothache and stylistic experimentation.)

It’s no wonder that modern dentistry is usually cited as one of the best reasons against time travel. The dentist Horace Wells (1815-1848) originated the use of nitrous oxide (laughing gas) as an anaesthetic during dental surgery. Wells died – partly as a result of an addiction of chloroform, ironically – before nitrous oxide became the anaesthetic of choice, rather than ether for example, among dentists. In South Africa, I’ve found evidence to suggest that it was possible to have teeth extracted under anaesthetic from around the 1880s – although it’s likely that this was available to wealthier patients before then.

In fact, the state of one’s teeth has been a potent indicator of class difference since at least the nineteenth century. Access to dentists and technology – powders, pastes – to prevent tooth decay meant that the middle and upper classes had better teeth than those who were poor, whose diets tended to feature substantial amounts of tooth-eroding sugar, and whose visits to dentists – who had usually had little or no training – were done only in case of dire emergency.

In the pub conversation described in TS Eliot’s The Waste Land (1922), the speaker refers to a friend, Lil, who worries that her recently demobbed husband will leave her, partly because she had aged so much during the recent Great War:

Now Albert’s coming back, make yourself a bit smart.
He’ll want to know what you done with that money he gave you
To get yourself some teeth. He did, I was there.
You have them all out, Lil, and get a nice set

As false teeth became cheaper and more widely available, it seemed to make better sense to have all one’s teeth out at once, rather than suffer a lifetime’s worth of dental pain.

We attach a wide range of meanings to teeth: from the elongated incisors of vampires, to the whiter-than-white rictus grins of celebrities. My friend Shahpar in Dhaka points out that in south Asia, some Muslims associate oral hygiene using the bark of the miswak tree with holiness, as they believe that the Prophet used the bark to clean his teeth. More generally, people in the region place an exceptionally high value on having a healthy, full mouth of teeth – reflected in some truly appalling jokes.

I’ve been reading about anxieties about oral hygiene and dentistry recently, hence this interest in shifting cultural and social constructions of teeth. During the early decades of the twentieth century, global anxieties about infant mortality and childhood health, resulted in a heightened concern about the care of children’s teeth. This was part of an infant welfare movement which had emerged all over the world at the end of the nineteenth century, in response to unease about high rates of infant mortality (usually as a result of diarrhoea), the apparently failing health of urban working-class men, and eugenicist anxieties about maintaining white control over political, social, and economic power.

Denture Shop, India, 1946*

Although child welfare campaigners during the nineteenth century drew parents’ attention to the need to instil in their children good habits of dental hygiene, the discourse around the state of children’s teeth during the early twentieth century differed. To be fair, rotting teeth and gum disease are the cause of a range of health problems, and it makes sense to direct public health policy towards making dental services freely available.

But particularly during the 1920s and 1930s, preventing poor oral hygiene and tooth decay began to take on moral overtones. Doctors and child welfare activists increasingly understood bad oral health as a signifier of chaotic, ‘unscientific’ upbringings – which, they believed, tended to occur in working-class families. Writing about Major General Sir Frederick Barton Maurice’s influential 1903 study of the large numbers of volunteers who were deemed to be physically unfit to fight in the South African War (1899-1902), Anna Davin explains:

If, as it seemed, these puny young men were typical of their class (‘the class which necessarily supplies the ranks of our army’), the problem was to discover why [they suffered from so many physical ailments], and to change things. Proceeding to speculate on possible explanations, [Maurice] accounted for the prevalence of bad teeth among recruits by unsuitable food in childhood (‘the universal testimony that I have heard is that the parents give the children even in infancy the food from off their own plates’), and decided at once that ‘the great original cause’ (of bad teeth at this point, but subsequently, and with as little evidence, of all the ill-health) was ‘ignorance on the part of the mothers of the necessary conditions for the bringing up of healthy children’.

This was one of several essays and articles which argued that poor nutrition in childhood – most notably feeding babies food meant for adults – caused ‘bad teeth’ and, thus, compromised health in adulthood. The best means of remedying this situation was to encourage mothers (and in the minds of doctors, welfare campaigners, and policy makers, these mothers were inevitably working-class) to adhere to ‘scientific principles’ in raising their children, chief of which was providing babies and young children with a diet calibrated precisely to their needs. These principles and diets were formulated by health professionals – medical men – and they, as well as nurses, health visitors, and others, encouraged mothers to abandon ‘superstitious’ and ‘ignorant’ childrearing practice in favour of properly ‘scientific’ guidelines.

Those doctors and campaigners influenced by eugenics argued, though, that children’s moral character depended on good dental hygiene. (Susanne Klausen explains what we mean by ‘eugenics’: ‘in its broadest definition…eugenics was concerned with improving the qualities of the human race either through controlling reproduction or by changing the environment or both.’) In The Story of the Teeth, and How to Save Them (1935), Dr Truby King, the extraordinarily influential founder of the global mothercraft movement, argued that the health and strength of babies’ and children’s teeth depended, firstly, on the health of the pregnant and lactating mother, and, secondly, on proper nutrition.

Breastfeeding – not on demand, but at regular intervals depending on the age of the baby – was, he believed, the foundation for the development of strong teeth and jaws. The introduction of nutritious food once the baby was six months old should, he wrote, encourage the child to chew, thus stimulating the nerves and blood vessels in the face, causing the milk and permanent teeth to emerge quickly and cleanly.

King had dire warnings to those parents – particularly mothers – who, he suggested, ‘gave in’ to the demands of their babies and children:

Decay of the teeth is not a mere chance unfortunate disability of the day – it is the most urgent and gravest of all diseases of our time – a more serious national scourge than Cancer or Consumption….

