Monday, 16 September 2013

The devolution of breastfeeding: part two

Welcome to part two in a trilogy of posts examining the cultural distortion and disintegration of breastfeeding. The stories you are about to read provide a snapshot of the widespread cultural trend to denormalise, and thus warp, our view of lactation. You can find part one here.

Infant formula as grand metaphor
Sydney, Australia, 1 September 2005. 

First, I read the headline: “Infant formula makes the taxman whimper”. Then I read the article. But nowhere is there any mention at all of infant formula or even of feeding babies. Instead, the article describes the results of new research by the Australian Federal Treasury showing that the tax and welfare changes introduced by Prime Minister John Howard and Treasurer Peter Costello have resulted in a jump in after-tax income by almost a third more than inflation in the first decade of the Howard Government.

Using my powers of deductive reasoning, I conclude that all 20 of the hypothetical families featured in the Treasury study are failing to breastfeed their children. Furthermore, I conclude that these same families are not really making out nearly as well financially as the fat rats in the Howard & Costello Cheese Factory portrayed by the journalist.

After all, families that fail to breastfeed their children have to spend quite handsome sums not only on buying a breast-milk substitute but also in contending with the short- and longer-term fallout, whether for themselves or their children, across the entire life course. This includes, among other nasties, impaired brain development and visual acuity, heightened risk of premature mortality and multiple ailments, for example, cardiovascular, respiratory and diarrheal disease, type 2 diabetes, ear infections, allergies, obesity, breast and ovarian cancer in mothers, childhood leukemia, rheumatoid arthritis, and even mothers’ capacity to deal with stress.

Or perhaps I've got it all wrong. Maybe it’s nothing more mysterious or complex than a headline writer who sees the words “infant formula” as metaphor, the verbal equivalent of the still-ubiquitous feeding-bottle ideogram in the world’s airports, you know that back-lit graphic symbol of a child’s feeding-bottle suspended prominently from terminal ceilings (along with signs indicating where the toilets are located) that shows mothers – including, ironically, breastfeeding mothers – where they can go and comfortably feed and otherwise care for their children.

In the mind of the headline writer, then, this is unquestionably how things really are child-feeding wise, at least in Australia. But “infant formula” is not only synonymous with “child-feeding”; it has also attained the lofty, even enviable, rank of complete societal metaphor covering neatly such key conceptual images as family formation patterns and child-bearing and rearing practices.

Yes, that must be it. In fact, I’m sure it is. You see, what convinced me was when I replaced “infant formula” with “breastfeeding” in the headline. Somehow, “Breastfeeding makes the taxman whimper” just didn’t have the same authentic ring.

How long is “prolonged”?
Geneva, Switzerland, 30 September 2005. 

The report by Mandel and colleagues about the fat and energy content of expressed human milk in “prolonged” lactation provides as interesting a scientific analysis of the composition of human milk as it does a glimpse at the cultural bias from which the analysis is made.

Indeed, the authors’ very definition of “prolonged lactation” is at odds with the article’s last sentence, which appears to acknowledge the contribution of anthropologist Katherine Dettwyler to our collective understanding of the normal and natural – not the prolonged – duration of breastfeeding for modern humans: 2.5 years at a minimum and about 7 years at a maximum.

The article’s last sentence also provides a striking contrast to its first: “The optimal duration of breastfeeding is unknown.” Even if we don’t know yet, from the perspective of child-led weaning it is safe to say that at least the children do.

Unfortunately, the American Academy of Pediatrics’ open-ended recommendation – “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child” – has not been cited fully; whereas the World Health Organization’s policy –“while breastfeeding continues for up to two years of age or beyond” – has been omitted entirely.

That researchers are only just getting around to investigating human milk’s fat and energy content after one year of lactation speaks volumes about breastfeeding’s perceived nutritional and psychosocial value for toddlers. It also brings to mind, at the opposite end of the child feeding spectrum, the widespread belief just a generation ago that human milk was fine but only for babies born at term; that is, until researchers took a look at the milk of mothers who actually delivered preterm and concluded that it was in fact better suited for babies born early.

