The Politics of Breastfeeding

a book by Gabrielle Palmer


As propaganda about the benefits of breastfeeding increases, so do the worldwide sales of artificial milks and feeding bottles, and the number of breastfed babies decreases. This book asks why more babies are given artificial milk when breastmilk is a nutritionally balanced food and a wonder drug that both prevents and treats disease.
The author examines the political reasons for this situation and social attitudes to women. She reveals the myths and superstitions of modern medicine, and considers the vulnerability of doctors to commercial pressures and misinformation, and the link between the decline in breastfeeding, the population explosion and child malnutrition.

Imagine a young man embarking on his first attempt at sexual penetration. Ask him to set about the project in a special sex centre where there are 'experts' he has never met before, ready to supervise and tell him how it ought to be done. Presume that his partner is as inexperienced as himself and that he is asked if he is going to 'try and achieve an erection'. When he starts, a busy 'expert', who may never have personally experienced sexual relations, starts telling him how to do it and inspects his body with a critical expression, prodding him and his partner in an insensitive manner. By the bed is an artificial penis, put there, as the young man is told, 'just in case you can't manage it. Many young men can't make it; it is not their fault, nature often fails.' Everyone knows how sensitive sexual partners must be in order to nurture the psyche, as well as the body, of the male, yet such sensitivity has been conspicuously absent form the milieu of hospitalised parturient women. There are thousands of horror stories of medical staff snapping at women, brusquely pushing the baby on to the breast, dragging her off and distributing the feeding bottles whose very presence is saying, 'You won't do it, you can't do it.' It is no wonder that, the world over, a decline in breastfeeding is linked with an increase in hospital births."

Both late menarche and breast­feeding contributed significantly to child spacing in pre-industrial Europe and still does in the developing world, for breastfeeding prevents more births worldwide than all other forms of contraception put together.......the west's export and promotion of artificial baby foods, together with the grosser errors in infant feeding techniques disseminated by health workers, have had a serious effect on birth spacing, which is a key factor in both demographic trends and in the well-being of individual women. This method of fertility control had been recognised since ancient times, but its importance was forgotten and ignored during the last two centuries because the changes in social organisation and in breastfeeding practices damaged its effectiveness. A seventeenth-century working Englishwoman married late and had well-spaced pregnancies. She used breastfeeding both to supplement her living and to space and limit her own childbearing. As unrestricted breastfeeding was the normal practice in those days she would have been unlikely to ovulate. Wealthy women were discouraged from feeding their own babies in order to reproduce greater numbers of the nobility. Slaves had their breastfeeding time limited so that they could breed more slaves for their owners. Yet by the twentieth century in Europe the use of lactation as a means of child spacing was not discussed or considered by doctors or advocates of birth control.

By the twentieth century breastfeeding in much of western Europe and North America was quite different behaviourally from what it had been and what it still is in the areas of the world where it has not been disrupted. As the 'men of sense' (see page 41) took over the management from women, new ideas came into vogue. First came the limiting of feeds to an ideal of not more than five times a day, the prohibition of night feeding and then a limiting of the actual feed times. Only someone who did not spend twenty-four hours a day with a baby could have thought of restricting feeding time. These ideas had arisen from the dread of overfeeding, but they actually caused the problem of under­feeding, as the baby was prevented from stimulating the amount of milk she actually needed. Consequently there was a greater requirement for supplements which in turn decreased the baby's control of the breast milk supply. The discouragement of sleeping with the baby at night, which had been the norm since the dawn of human life, spread throughout the nineteenth century. In England, the early twentieth century health visitors zealously handed out banana boxes (available via cheap colonial labour) to serve as cradles in order to try and stamp out the habit of mothers and babies sleeping together. This was to prevent overlaying, supposedly a common cause of infant death, though this is debatable. Such deaths are unreported in those countries where it is still custom for babies and mothers to sleep together. What this separation did do was increase the risk of infant hypothermia, maybe cot (crib) death and lessen the important contraceptive protection of night suckling which is crucial for the maintenance of the frequent nipple stimulation necessary to maintain anovulation. A mother sleeping with her baby in her arms might not even be awakened, but that occasional mouthing is an important contraceptive. With these reductions in suckling time and the increasing promotion and use of other infant foods, mothers were truly breastfeeding less and less. Even the use of a dummy or boiled water given by spoon can reduce the nipple stimulation needed to maintain infertility.