Why? Because oral hygiene and healthy teeth ensured that the citizens of the future would be morally good, productive, conscientious individuals:

‘Building the Teeth’ and ‘Forming a Character’ are parts of construction of the same edifice – standing in the relationship of the underground foundations of a building to the superstructure.

Our dentists tell us that nowadays when they insist on the eating of crusts and other hard food [necessary for encouraging the child to chew and, thus, in King’s view, develop its jaw], the mother often says ‘Our children simply won’t!’ Such children merely exemplify the ineptitude of their parents – parents too sentimental, weakly emotional, careless, or indifferent to train their children properly. The ‘can’t-be-so-cruel’ mother who cries half the night and frets all day on account of the mother’s failure to fulfil one of the first of maternal duties, should not blame Providence or Heredity because her progeny has turned out a ‘simply-won’t’ in infancy, and will become a selfish ‘simply-can’t’ in later childhood and adolescence. Power to obey the ‘Ten Commandments,’ or to conform to the temporal laws and usages of Society is not to be expected of ‘SPOILED’ babies when they reach adult life. …

Unselfishness and altruism are not the natural outcome of habitual self-indulgence. Damaged health and the absence of discipline and control in early life are the natural foundations of failure later on – failure through the lack of control which underlies all weakness of character, vice, and criminality.

Good teeth meant good citizens. Bizarre as this thinking may have been, it did – often – have positive outcomes. For instance, similar views held among South African doctors and child welfare campaigners were behind the establishment of a network of dental clinics for poor children – albeit mainly white children – during the 1920s and 1930s. Children whose parents could not afford private dental care, could attend these clinics gratis.

One of the most striking characteristics of eugenicist thinking was its tendency to blame mothers’ ignorance, stupidity, or credulousness for the poor health of their babies and children, ignoring the environmental factors – the contexts – in which they raised their offspring. King’s implication was that mothers were ultimately responsible for the ‘vice and criminality’ of society: if they, he wrote, had simply disciplined their children, feeding them properly and ignoring their demands, then all adults would be productive, self-controlled citizens.

Although King’s reasoning is demonstrably bonkers, this tendency to blame (single) mothers for children’s anti-social behaviour persists, particularly within right-wing political and media circles. This is a strategy which absolves the state and other institutions of any responsibility for ensuring that children are adequately care for.

The study of attitudes towards teeth and dentistry reveals a range of beliefs about parenting, childhood, and, nutrition. It seems, then, that we are not only what we eat, but we are also how we eat.

Sources cited here:

Anna Davin, ‘Imperialism and Motherhood,’ History Workshop, no. 5 (Spring 1978), pp. 9-65.

Susanne Klausen, ‘“For the Sake of the Race”: Eugenic Discourses of Feeblemindedness and Motherhood in the South African Medical Record, 1903-1926,’ Journal of Southern African Studies, vol. 23, no. 1 (March 1997), pp. 27-50.

Antora Mahmud Khan and Syed Masud Ahmed, ‘“Why do I have to Clean Teeth Regularly?” Perceptions and State of
Oral and Dental Health in a Low-income Rural Community in Bangladesh’ (Dhaka: BRAC, 2011).

Truby King, The Story of the Teeth and How to Save Them (Auckland: Whitcombe & Tombes, 1935).

Further Reading:

Naomi Murakawa, ‘Toothless: The Methamphetamine “Epidemic,” “Meth Mouth,” and the Racial Construction of Drug Scares,’ Du Bois Review, vol. 8, no. 1 (2011), pp. 219-228.

Alyssa Picard, Making the American Mouth: Dentists and Public Health in the Twentieth Century. (New Brunswick: Rutgers University Press. 2009).

David Sonstrom, ‘Teeth in Victorian Art,’ Victorian Literature and Culture, vol. 29, no. 2 (2001), pp. 351-382.

* This photograph is from Retronaut.

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Breast is Best?

On a cold morning in early December last year, I found myself sitting in the Highgate Literary and Scientific Institution in London, looking at pages and pages of breasts.

Pausing occasionally to wonder at the collection of life choices which had led to this moment, I scanned these black and white photographs of lactating women from the 1920s and 1930s, attempting to understand the set of criteria according to which they were categorised into ‘good’ and ‘bad’ breasts.

The pictures were taken and kept by the Mothercraft Training Centre in London, and were intended for nurses and other healthcare practitioners working with mothers and young babies. Informed by the programme of scientific childrearing developed by the New Zealand doctor Truby King during the first decade of the twentieth century, the Centre’s staff promoted breastfeeding as the best way of providing babies with adequate nutrition.

In King’s view, breastfeeding needed to be approached scientifically. Mothers should not feed on demand but, rather, according to a strict schedule, depending on the age of the infant. This feeding by the clock was a technique aimed as much at mothers as it was at shaping obedient and self-reliant babies and young children.

Like other specialists in the relatively new field of paediatrics, King believed that mothers were irrational and emotional, and inclined to follow what he characterised as the unscientific and unsanitary advice provided by their female relatives. By breastfeeding in King’s ‘scientific’ manner, mothers could learn to be rational creatures.

In King’s view, not only were there right and wrong ways of breastfeeding, but also good and bad breasts. The photographs in the Mothercraft Training Centre’s collection were meant to help nurses identify the link between the shape of women’s breasts and the ways they would feed their babies.

I was reminded of these photographs this week by the most recent cover of Time magazine, which features 26 year-old Jamie Lynn Grumet breastfeeding her son. She is young, slim, and wears a skimpy top, and her child is a sturdy three year-old.