The statement “Whether continued high saturated fat and cholesterol intake through breastfeeding beyond the first year of life is beneficial in unknown” only serves to reinforce the article’s cultural bias. (Why wouldn’t it be? After all, breast milk is still milk.) Not so long ago pediatricians believed that breast milk was “low” in iron, at least compared to infant formula. If breast milk is now seen as “high” in saturated fat, to what is it being compared?

Milk’s fat content varies considerably among species, and even within the same species, for example the kangaroo that routinely produces two milks for different-age offspring. It’s time we adopted the perspective that what Mother Nature has provided is the default even as we strive to understand why.

We could take a cue from the results of Australia’s first study of mothers who were breastfeeding children at least two years of age or older (107 mothers aged 21 to 45 years (average 34 years) and 114 children aged 24 to 78 months (average 36 months)). When children were asked about breastfeeding, nearly all said they breastfed because they liked the milk and it made the feel happy or good. They also reported that breast milk tastes “as good as chocolate” and “better than ice cream”.

Pushing pacifiers and panning co-sleeping
Washington, DC, USA, 10 October 2005.

The American Academy of Pediatrics revises its SIDS recommendations today, including in favor of using pacifiers from one month of age and against co-sleeping. The Academy doesn’t get a free ride, however; almost immediately the world’s foremost mother-to-mother support organization, La Leche League International, the International Lactation Consultant Association, the Academy of Breastfeeding Medicine and the United States Breastfeeding Committee issue their research-based dissenting responses. The League notes that “the obvious omission of input by the AAP’s Section on Breastfeeding may account for the fact that breastfeeding management issues were not taken into consideration”. Reaffirming that “the baby who is exclusively breastfed for six months is the appropriate resource model,” ILCA noted that “very few of the studies cited in the AAP policy statement defined either exclusivity or duration”. The president of the Academy of Breastfeeding Medicine describes the statement as “a truly astounding triumph of ethnocentric assumptions over common sense and medical research”. Meanwhile, the United States Breastfeeding Committee recommends caution before advising pacifiers for breastfeeding infants even after one month of age. It also emphasizes the importance of closeness to one’s infant and supports the statement of the Academy’s Section on Breastfeeding that mothers and infants sleep in close proximity.

From one extreme to the other 
New Brunswick, Canada, 11 October 2005. 

The Irving newspaper group has pulled the latest issue of Here magazine, a free weekly magazine targeting urban youth, from store shelves and fired its editor after a close-up photo of a breastfeeding baby appeared on its cover. The photo is an extreme close-up of a tiny suckling baby; the cover promoted a story about World Breastfeeding Week, which began on 1 October, while highlighting the low rates of breastfeeding in New Brunswick. Irving news executives replaced the photo with a cartoon drawing of a woman holding a baby in a blanket. Former Here editor Miriam Christensen says she was fired on 6 October after Brunswick News executives recalled the original cover from delivery trucks and stores across the province. She is surprised at her former employer’s reaction to the photo, and says she didn’t think an image of a nursing baby would offend anyone. Brunswick News vice-president Victor Mlodecki told CBC the original cover was inappropriate for some of the locations that might have distributed it. Freelance journalist Brent MacDonald wrote the story and is angry the photo was pulled. He says the cover was an important part of the piece. He says he doesn’t work for the paper any more. “The photo was pulled, the image of a mother breastfeeding her baby, and it really didn’t do justice to the story, or the real issue here, that mothers in New Brunswick aren’t breastfeeding their babies and babies are being short changed.” According to a report of the New Brunswick Advisory Council on the Status of Women, 64% of NB mothers who gave birth between 1998 and 2003 breastfed (the national average was 85%) but only 26% breastfed for four months (48% nationally) and 17% past six months (39% nationally).

Making breastfeeding the exception 
Dallas, Texas, USA, 23 October 2005.

