A feminist critique of breastfeeding promotion

Slut Walk Toronto 2012

I have been arguing for years that breastfeeding promotion in general, and the Baby Friendly Hospital Initiative (BFHI) in particular, are both paternalistic and deeply anti-feminist. A paper published last year in the journal Midwifery provides a similar feminist critique.

The paper is Infant feeding and maternal guilt: The application of a feminist phenomenological framework to guide clinician practices in breast feeding promotion. Unfortunately, it is jam packed with academic jargon, but if you can get past that it provides a compelling commentary on the biggest problems with contemporary breastfeeding promotion.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Fed isn’t merely best; fed is feminist![/pullquote]

The authors are strong proponents of breastfeeding, but they are equally strong proponents of women’s rights. They provide a succinct explication of the problem:

Feminist scholars … propose that utilizing only medical evidence to promote ‘breast is best’ fails to recognize the experience of the mother and the social constraints that breast feeding imposes on personal and professional facets of a woman’s life. Thus, it is an example of the power used by health care pro- viders to reinforce ‘normative’ maternal behaviour.

For example, the Baby Friendly Hospital Iniative substitutes medical paternalism for maternal choice.

While the benefits of breast feeding are well recognized, examination of the way in which such breast feeding promotion programs are organized highlights the patriarchal nature of current health care practices. Although choosing to feed their infant artificial milk is a viable choice for mothers in developed nations, care providers do not communicate this message during the perinatal period. Therefore, it is evident that while mothers have a choice, there is a ‘best’ choice that is medically and socially defined by the health care system.

Indeed the BFHI is explicitly paternalistic. There is no effort to even pretend that mothers could or should have any say in how their infants are fed. Moreover providers are both muzzled and constrained in their actions by the BFHI’s Ten Steps. This is a clear ethical violation of medical autonomy.

Would it be ethical for a brain surgeon to avoid telling patients about the efficacy of radiation for the treatment of brain tumors just because he was convinced that surgery was “best”? No. Would it be ethical for an obstetrician to neglect to tell women about the risks of Cesarean section when recommending a C-section for a breech baby? Of course not. So how can it possibly be ethical to refuse to discuss the risks of breastfeeding and the benefits of formula feeding for some mothers in some situations? It can’t.

But the BFHI isn’t merely unethically paternalistic, it is deeply anti-feminist, treating women as breastmilk dispensers instead of persons.

While ‘breast is best’ is the language frequently used in broader health promotional initiatives and by care providers in recognizing the benefit of breast feeding, feminist scholars have identified that such a discourse disembodies the provision of milk from the maternal body experience of breast feeding… Such disembodiment acts to prevent a woman from experiencing her breasts as her own, but rather as a possession of her baby. By placing breast feeding focus on the biomedical and nutritional benefits of breast milk, as opposed to maternal experience associated with nursing her infant, health care providers are perpetuating the patriarchal conceptualization of the ‘good mother’ as one who is defined as selflessly giving by nursing her child while asking for nothing in return.

The BFHI doesn’t even try to hide this objectification of women, dubbing itself as “baby friendly” while ignoring mothers entirely.

The tendency of lactivists to objectify women as nothing more than a pair of breasts is reinforced by the absurd efforts of lactivists to divorce breasts from sexuality. The assumption is that breasts are sexualized by men and that women cannot and should not derive sexual pleasure from their breasts.

The division of breast feeding and sexuality further represents the social regulation of the female body, in that a woman can embrace her sexuality or the mothering role in breast feeding, but not both… ‘Good’ mothers are largely viewed as asexual, and the dissociation of providing breast milk and the embodied experience of breast feeding hinders women’s rights to experience pleasure in both breast feeding and her sexuality.

When apprised of the paternalism and sexism of breastfeeding promotion, lactivists offer a rejoinder that they think should shut down all discussion: But, but, but … ‘The Science.”

The science, of course, is hardly definitive. Most of the evidence is weak, conflicting and riddled with confounding variables like maternal education and socioeconomic status. As a fantastic piece in Quartz, The class dynamics of breastfeeding in the United States of America, notes:

“Breast is best” has not always been the mantra of the upper classes in the US. While the cultural definition of the “best” food for babies has fluctuated over the last century between infant formula and breast milk, one thing has remained constant: the most socially desirable form of infant nutrition has been whichever is harder for poor parents to access.

Breastfeeding has become normative NOT because science shows that it is far better than bottle feeding, but because it has become the preferred choice of the upper classes. Breastfeeding promotion has become an exercise in race based and class based paternalism with lactivists (almost always Western, white, well off women) ritually bemoaning the “irresponsible” behavior of their brown and/or poor sisters.

What might a non-paternalistic, feminist approach to breastfeeding support look like?