The debate which erupted around the cover focussed on the age of the boy: wasn’t it weird, asked some, for a mother to be feeding so old a child? The picture – deliberately, I think – provoked this controversy by upsetting contemporary notions of what nurturing motherhood should look like.

But what interested me is that Time chose this particular photograph for its cover. The edition’s focus is not, in fact, on breastfeeding. It’s about a popular childrearing guide The Baby Book (1992) written by William Sears, which advocates that mothers and babies remain as close together as possible for as long as possible. Kate Pickert explains:

While the concept sounds simple, the practicalities of attachment parenting ask a great deal of mothers. The three basic tenets are breast-feeding (sometimes into toddlerhood), co-sleeping (inviting babies into the parental bed or pulling a bassinet alongside it) and ‘baby wearing,’ in which infants are literally attached to their mothers via slings. Attachment-parenting dogma also says that every baby’s whimper is a plea for help and that no infant should ever be left to cry.

Hilariously lampooned by Maggie Gyllenhaal in Away We Go, attachment parenting has been the subject of extensive and frequently ferocious debate. Breastfeeding, though, is only one feature of this particular mode of parenting. So why the cover on Time? It’s partly because photographs of breastfeeding women still – depressingly – provoke argument. As Jill Lepore writes, there’s a long history of banning magazines which print pictures of breastfeeding women:

Like its historical antecedents – a centrefold in a 1938 issue of Life called ‘The Birth of a Baby,’ and another, in 1965, called ‘The Drama of Life’ – it has gotten a great deal of attention. Sales have been brisk. Interest has been prurient. Outrage is all the rage.

Lifes ‘Birth of a Baby’ issue was banned all over the country (but not before selling seventeen million copies). Overnight, Gallup conducted a nationwide poll, asking: ‘In your opinion, do these pictures violate the law against publication of material which is obscene, filthy or indecent?’ (Twenty-four per cent of respondents said yes; seventy-six per cent no.) A generation later, the photographs on the 1965 cover, ‘The Drama of Life’ were shipped into outer space on board the Voyager (but not before selling eight million copies in four days). Each gave rise to criticism, some of it quite wonderful. The week after Life published ‘The Birth of a Baby,’ The New Yorker published a parody, called ‘The Birth of an Adult,’ written by EB White. ‘The Birth of an Adult is presented with no particular regard for good taste,’ White wrote. ‘The editors feel that adults are so rare, no question of taste is involved.’

‘Respectable’ news magazines often print photographs of women with semi-covered breasts. If these usually sexualised images of women are tolerated, why do pictures of breastfeeding women provoke such disgust? Given that the World Health Organisation and many governments advise mothers to breastfeed their babies exclusively for the first six months of life, it seems strange that breastfeeding women should be regarded as a kind of social embarrassment.

Indeed, Facebook’s decision to treat photographs of women breastfeeding as pornography, and women’s experiences of being forced out of public spaces when breastfeeding, seem to suggest that the issue is connected to how women’s bodies are understood socially.

Our bodies are socially and culturally constructed. As South Africa has seen over the past fortnight, the portrayal of the President’s penis in Brett Murray’s painting ‘The Spear’ has provoked outrage partly because it defies taboos around nudity in some South African communities and is seen as being part of a long history of white exploitation of black bodies.

Depictions of breastfeeding women are relatively common in art before the early twentieth century. These were meant to celebrate women as mothers – in a role which most believed celebrated women’s God-given and ‘natural’ role on earth. The photographs of lactating breasts in the Mothercraft Training Centre collection were intended for medical purposes – as were the pictures of breastfeeding mothers in mothercraft publications. I wonder if it’s possible to link the worldwide decline in breastfeeding during the 1940s and 1950s to the decreasing tolerance for the portrayal of breastfeeding women in popular publications? As breasts have become increasingly sexualised in advertising and the media, has this accompanied a discomfort with the idea that they can also be used to nourish and to nurture?

Although decades apart, there are similarities between the attitudes which informed mothercraft and those behind the Time cover: that women’s bodies are not their own to control. The Time cover suggests, firstly, that breastfeeding in public is not only worthy of comment, but also freakish – that it should be done within the secluded confines of the home. And, secondly, it implies that when women are in charge of raising their children, they behave irrationally: that they embrace ‘gurus’ and are ‘driven to extremes’. There is nothing on this cover to suggest that this mother chose – calmly and carefully – to feed and to care for her child in this way.

Further Reading

Marilyn Yalom, A History of the Breast (New York: Ballantine Books, 1997).

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No Sweeteners

One of the best things about being an academic is the stuff that people send you in the – usually entirely correct – belief that you’ll find it interesting. I’ve had emails about pink slime (for the blog) and on programmes about children’s literature (for my research). Recently, my friend Elizabeth, who’s a lawyer, forwarded me this from Legalbrief:

New draft baby feeding regulations will forbid formula manufacturers from ‘aggressively marketing’ their products to mothers and from sponsoring meals and professional development courses for healthcare practitioners, says a Weekend Argus report. It adds the standards set in the draft regulations, which the Department of Health has released for public comment, intend to promote safe nutrition for babies and young children and restrict inappropriate marketing practices. The department stressed that the regulations would not stop baby formula and complementary foods from being sold at retailers. ‘Although breastfeeding is best, government recognises that some women cannot breast-feed or decide not to breast-feed. These regulations do not in any way compel women to breast-feed against their will,’ the department is reported to have stated.

The proposed regulations, which fall under Section 15 (1) of the Foodstuffs, Cosmetics and Disinfectants Act, 1972, make for fascinating reading. Other than banning trans fats and artificial sweeteners in baby formula, their emphasis is on curtailing the advertising and promotion of artificial foods.