To: The Susan G. Komen Breast Cancer Foundation, Dallas, TX

I am writing to say how pleased I am to read the section of your site on “Not Breastfeeding”, which states:

There has been much debate about the effects of breastfeeding on a woman's risk of breast cancer. Although the issue is still under investigation, there is now good evidence that breastfeeding protects against the disease, particularly in premenopausal women. 
Add this reduced risk of breast cancer to the other benefits of breastfeeding—such as fewer childhood infections, fewer sick days used to care for an ill child, a quicker return to pre-pregnancy weight and possibly a lower risk of ovarian cancer—and there are compelling reasons for women to choose to breastfeed their children if the resources are available and they are capable of doing so.

However, I do have one suggestion with regard to the last 12 words of this text.

Parents are routinely encouraged to protect their children’s lives and well-being by having them vaccinated against the major childhood diseases and transported in safe car seats, and by keeping potentially dangerous substances (e.g. medicines and cleaning products) out of reach. But surely no one would consider adding a qualifying phrase like “if the resources are available and they are capable of doing so”.

There are two points here. The first is a question of logic – if the advice is taken, the health of mothers and children is protected and the risk of disease, and injury or death, is lowered, irrespective of resource availability or capability; and, second, it is difficult to see why the nutritional norm for mothers and babies should be the subject of a qualified endorsement when every other public-health recommendation is presented in a straightforward categorical manner.

Yours sincerely,
James Akre
Geneva, Switzerland

The irony and the paradox 
Dundee, Scotland, 27 October 2005. 

Today, I learn that fewer than half of all mothers in Dundee, Scotland, are breastfeeding their babies when they are discharged from hospital. Figures released by National Health Service Tayside to Marlyn Glen (a member of the Scottish Parliament who co-sponsored the Breastfeeding (Scotland) Act which, since March 2005, protects the right of mothers to breastfeed publicly) show that although the number of mothers breastfeeding is rising, breastfeeding rates in Dundee are still far lower than elsewhere in Tayside (the region takes its name from the River Tay and covers 3000 sq. miles with a population of 400,000 people). In 1997/1998, only 30% of mothers were breastfeeding at the time of discharge. Though 2003/2004 figures show a rise to 46%, this is still nearly 10% lower than the rate for Tayside as a whole. The real revelation, however, is the rate at six weeks postpartum: just over a quarter (26.4%) of Dundee’s babies are being breastfed at this point, the lowest rate in Scotland. (By comparison, just over half of women initiate breastfeeding in Argyll and Clyde, and by six weeks only 32% are still at it)

Oh, the irony and the paradox! It was in Dundee between 1985 and 1989 that Peter Howie and colleagues undertook their history-making study of feeding practices and sickness episodes, especially gastrointestinal disease, among 618 mother-child pairs in the first two years of life. They are the first researchers to overcome previous methodological difficulties to demonstrate, once and for all, that even in a middle-class environment in an industrialized country it is, indeed, breastfeeding that makes the significant difference in protecting babies against infection. Their results are a beacon in the literature no doubt, though all but forgotten it seems, at least as far as today’s Dundee mothers are concerned. Obviously, there’s still a lot to do to bridge the gap between science, policy and practice to protect the health of mothers and children.

More real-world examples of attitudes that are incompatible with Nature's plan will be posted in part three, next week.

James Akre prepared this post for The Alpha Parent. It is adapted from his book "The problem with breastfeeding. A personal reflection" (Hale Publishing, 2006). As founder, chairman and CEO of the International Breastfeeding Support Collective, James focuses on the sociocultural dimension of the universal biological norm for feeding infants and young children, and on pathways for returning breastfeeding to the realm of the ho-hum ordinary everywhere. He is a member of the editorial board of the International Breastfeeding Journal and of the Scientific Advisory Committee of La Leche League France, and past member of the board of directors of the International Board of Lactation Consultant Examiners (IBLCE).


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