In caring for families in maternal child settings, clinicians must provide care that balances optimal infant nutritional needs with the psychological needs of the mother. Breast feeding promotion as it is currently practiced oppresses maternal choice and voice in infant feeding decisions … In light of this, it is critical that the traditional hierarchical relationship that is employed by nurses and other health care providers when providing breast feeding education and support is shifted to a collaborative partnership between the woman and care provider…

Imagine that, an approach to breastfeeding support that respects the autonomy, agency and worth of women!

…[A] philosophy of care in which maternal embodied experiences of breasts and breast feeding are prioritized would serve to reduce guilt by recognizing and attending to women’s needs and lived experiences in establishing the breast feeding relationship. Validation of such practices with women and gender diverse peoples in the perinatal period would serve to further advance understanding of ways by which to promote breast feeding without instilling maternal guilt.

That’s because fed isn’t merely best for babies; fed is feminist.

  • yentavegan

    Breastfeeding my children was a feminist act 30 years ago. The definition of Feminist and feminism has been re-branded to reflect the needs of the marketplace.

  • Merrie

    Step 7, practice rooming in… ALLOW mothers and infants to remain together 24 hours a day. It doesn’t say require it. Why do so many hospitals interpret it that way?

    • swbarnes2

      From “Guidelines and Evaluation Criteria for Facilities Seeking Baby-Friendly Designation 2016 revision”

      “7.1.2: Criterion for evaluation: Of randomly selected mothers with healthy term infants, at least 80% will report that since they came to their room after birth (or since they were able to respond to their infants in the case of cesarean birth), their infants have stayed with them in the same room day and night except for up to one hour per 24-hour period for facility procedures, unless there are documented justifiable reasons for a longer separation”

      I strongly doubt “I need a break from this baby” is a ‘justifiable reason’. So BFHI hospitals really have no choice.

  • doula123

    I’m very unpopular with fellow doulas for waxing lyrical about this, but on this occasion I agree totally with Dr Amy. Pressure to breastfeed is rife in the UK from midwives, yet any real, actual helpful support to do is completely lacking. And the whole ‘breast is best’ thing pisses me off beyond words. I’ve seen clients sobbing while feeding their babies because of this nonsense. I’ve read many times that stress hormones are passed through breast milk, so how can breast be best if the owner of those breasts is exhausted, stressed out and riddled with guilt and shame because she desperately wants to switch to formula? https://academic.oup.com/beheco/article/26/1/269/2262730/Cortisol-in-mother-s-milk-across-lactation

  • Steph858

    Did anyone else see this: http://www.bbc.co.uk/news/business-40281403 ? This kind of article would be par for the course with the Daily Mail, but I expected better from the BBC.

  • EmbraceYourInnerCrone

    The disembodied body part aspect of “Breast is Best” reminds me of the “Save the TaTas” ” we heart boobies” aspect of some breast cancer fund-raising. It completely discounts the actual person, and turns them into a collection of body parts.

  • Emilie Bishop

    It’s also ableist–not every woman is capable of breastfeeding, regardless of desire. What is more deeply insulting to anyone than people in authority telling them they aren’t “best”/good enough due to circumstances beyond their control? The humane response is to find ways around their circumstances. Oh wait, some geniuses already did that in this case–FORMULA! Now let’s work on getting sanitary, affordable supplements to ALL families who need them without shame, shall we? Enough of this nonsense!

    • Mel

      Lactivism is ableist on several fronts. You’ve described the ableist mentality towards women excellently; it comes through on medical outcomes for formula fed infants as well. Doing “what is best for babies” is the positive spin version of “Don’t let your baby be damaged goods”.

      Growing up with a mild disability with a more visibly disabled twin sister and having had a brother pass away young, I’ve had plenty of people visibly react like our family is the worst-case scenario they’ve always dreaded. The irony is that I find their failure to address their fears and prejudices a much more problematic situation than anything that’s happened in my life.

      • Cat

        Ugh, I’m so sorry that people are dickheads! And you’re spot on – the subtext is that if you breastfeed exclusively, have a drug-free birth and follow all the other rules, then you’re guaranteed a “perfect” baby (whatever that is).

        • Roadstergal

          IMO, it’s even more insidious than that. It’s the idea that a not-‘perfect’ baby is due to something you did ‘wrong.’ So you _have_ to have a drug-free birth and EBF and AP or you’ll definitely ‘mess up’ your kid, but your kid might end up ‘messed up’ anyway because you did something else ‘wrong.’

          As Mel notes, it’s horrible on two different levels. The first is treating a child like a commodity to be valued on standardized terms, rather than a unique individual with unique combinations of strengths and challenges. And then it ‘blames’ mom for not having a Stepford Child.

  • Roadstergal

    #fedisbest and #fedisfeminist – I love it!

    This is a great post, but I think this bit – “‘Good’ mothers are largely viewed as asexual” – has so much in it to unpack. It reminds me of the Madonna/Whore dichotomy; good mothers are Madonnas, ‘virgins’ even in pregnancy, fully devoted to the babe, their bodies existing only for asexual motherhood. La Leche League’s Catholic roots make a lot of sense to me in this context.