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).

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