Most women who are breastfeeding do not menstruate and for thousands of years many have known that there is a connection between the resumption of menstruation and fertility. Certain groups actually shortened the period of breastfeeding so as to increase their birth rate. There has not been a great deal of communication between ordinary women (who may be reticent about discussing their bodies' functions) and researchers who until recently had mostly been men. Consequently this 'old wives' tale' was disregarded for many years.

As long as the baby is suckling at least six times a day, amounting to sixty-five minutes in total and preferably including some night feeding, a woman is unlikely to release a ripe egg (ovulate) from her ovary. Most women do not ovulate until after they have resumed menstruation, though about 10 per cent might do so prior to their first period. This is more likely to happen the longer the lactation lasts, so that women who breastfeed for several years are the ones who  are most likely to have a pre-menstrual ovulation. So for most women, in the early months, as long as they and their babies are together and they can suckle whenever I hey want, infertility is maintained. The factor which dramatically decreases suckling and therefore increases the possibility of pregnancy, if the woman is heterosexually active, is the introduction of supplementary foods to the baby. This means that juices, water, artificial baby milk, gruels, dummies or even mucking a thumb or a blanket could alter the suckling behaviour and hence the contraceptive effect of breastfeeding. If suckling is frequent then duration of suckling is less important, but the western habit of 'feed' times with clock watching and boiled water in between 'feeds' would certainly have disturbed this biological mechanism. The number of unwanted pregnancies (and miscarriages) will have increased all over the world where medical advice and commercial misinformation has interfered with normal breastfeeding.

This breastfeeding infertility is thought to be due to the suppression of the release of a hormone called gonadotrophin-releasing hormone (GnRH), necessary for the secretion of luteinising hormone (LH) which is needed for the maturation of the egg (ovum). This activity happens in the hypothalmus, that part of the brain above the pituitary gland which controls thirst, hunger and sexual function and is also believed to be linked with emotional activity and sleep patterns. The precise mechanism is not understood but one theory, derived from animal studies, is that suckling might increase the opiate activity, in the hypothalmus and that this suppresses the GnRH release. Interestingly, heroin use suppresses gonadotrophin and causes an increase in prolactin levels just as in lactation. There has been a recent interest in natural opiate activity; breastfeeding does make some women feel great and perhaps this is one reason why. Because when blood serum levels of prolactin (the milk-making hormone) were measured, investigators noticed a rise that correlated with infertility, it used to be thought that this hormone was itself the inhibitor of ovulation, but now it is thought merely to accompany the process. Prolactin is also stimulated by frequency suckling, so that the levels measured in a woman's blood serum can indicate her likelihood of being fertile.

Mrs Margaret McNaught, one of Britain's 'champion mothers', had twenty-two single children in twenty-eight years, which is a mean interval of 1.3 years between each birth.8 Mrs McNaught did not breastfeed her children, and was given stilboestrol as a lactation suppressant at birth. If she had breastfed each child for just three months the McNaught family might have been five fewer and this little family population explosion would have been reduced by almost a quarter. I do not wish to show any disrespect to the McNaught family, but their example shows how significant lactation suppression can be on one woman's fertility. The health workers persuaded women around the world to reduce their duration of breastfeeding and the companies which managed to get women to stop even earlier have had a potent effect on the world's population explosion, yet the false presentation of this situation as a problem caused by irresponsible individuals has prompted the unthinking genocidal sentiments of many people like my friend.   What appeals to me about this fascinating strategy of anovulation during lactation is that it destroys the arguments made by some religious and cultural groups that nature designed sexual activity only for procreation.

Babies tend to be loathed by many people, especially where rigidity in childcare has been well established for several generations. It seems likely that the presence of a baby stirs up feelings of a sad period in our own lives and we can project that onto the baby. People in western society get angry or upset when they think a baby is dominating the attention of an adult, perhaps because it unconsciously reminds them of their own inability to get their needs met as a baby. The 'loud noise at one end and no sense of responsibility at the other' definition of a baby denies the vulnerability of a new child. Similar factors may influence the rates of post-natal depression. Post-natal depression is considered by some to be hormonal in origin, yet why the hormonal state is assumed to precede the emotional state is unexplained. .....It is so evident in those societies where babies are nurtured, never left to cry and breastfed whenever they ask, that not only are the babies far more socially pleasing in that they are more content and alert, but also that adults in those societies do not view babies with the alarm and revulsion that so many people show in my own society. Also, where babies are cherished, children usually appear better socially integrated than in some western societies. One rarely meets the whining 'brat' who so often justifies the exclusion of children from adult company. The extremes of bitchiness and horror shown by some adults' over-attention to a baby is more than cultural habit; it has some deeper emotional cause.