For instance, the packaging of baby formula may not have pictures of infants, young children, or any other ‘humanised figures,’ except for those included in instructions for preparing the product. Tins and containers may not ‘contain any information or make any negative claim relating to the nutritional content or other properties of human milk’, and they’re not allowed to include toys or gifts. Packaging must include in English, in bold letters at least 3mm tall, the message: ‘Breast milk is the best food for babies.’

The regulations will also radically limit the advertising of baby formula shops, in print and online, ban the distribution of gift packs and free samples, and prevent formula manufacturers from sponsoring or donating equipment bearing the logo of their products. These manufacturers may not

provide research grants or any other financial assistance relating to infant or young child nutrition to health care personnel working in a health establishment or health care personnel linked to a health establishment.

Nor may they give doctors, nurses, and health workers gifts, and ‘heads of health establishments, national, provincial and local health authorities shall take measures to promote, support and protect breastfeeding.’

It’s an ambitious piece of legislation, but one which is entirely in line with the World Health Organisation’s International Code on the Marketing of Breast Milk Substitutes. The Code was adapted in 1981, and places stringent regulations on how baby formula is advertised: it advises that baby milk formula should not be allowed to market products directly to pregnant women and mothers with young children, including handing out samples. Products should also state that breast milk is superior to formula.

Implementation of the Code has been slow, and there is evidence to suggest that it has been particularly poorly policed in developing nations where oversight of the activities of powerful multinationals is often lax. The South African regulations are far stricter than the Code, particularly as regards the relationship between the pharmaceuticals industry and academic research, but address a problem which campaigners have long identified: that there is a link between the way in which formula is advertised and how women feed their babies.

This isn’t to suggest that women should have their choices about how they feed their babies curtailed – or that it’s only advertising which causes women to choose to use baby formula. Far from it. The problem, though, is that, particularly in poor nations, advertising or other promotional methods encourage breastfeeding mothers to switch to baby formula when it’s unlikely that they’ll be able to afford to buy more formula, and where they may dilute formula with too much water to make it go further. This water may not be clean, and it’s difficult to keep bottles and teats sterile without electricity or plumbing.

The purpose of these regulations is to ensure that formula manufacturers don’t use the often less than ideal conditions in which mothers in developing nations raise their babies, to their own advantage.

We tend to associate the WHO’s Code with the Nestle Boycott, which was launched in 1977. The Boycott was based on a pamphlet published by War on Want in 1974, titled ‘The Baby Killer’ and, in Switzerland, ‘Nestle Kills Babies’. The charity alleged that Nestle’s advertising strategies were responsible for high rates of child mortality. After a legal tussle as well as an attempt to refute the Boycott’s allegations, Nestle agreed to implement the Code in 1984, although there remains some scepticism as to Nestle’s, and other companies’, commitment to this.

But concern about the advertising of baby formula predated the 1970s, and even the 1940s, when breastfeeding began to decline globally. As I’ve sat in the National Library over the past few months, reading Child Welfare and other child health magazines from the first half of the twentieth century, I’ve been struck by the number of advertisements for baby formula. They all feature fat, healthy babies and testimonials from relieved mothers who claim that the child was fed from birth on Lactogen or whichever other patent food.

Even Truby King, early twentieth-century breastfeeding evangelical and founder of the global mothercraft movement, developed artificial baby food which was produced in New Zealand and then shipped all over the world. Kariol, Karilac, and Karil were meant to be prescribed for babies who were not, for whatever reason, breastfed either as a supplement to cows’ milk, or to be taken on their own.

Although King’s patent foods seemed to contradict his enthusiasm for breastfeeding – and he came under enormous criticism in New Zealand and Australia for his promotion of Kariol and Karilac – there was a certain logic to his decision to manufacture wholesome baby formula. During the early decades of the twentieth century, doctors in Britain and the United States noticed that bottle-fed babies were considerably more likely to die during early infancy than those who were breastfed. Artificial foods – which ranged from thin porridges and condensed milk to baby formulas – were often nutritionally inadequate, particularly in poor families who could not afford better and more expensive substitutes.

But they also identified a link between bottle feeding and diarrhoea, then, as now, one of the main causes of death in infancy. William J. Howarth, the Medical Officer of Health for Derby

arranged in 1900 to receive weekly lists of the births registered during the past seven days from the local registrar. From November of that year until November 1093 women inspectors enquired into the feeding method of each registered child by personally visiting the mother and infant at home.

The results of the study, published in 1905, were telling. Of the infants surveyed, 63% were breastfeed, 17% were partly bottle-fed, and 19% entirely bottle-fed:

The mortality rates from ‘diarrhoea and epidemic enteritis’ in addition to those from ‘gastritis and gastro-enteritis’ were as expected: 52, or 10 per 1,000 of the breastfed, 36 or 25.1 per 1,000 of the mixed-fed, and 94 or 57.9 per 1,000 of the bottle-fed babies died. In other words the mortality rate of the bottle-fed infants was nearly six times greater than that of the breast-fed babies.

Howarth concluded: ‘In not one single instance does the death-rate in any class of disease among hand-fed children even approximate that recorded among children who are breastfed; the rate is invariably higher.’

The problem, in terms of the link between bottle feeding and diarrhoea, was not so much the nutritional content of artificial foods, but the difficulties in keeping them free from contamination, and particularly during summer when infant mortality rates soared.

