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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).

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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.