In my long post on breastfeeding advocacy I wrote that there are two different breastfeeding conversations, one about public health and another about private choices. In response I got some enthusiastic emails and comments along with some angry ones. Some formula-feeding women asked, "Why can't you leave us alone?"
If you are a mother struggling with breastfeeding, or a mother who weaned unhappily, or a mother who never put her baby to the breast, here's what I'd like to say to you: we're on the same side. I am only another mother muddling through, hoping for the best for my children. When we cross paths in my neighborhood or here in cyberspace I'm not squinting at you through a guiltometer, deciding you don't measure up.
Why, then, do I sometimes use risk-based language (decried as the "makes-moms-feel-guilty" approach) in talking about breastfeeding?
In my view it's like temperature scales. Sometimes you need different ways to label the same reality. When I talk with a mother who's had a hard time breastfeeding I'm going to use the Kelvin scale, in which there are no negatives. Any human milk is valuable, especially in the first days postpartum. Kathy Dettwyler compares the value of breastfeeding to the yield of an oil well that gushes out bountifully at first and gradually slows down. I like this analogy a lot: if your baby goes to breast even once in those early days, you've struck oil. When to shut down production is your choice. I understand that maintaining oil wells can lead to unexpected complications (just ask the Iraqis).
The Kelvin scale has its limitations, though. If I tell you it's 263 degrees out, you may not know off the top of your head whether you need a parka or a bikini. Sometimes it's immensely useful for our frame of reference to shift with context. Diane Wiessinger has written eloquently about the hazards of focusing only on the benefits of breastfeeding. If bottle-feeding is regarded as the norm, as the formula companies would like, it's too easy for breastfeeding to be viewed as nothing more than a nice bonus for über-moms with time on their hands. See them nurse their babies in between batches of homemade granola and lessons in Teach Your Newborn To Speak Italian!
But breastfeeding is not a frill; it is an enormous public health issue. One study determined that reaching the Healthy People 2010 goals for breastfeeding initiation and duration would save a minimum of $3.6 billion -- billion! -- in healthcare costs. Per year! That's more than the GDP of 15 different African countries. And furthermore, it's a conservative estimate because this study only considers three diseases.
Breastfeeding is also a women's issue. With our own bodies, we can make something miraculous. Everyone knows that breastfeeding protects babies against allergies and ear infections. But the list goes on and on: inguinal hernia, childhood lymphoma, UTIs, and so many other things that you would stop reading if I tried to list them all. It protects mothers against ovarian cancer and premenopausal breast cancer. Breastmilk kills tumor cells and destroys warts. It nourishes our children so efficiently that eight-month-old breastfed babies have ingested 30,000 fewer calories than their bottle-fed counterparts. Many families swear by breastmilk as a pinkeye remedy. Peace and harmony follow after lactating women everywhere, and violets spring up from their footprints! (I deal with too much sibling strife for that last one to be anything other than a joke. And the only thing springing up in my path is more laundry.)
Seriously, though: why do so few women speak up when this amazing gift we can give our babies is devalued, when people say formula is "just as good"? And why are there women calling other women nazis because they are telling the truth about their bodies?
Because I care about women and babies and truth in advertising and public health to boot, I do use risk-based language when the powers that be are undermining breastfeeding. When I write to Nestle about why I boycott their products. When I plan a letter to my state legislator about a law protecting breastfeeding in public. (Which I then -- oops -- forget to send. But the law passed anyway so I won't sweat it.) When I'm talking about a restaurant that says breastfeeding is obscene but wet T-shirt contests are okay. Early last winter when all that stuff went down with the Ad Council's breastfeeding campaign, I wrote a scorching letter to Tommy Thompson -- a risk-oriented letter. (I would have liked to send a Howler, but I, alas, am owl-less. And I know better than to screech when I'm trying to persuade.) If you had read my letter, you might have pigeonholed me as "one of those nipple nazis." But I am not any kind of nazi. I'm using Celsius in that conversation because it's more effective than Kelvin or Fahrenheit. It's a different way of talking about the same set of facts.
Let me say again that I understand how many obstacles women face in this country when they set out to nurse their babies. I was lucky with my first son -- all kinds of lucky. The NICU gave me rotten advice about pumping, but I am an overproducer so I could compensate for the inadequate pumping schedule. They gave me rotten advice about engorgement, but I survived with no lasting damage. They gave me horrible stupid awful inexcusably bad advice (not that I was bitter or anything) about getting Alex to the breast, but we figured it out once we got home. I can attribute some of our success to determination, but I know a lot of it was just plain luck. When I see you in a restaurant with a bottle, I don't know what you've been up against. I'm not going to assume you didn't try hard enough.
Breastfeeding advocacy can be a delicate thing. We're looking at the graphs of initiation and duration rates, hoping that for the sake of babies and their mothers, and for the sake of our creaking groaning overstressed healthcare system, we can increase the area under the curve. The math is relatively straightforward, but the emotional calculus is complex. Where do you start when you hope to change a whole culture? In oil-well terms, how do you balance the undeniable need for a national resource with respect for the landowner's right to run things as she sees fit?
To muddy the waters further, we also need to think about a third conversation -- the one we have with people about how to feed their future babies. On reflection, I think this might be where most of the anger comes from. The team that prepared the national breastfeeding awareness campaign found that "benefits of breastfeeding" language had no impact on how the people surveyed planned to feed their children. Talking about the risks of formula, on the other hand, did make a difference. But what happens in this country, where medicalized births are the norm and good breastfeeding support can be hard to find, when families think of formula as risky? Does it galvanize them when they encounter problems? Does it motivate them to demand more support from doctors and hospitals? Or does it leave them angry at breastfeeding advocates when things don't go as planned?
I don't have answers to those questions. I'd love some input, preferably epithet-free. Just one more thing here and I'll be done:
As passionate as I am about breastfeeding, I know that it's only one part of my job as mom. When I think back on my time as a mother there are things I am proud of (getting my reluctant oldest son out of diapers was one of my shining moments) and things I regret (getting my reluctant second son out of diapers was not). I expect you'd say the same thing. I know too that I have never wanted anything as badly as I want to do the right thing by my children. Again, I'm guessing the same is true for you. So if we cross paths, please know that I'm assuming the best about you and your intentions regardless of our differences. I hope, when you hear me talk about this subject that's so close to my heart, that you can do the same for me.
Recent Comments