Indeed, South African advertisements for Lactogen emphasised that the product did not spoil in warm weather. As criticism of artificial foods grew louder, so advertising became more subtle, and better adept at appealing to mothers aware of the potential problems of bottle feeding. Doctors were, though, also aware of the effects of advertising on mothers’ choices, as a medical officer based in Johannesburg wrote in 1925:

No one can deny the fact that the proprietary foods of today are a vast improvement upon those of twenty years ago. They all contain very sound instructions as to the preparation of the food and the amount to be given. The advertising of such foods is carried out on a most extensive scale and in a clever and attractive manner. No hoarding today is without a picture of a flabby and over-fat infant alleged to have been reared solely on the proprietary food advertised thereon. Many a mother who for one reason or another, is not satisfied with the progress of her baby, sees this advertisement, and immediately rushes off to secure this particular food for non-thriving infant.

But not only mothers were influenced by this advertising. He admitted that it was ‘only too true that many medical men and trained nurses are also gulled by such advertisements and circulars’. Dr Cicely Williams, best known for her identification of the condition kwashiorkor in the 1930s, worked in the Colonial Medical Service in West Africa and southeast Asia before World War II and became particularly interested in the treatment of the diseases of early infancy.

She was critical of the introduction of baby formula to Singapore and Malaya, where white-coated sales reps distributed samples of artificial foods to poor mothers. In 1939 she published a pamphlet, ‘Milk and Murder,’ in which she pointed out the benefits to both mothers and babies of breastfeeding.

Nevertheless, Nestle and other companies were still using the same strategies to convince mothers in developing nations to use baby formula in the 1970s, and there are still concerns that they are not fully compliant with the Code on breast milk substitutes. The new South African regulations, if passed, are aimed at remedying this.

The cause for these new regulations and other measures introduced internationally to encourage mothers to breastfeed for the first six months of life, is a concern that rates of breastfeeding remain low in comparison to what they were during the early twentieth century. For all the good that the Code and other laws have done, it remains the exception, rather than the rule, for women to breastfeed for such an extended period of time.

However true it may be that advertising does have an impact on women’s choices, it’s certainly not the only factor which influences how women feed their babies. What’s missing from these measures is any attempt to communicate with mothers themselves. As doctors in the early twentieth century believed that mothers, whom they characterised as emotional and irrational, simply followed any and all advice which they read or heard, so campaigners and governments today seem to be too quick to seek only one reason for women’s decision to breast- or bottle-feed.

In fact, we need to make it easier for women to choose to breastfeed: to eliminate the ridiculous prejudice against breastfeeding in public spaces; for work and childcare not to be mutually exclusive; and for sympathetic advice and information to be made available for all new mothers.

Further Reading

Texts cited here:

Linda Bryder, A Voice for Mothers: The Plunket Society and Infant Welfare, 1907-2000 (Auckland: University of Auckland Press, 2003).

Deborah Dwork, War is Good for Babies and Other Young Children: A History of the Infant and Child Welfare Movement in England, 1898-1918 (London and New York: Tavistock Publications, 1987).

Philippa Mein Smith, Mothers and King Baby: Infant Survival and Welfare in an Imperial World: Australia, 1880-1950 (Basingstoke: Macmillan, 1997).

Other sources:

Rima D. Apple, Mothers and Medicine: A Social History of Infant Feeding (Madison: University of Wisconsin Press, 1987).

Linda M. Blum, At the Brast: Ideologies of Breastfeeding and Motherhood in the Contemporary United States (Boston: Beacon Press, 1999).

Marulyn Yalom, A History of the Breast (New York: Ballantine Books, 1997).
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Milking It

This week the committee organising the 2012 Olympics in London caused widespread anger when it announced that breastfeeding mothers would have to buy an extra ticket to bring their babies into sports venues. Some venues have a few discounted tickets for children, but others don’t. One commentator posted on Mumsnet

that while she and her husband were lucky enough to get tickets to an equestrian event in August, organisers had told her there are no children’s tickets so she will have to pay £95 for a three-month old in a sling.

Those who can’t afford an extra ticket, or who lose out in the next round of ticket allocation, are advised to stay away. Unsurprisingly, Britain’s Equality and Human Rights Commission has suggested that this is potentially a case of ‘indirect sex discrimination’ because it will affect considerably more women than men.

This situation is ridiculous in so many ways. What angers me the most is that the Olympic committee took this decision in a country where the National Health Service advises that babies be breastfed exclusively for the first six months of life. The members of the committee seem either to think that women shouldn’t breastfeed in public – an irritating view about which I am going to be extraordinarily rude at some stage – or that mothers with babies have no desire to attend public events.

In the midst of the uproar, The Ecologist tweeted an article which it had published six years ago about the debate over whether women should breast- or bottle-feed their babies. It’s an argument that parents, doctors, and policy makers have been holding since at least the beginning of the twentieth century, and it’s to the credit of Pat Thomas that her piece provides a good overview of shifting attitudes towards infant feeding over the course of the past hundred years or so.

But it’s also a problematic piece of writing, and one which demonstrates particularly well why so many mothers feel bullied about how they decide to feed their babies. Thomas makes no attempt to hide her view that all mothers should breastfeed their children. She begins with a terrifying list of statistics:

The health consequences – twice the risk of dying in the first six weeks of life, five times the risk of gastroenteritis, twice the risk of developing eczema and diabetes and up to eight times the risk of developing lymphatic cancer – are staggering. With UK formula manufacturers spending around £20 per baby promoting this ‘baby junk food’, compared to the paltry 14 pence per baby the government spends promoting breastfeeding, can we ever hope to reverse the trend?

I’d love to know where she found these figures – particularly given her opening statement that women have breastfed for ‘nearly half a million years’. (How does she know this? Why the coy, qualifying ‘nearly’?) Thomas is, though, correct to point to the compelling evidence that breastfed babies tend to be healthier than those who are fed on formula, and that breastfed children may do better at school and have stronger immune systems. Also, there is a direct and proven link between the use of baby formula and high child mortality rates in the developing world.

