A new paper on breastfeeding and guilt


A new paper, Resisting Guilt: Mothers’ Breastfeeding Intentions and Formula Use by Holcomb, explores what happens when breastfeeding is represented as a “choice” that is an unalloyed good for all babies and all mothers.

Although lactivists insist that such a claim is the inevitable result of scientific research, in truth the claim is a cultural construct. The reality is that breastfeeding is often not a matter of choice, and is not an unalloyed good for either mothers or babies. Many mothers live in that intersection between reality and cultural imperative, an intersection that is saturated with guilt. Holcomb seeks to understand how women manage that guilt.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding is often not a matter of choice, and is not an unalloyed good for either mothers or babies. [/pullquote]

The paper offers an excellent exposition of the scientific evidence and the cultural dominance of a narrative that was created by and for privileged, mostly white women to suit themselves.

Lactivists encapsulated their views in the phrase “Breast is Best,” but:

It is important to note, however, that the research upon which this perception of “breast is best” is based has been critiqued… Some researchers argue that the positive benefits are often overstated; that research studies indicating a lack of significance are downplayed; and that broader family characteristics, such as socioeconomic status, have more of an impact on health outcomes than does breastfeeding… [M]any of the benefits of breastfeeding become statistically insignificant in within-family models that look at differences between siblings where one child was breastfed and the other was not… Despite these critiques, the discourse of “breast is best” maintains a powerful status.

Moreover, breastfeeding rates are closely correlated with socioeconomic factors:

…[P]rior research on breastfeeding indicates that age, level of education, income, race, and ethnicity are correlated with breastfeeding behaviors… Some scholars point to structural barriers, such as maternity leave policies, inflexible work, inadequate healthcare, and complex historical factors as some of the reasons behind these differences.

In other words:

Hegemonic understandings of good mothering include breastfeeding, but it is critical to keep in mind the raced and classed nature of those understandings.

How do women deal with the resulting guilt? They do this by resisting the fundamental claims of lactivism.

Breastfeeding is often NOT a choice.

..[W]omen in this study often found things beyond their control. Even though they knew the benefits of breastfeeding and tried to find medical staff supportive of breastfeeding, they experienced aspects of the process that were outside of their control—they had their own medical emergencies, formula was used without their consent, and those with medical authority recommended using formula. These mothers did not discuss their use of formula in terms of regret, guilt, or failure but rather as something that happened, at the advice of medical staff, despite their best laid plans.

In addition, breastfeeding is not a choice when women up to 15% of first time mothers are unable to produce enough breastmilk to fully nourish an infant. Moreover, some infants have difficulty obtaining milk from the breast because of poor sucking ability or structural issues (tongue-tie).

It isn’t merely physical factors that make breastfeeding difficult or impossible; socioeconomic factors also contribute.

…[B]reastfeeding occurs within a complex social context that can include working or going to school. When social context is included in discussions of breastfeeding, breastfeeding success becomes more than an individual decision and individual knowledge, incorporating factors such as work, school, racial and ethnic traditions, and historical factors.

Breastfeeding is not good for every baby.

Infant health is put at risk if mothers are not able to produce enough breastmilk. Babies suffer terribly from hunger, screaming for hours on end. Without formula supplementation some babies will develop dehydration, hypoglycemia, severe jaundice, failure to thrive, brain damage; some babies will even die. Contrary to the claims of lactivists, these harmful results are, unfortunately, not rare.

Breastfeeding is not good for every mother.

In the cosmology of lactivism, mothers are reduced to milk dispensers. But mothers are people and they matter. There is nothing beneficial to mothers from pain, frustration, exhaustion and postpartum depression.

…[M]others found the use of formula to be acceptable in that it allowed them to alleviate stress associated with continued breastfeeding or provided them the opportunity to focus on other aspects of well-being. Using formula allowed mothers to focus on other things, such as making homemade baby food, being present at work, and nurturing relationships with partners. Their children seemed to transition to formula smoothly, without upset intestinal tracts or lengthy episodes of crying. Given the stress and anxiety that they experienced during breastfeeding, and the ease of using formula, the mothers decided that using formula enhanced the greater good and that the method of nutritional delivery was not the only factor contributing to family well-being.

Combination feeding or exclusive formula feeding are often best for individual babies, individual mothers and individual families.

The ultimate irony, of course, is that strenuous efforts to increase breastfeeding rates have been ineffective. That’s just what you would expect when breastfeeding is not simply a choice, and is often experienced by babies are mothers as harmful, not healthful.

As Holcomb notes:

The women in this project—who were mostly white, highly educated, with higher earnings and who wanted to breastfeed—should have been “successful” breast feeders. It is particularly telling that even with this sample demographic, nine mothers (40%) used formula within the first week. Only six mothers (27%) breastfed for an entire year without using formula. Eight mothers (36%) had completely stopped breastfeeding by six months. The challenges they experienced are worth exploring in more detail, as they were mothers who wanted to breastfeed and who, demographically speaking, were expected to breastfeed for longer periods.

This is a small study and ought to be repeated on a larger scale before we can draw firm conclusions. But it does highlight an important fact:

…Breastfeeding is a process that unfolds over time (often in response to unexpected challenges along the way) and occurs within a context in which many other factors are significant. Future discussions of breastfeeding need to move beyond a focus on individual mothers and toward a recognition of how various aspects of social context impact breastfeeding experiences.

In other words, it is inaccurate to frame breastfeeding as a choice or best for either babies or mothers. The incontrovertible truth is that Fed Is Best. And the privileged, white women (such as myself) who have breastfed successfully are just lucky, not superior.