She blames the slow decline of breastfeeding over the course of the twentieth century on the medicalization of childcare, and on the advertising strategies employed by formula companies – most notoriously Nestle. I have little to add to her second point, other that, broadly, I agree with her. The International Code of Marketing of Breastmilk Substitutes, a response to the Nestle Boycott of the late seventies, needs to be properly implemented. But her argument about the medicalization of women’s experiences of childbirth and childrearing is not entirely correct. She quotes Mary Renfrew from the Mother and Infant Research Unit at the University of York:

‘If you look at medical textbooks from the early part of the 20th century, you’ll find many quotes about making breastfeeding scientific and exact, and it’s out of these that you can see things beginning to fall apart.’ This falling apart, says Renfrew, is largely due to the fear and mistrust that science had of the natural process of breastfeeding.

In particular, the fact that a mother can put a baby on the breast and do something else while breastfeeding, and have the baby naturally come off the breast when it’s had enough, was seen as disorderly and inexact. The medical/scientific model replaced this natural situation with precise measurements – for instance, how many millilitres of milk a baby should ideally have at each sitting – which skewed the natural balance between mother and baby, and established bottlefeeding as a biological norm.

During the early years of twentieth century, global concern about high rates of child mortality animated a child welfare movement which aimed to improve the conditions in which children were raised. In Europe, North America, Australia, New Zealand, and parts of Africa and Latin America, medical professionals held up rational and scientific methods of feeding and caring for babies as the best means of eradicating the ‘ignorant’ practises which, many believed, caused babies to die. This new emphasis on hygiene, speedy medical intervention, and regular monitoring of babies’ development and health at clinics and hospitals did lower rates of morbidity – as did declining fertility rates, the control of infectious disease, economic prosperity, and increased attendance of school.

Doctors and specialists in the relatively new field of paediatrics were particularly interested in how babies were fed. Contrary to what Thomas suggests, the nineteenth-century orthodoxy that breastfeeding was the healthiest and best option for both mothers and babies lasted well into the 1940s. Innovations in artificial formulas provided mothers who couldn’t breastfeed – for whatever reason – with good alternatives, and doctors did recommend them. There were anxieties that malnourished mothers’ milk would not feed babies sufficiently, and doctors recommended ‘top ups’ with formula or other liquid.

The real difference between nineteenth- and twentieth-century attitudes towards breastfeeding was that it was increasingly controlled and patrolled by trained professionals. As Renfrew notes, mothers were told how much milk their babies needed at each feed, and there was a lot of debate in medical journals and in other professional forums about how and when babies should be fed.

The set of guidelines formulated by the incredibly influential, New Zealand-based Dr Truby King emphasised the importance of routine in feeding. King’s mothercraft movement – which established clinics and training centres around the British Empire during the first half of the twentieth century – taught mothers to feed ‘by the clock’. At five months, a baby was to be fed only five times per day – and at the same time every day – while one month-old babies had an extra, sixth feed.

Like many childcare professionals of the period, King believed that feeding on demand was not only unhealthy – it placed babies at risk of under- or overfeeding – but it was morally and intellectually damaging too. Babies who understood that crying would cause them to be fed would become spoilt, lazy children and adults. Indeed, this points to the infant welfare movement’s more general preoccupation with mothers and motherhood. As the interests of the state were seen, increasingly, as being linked to the proper rearing and education of children, the role of the mother grew in importance. King called his centres ‘shrines to motherhood’, for instance.

But the naturally fussy, over-cautious, and credulous mother was not to be trusted to follow her own instincts: authorities and professionals, who tended to be male, were to provide her with rational, scientific advice on raising her baby. It’s difficult to gauge mothers’ response to the information aimed at them. In her study of mothers in the United States in the 1920s and 1930s, Julia Grant concludes that mothers did heed childcare professionals, but modified their advice according to the views and experiences of their peers. Similarly, mothers in New Zealand took what they wanted from King’s pamphlets on childrearing.

Equally, mothercraft clinics and breastfeeding advice days were well attended by mothers and babies. Several mothercraft centres all over the world also included a dietetic wing, where nursing mothers could stay for up to a fortnight, learning how to breastfeed their babies. There, they would be taught how to breastfeed by the clock, and how to cope with mastitis and painful breasts and nipples. Wonderfully, hospital fees were means tested, so poor mothers could attend for free.

Throughout its existence, the Cape Town dietetic hospital never had an empty waiting list, and similar units in Britain, Australia, and New Zealand were as enthusiastically supported by women. Mothercraft seems to have been at its most successful when mothers could choose how and when they wanted to its advice and services.

While it’s true that the medicalization of breastfeeding transformed this act into a ‘science’ which needed to be re-taught to mothers – that it became possible to inform a mother that she was breastfeeding incorrectly – and that this was underpinned by misogynistic and eugenicist ideas around childhood, motherhood, and the nation, it is as true that mothers did respond positively to the advice provided by mothercraft and other organisations. Clearly, mothers wanted more advice about how to feed their babies – and that they altered it to suit their conditions and needs.

It’s for this reason that I think that Thomas is doing mothers a disservice. Encouraging more women to breastfeed needs to respect the fact that women’s choices about how to feed their babies are influenced by a variety of factors and considerations. Thomas – and other breastfeeding evangelicals – seems to buy into the same discourse of maternal irresponsibility as childcare professionals did in the early twentieth century: the belief that women somehow don’t really understand what’s best for their babies, and must be properly educated. Even if her – and others’ – motives are progressive and well-meaning, they still fail to take mothers seriously.

Further Reading

Sources cited here:

Rima D. Apple, Mothers and Medicine: A Social History of Infant Feeding, 1890-1950 (Madison: University of Wisconsin Press, 1987).

Linda Bryder, A Voice for Mothers: The Plunket Society and Infant Welfare 1907-2000 (Auckland: Auckland University Press, 2003).

Julia Grant, Raising Baby by the Book: The Education of American Mothers (New Haven and London: Yale University Press, 1998).

Philippa Mein Smith, Mothers and King Baby: Infant Survival and Welfare in an Imperial World: Australia 1880-1950 (Basingstoke: Macmillan, 1997).

Other sources:

Linda M. Blum, At the Breast: Ideologies of Breastfeeding and Motherhood in the Contemporary United States (Boston: Beacon Press, 1999).

Molly Ladd-Taylor, Mother-Work: Women, Child Welfare, and the State, 1890-1930 (Urbana and Chicago: University of Illinois Press, 1994).

Marilyn Yalom, A History of the Breast (New York: Ballantine Books, 1997).

Creative Commons License
Tangerine and Cinnamon by Sarah Duff is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

Which Formula?

So this is my blog’s thirty-sixth post. And, wow, what a year it’s been. Thank you, dear readers, for staying the course, and I promise more for 2012. This, though, is going to be the last essay for 2011. I’ll be spending December eating, cooking, researching, and teasing the cat. Really, it’s going to be wild. But before the fun begins, I’ll be in the UK for ten days, to present a seminar paper and to do a little research at the amazing Wellcome Library.

My real, live academic research pertains to the history of childhood in the British Empire. My PhD thesis traces the ways in which ideas around childhood and youth changed in the Cape Colony during the second half of the nineteenth century. It pays particular attention to the role and impact of Dutch Reformed evangelicalism in this process. But my postdoctoral project – which is being funded by the National Research Foundation (peace be upon it) – looks at the work of the Mothercraft movement within the British Empire between 1907 and 1945.

Mothercraft was pioneered in New Zealand in 1907 in response to concerns about the very high child mortality rates among the country’s Pākehā population. Dr Truby King devised a twelve-point programme to teach specially-trained nurses – known as Plunket nurses in New Zealand and Athlone nurses in South Africa – how to encourage mothers raise healthy babies. The success of Mothercraft was such that King was invited to establish a Mothercraft Training Centre in Britain in 1917. First called the Babies of the Empire League, it sent its nurses around the Empire: to Canada, Australia, India, east Africa, the Caribbean, and South Africa. My project focuses on the work the South African Mothercraft Centre and League, which were established in the mid-1920s.

But what, I hear you say, does this have to do with food? Well, a surprising amount. One of the main emphases of Mothercraft was on the proper feeding of babies. King was an enthusiastic promoter of breastfeeding.

We have a misconception that most babies were fed by wet nurses during the nineteenth century. It bolsters the view we have of middle-class Victorian ladies who were so terrified of their own bodies that feeding their babies was simply beyond the pale. This wasn’t strictly true, though. To begin with, wet nurses were expensive to hire and only the very wealthiest families could afford them. Most middle class women fed their own babies, as did many working-class women too.

In fact, the majority of women who relied on others to feed their babies were poor. In a time when working hours were yet to be properly defined by law, long days in factories or shops were the norm for female urban workers. Those without relatives, paid ‘baby farms’ – a house run by a woman who would care for babies and young children – to care for their offspring, often for weeks at a time. The quality of the care in these early crèches was variable: some were good, but many neglected the babies kept there. All over the world, baby farms had astonishingly high mortality rates.

Most of the popular childrearing manuals of the 1800s recommended that women breastfeed their babies. Thomas Bull, the author of the very popular Maternal Management of Children, in Health and Disease (1840) recommended breastfeeding on the grounds that it benefitted both mother and baby.

The period of suckling is generally one of the most healthy of a women’s life. But there are exceptions to this as a general rule; and nursing, instead of being accompanied by health, may be the same cause of its being materially, and even fatally, impaired. This may arise out of one of two causes, – either, a parent continuing to suckle too long; or, from the original powers or strength not being equal to the continued drain on the system.

If the mother could not breastfeed, then the best alternative was to hire a wet nurse. Only if this was an impossibility should the child be raised ‘by hand’:

To accomplish this with success requires the most careful attention on the part of the parent, and at all times is attended with risk to the life of the child; for although some children, thus reared, live and have sound health, these are exceptions to the general rule, artificial feeding being in most instances unsuccessful.

Bull acknowledged that the various concoctions fed to babies tended often to undermine, rather than fortify, their health. Popular recipes for baby formulas usually included corn or rice flour mixed to a paste with water or milk. This had little or no nutritional value, and would have been very difficult for immature digestive systems to process. Other popular substitutes were cows’ or goats’ milk, tea, and thin gruel.

It’s little wonder, then, that the Mothercraft programme placed such emphasis on breastfeeding. Many Mothercraft Centres provided beds for new mothers, who could spend up to a fortnight there, learning how to feed their babies.

At around the same period, infant formulas were beginning to improve in quality and producers, most notably Nestlé, began to promote them as a healthy – even the healthier – and clean alternative to breast feeding. Nestlé is credited – rightly or wrongly – with the invention of formula milk in 1867. The popularity of powdered baby milk only began to grow during the 1940s and 1950s. Nestlé promoted Lactogen through recipe books, pamphlets, and free samples. Problematically, these were usually distributed at hospitals and clinics – at precisely the places where women would be taught how to breastfeed. By the middle of the twentieth century in the west, it was increasingly the norm for babies to be bottle fed.

I don’t particularly want to address the fraught debate over whether women should breastfeed or not. I am, though, interested in the politics of bottle feeding in the developing world, where big companies – like Nestlé – have promoted formula assiduously since the 1950s. Here, the issue with bottle feeding is not so much the quality of the formula, but the fact that it’s mixed with dirty water or fed to babies in unsterilized bottles. Also, many of the women who use formula can’t afford it, so they water it down, meaning that their children don’t receive adequate nutrition.

In 1974, War against Want published a pamphlet accusing Nestlé of profiting from the deaths of millions of children in poor countries. Three years later, an international boycott of Nestlé began, causing the World Health Organisation to proscribe the promotion of Lactogen and other formulas in its 1981 International Code for the Marketing of Breast Milk Substitutes.

But the Code has been poorly policed, and even in developed nations, compliance has been slow. In Australia, for instance, the advertising of baby milk powders only ended in the mid-1990s. There is much evidence to suggest that Nestlé and others continue the practice, albeit under different guises. In the United States, for instance, the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) distributes more than half the formula sold in the US every year. Companies provide this formula to the WIC at a discount.

All over the world, governments are endorsing breastfeeding in the first six months of life as the best – the healthiest and the cheapest – way of feeding a baby. Companies like Nestlé are actively undermining this, despite the best intentions of the WHO. The implications of the continued use of formula in the developing world are devastating:

According to Save the Children… infant mortality in Bangladesh alone could be cut by almost a third – saving the lives of 314 children every day – if breastfeeding rates were improved. Globally, the organisation believes, 3,800 lives could be saved each day. Given that world leaders are committed to cutting infant mortality by two thirds by 2015 as one of the Millennium Development Goals, protecting and promoting breastfeeding is almost certainly the biggest single thing that could be done to better child survival rates.

A few weeks ago I wrote a post which criticised the World Food Programme’s decision to go into partnership with a range of exceptionally dodgy multinationals – Cargill, Vodafone, Unilever, Yum!Brands – to reduce world hunger. I really don’t have anything against public/private partnerships, and am an enthusiastic supporter of corporate social responsibility (when it’s done well, though). But it’s deeply concerning that the WFP is providing unwitting PR to a group of particularly nasty businesses.

In a recent article for the Guardian, Felicity Lawrence discusses growing concern about big food companies’ decision to shift their focus to developing markets:

As affluent western markets reach saturation point, global food and drink firms have been opening up new frontiers among people living on $2 a day in low- and middle-income countries. The world’s poor have become their vehicle for growth.

SABMiller, Unilever, and Nestlé have developed campaigns to target poorer markets:

The companies say they are finding innovative ways to give isolated people the kind of choices the rich have enjoyed for years and are providing valuable jobs and incomes to some of the most marginalised. But health campaigners are raising the alarm. They fear the arrival of highly processed food and drink is also a vector for the lifestyle diseases, such as obesity, diabetes, heart disease and alcoholism, which are increasing at unprecedented rates in developing countries.

This is Nestlé’s strategy in Brazil:

Nestlé’s floating supermarket took its maiden voyage on the Amazon last year and has been distributing its products to around 800,000 isolated riverside people each month ever since. Christened Nestlé Até Você, Nestlé comes to you, the boat carries around 300 branded processed lines, including ice creams, and infant milk , but no other foods. The products are in smaller pack sizes to make them more affordable. The boat also acts as a collection point for the network of door-to-door saleswomen Nestlé has recruited to promote its brands. Targeting consumers from socioeconomic classes C, D and E is part of the company’s strategic plan for growth, it says. Nestlé has also set up a network of more than 7,500 resellers and 220 microdistributors to reach those at the bottom of the pyramid in the slums of Rio and São Paulo and other major Brazilian cities.

Even if Nestlé does respect the terms of the International Code for the Marketing of Breast Milk Substitutes, and I hope it does, not only is it selling unhealthy processed non-foods, but it also gains legitimacy via its partnership with…the United Nations. Earlier this year, Nestlé supported the UN’s ‘Every Woman Every Child’ initiative, which aims to improve child and maternal health. So an organisation implicated in contributing to the high rate of child mortality in the developing world, and in facilitating a global obesity epidemic, is working with the UN…to improve child health.

Merry Christmas.

Further Reading

Texts quoted here:

Thomas Bull, The Maternal Management of Children, in Health and Disease (London: Longman, Orme, Brown, Green, and Longmans, 1840).

Christina Hardyment, Dream Babies: Childcare Advice from John Locke to Gina Ford. Revised ed. (London: Frances Lincoln, 2007).

Virginia Thorley, ‘Commercial Interests and Advice on Infant Feeding: Marketing to Mothers in Postwar Queensland,’ Health and History, vol. 5, no. 1 (2003), pp. 65-89.

Other sources:

Linda Bryder, ‘Breastfeeding and Health Professionals in Britain, New Zealand and the United States, 1900-1970,’ Medical History. vol. 49, no. 2 (2005), pp. 179-196.

Linda Bryder, ‘From breast to bottle: a history of modern infant feeding.’ Endeavour, vol. 33, issue 2 (June 2009), pp. 54-59.

Linda Bryder, Not Just Weighing Babies: Plunket in Auckland, 1980-1998 (Pyramid Press, Auckland, 1998).

S.E. Duff, ‘What will this child be? Children, Childhood, and the Dutch Reformed Church in the Cape Colony, 1860-1894’ (PhD thesis, Birkbeck, University of London, 2010).

Nancy Rose Hunt, ‘“Le Bebe en Brousse”: European Women, African Birth Spacing and Colonial Intervention in Breast Feeding in the Belgian Congo,’ The International Journal of African Historical Studies, vol. 21, no. 3 (1988), pp. 401-432.

Creative Commons License Tangerine and Cinnamon by Sarah Duff is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

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