Here is an account from travellers in Nepal.
We stopped one night in a tea house in the Himalayas. The mother was cooking, but stopped to breastfeed the baby and the father took over at the stove. After the meal, when everything was cleared and put away, the parents began what was obviously a nightly ritual. The baby was lovingly massaged with oil and it was evident that both the parents and the baby thoroughly enjoyed the procedure. The baby was gurgling, the parents were smiling and sharing the task, one doing between the toes while the other concentrated on another area. Eventually the baby fell into a profound and peaceful sleep and the whole family retired contentedly to bed.
Compare this with a typical British scene where the family are watching television and groan when they hear the baby wake up in its expensively equipped nursery upstairs.

Perhaps it was because many mothers were not so emotionally crippled as Dr King and his peers, able to ignore the cries of a child in need of food or physical contact. However a couple of generations of women bravely attempted to deny their own and their child's feelings, and even today many mothers who 'give in' to their babies still meet disapproval in everyday life in the western world.

These misguided and cruel ideas were able to gain a foothold because of widespread literacy, control of women by medical authority and the breakdown of traditional support systems. The focus on the mother alone to provide all nurture is a cruel and unjust burden which is linked to the economic system. A rural Thai woman remarked incredulously to Penny van Esterick, 'How can a woman give birth and raise a child without her mother's assistance?'13 In her society babies are cherished, give a lot of joy and are never physically chastised.
On the positive side of this cyclical/cultural effect of baby care is the response of a mother who told me that she had discovered her own infantile sadness through psychotherapy, but that loving her own child and responding to his needs through breastfeeding and close physical contact helped heal her own pain. This endorses the fact that babies are born able to take an equal part in their first relationships, and if they are not distorted by outside influences the relationship between a baby and her carers can help the adults to grow as well as the child.

Some societies advocate sexual abstinence during lactation. This taboo is supposedly unknown in hunter-gatherer societies, but appears among early agriculturalists. This may have evolved in food-abundant societies (many areas of the world where hunger is now normal were formerly producers of surplus foods and agricultural products, which is why they were so attractive to colonial invaders) where women found that they were becoming pregnant earlier than was desirable. This indicates that though people might have been aware of the lactational protection, they also knew that in some regions it was not always 100 per cent effective, and it was so important to space births that they would not take any risks. It would be interesting to find out whether these sexual taboos are commoner amongst groups who have traditions of early food supplementation. Sometimes the taboo is backed up with a prohibitory myth, such as belief that semen will poison the milk. When Dr David Morley first worked in Nigeria, women told him they had stopped breastfeeding because thev were pregnant and he believed them, but when he kept records of dates he discovered they had their babies about fourteen months after they had announced their pregnancies. They stopped breastfeeding their babies when they felt ready to conceive another, often on the advice of the older women. It was common knowledge that complete sevrage was precarious and the fact that foreigners would often see sickly-looking 2-year-olds on the breast led Europeans, accustomed to stopping breastfeeding before the first year, to state dogmatically that breastmilk had no nutritional value after a year and that 'prolonged' breastfeeding 'caused' malnutrition. In fact the community recognised that a weak or ill child would probably only survive if his mother continued to suckle him.

Abrupt sevrage is a problem in some societies because many people believe that with a new pregnancy the milk belongs to the new foetus and will poison the suckling child. Under colonial influence and with 'development' there has been a breakdown of traditional mores and authority. As monogamy is encouraged women may feel pressured to engage in frequent sexual relations with their husbands in order to deter them from having sex with other women. Some husbands believe that semen does poison milk and persuade their wives to bottle-feed so that sex can be resumed soon after the birth.
Sexual abstinence exists in both monogamous and polygamous societies, and though twentieth-century ideas emphasise the ill-effects of sexual repression, there is scant evidence that periods of celibacy or non-coital sex do much harm. Being sexually repressed is not the same as being celibate. Also, the idea of polygamy being more exploitative of women than monogamy is inaccurate. In a polygamous society, adultery or promiscuity are often as strictly proscribed as in those that profess to be monogamous. In some African societies, if a man has two wives hut both are lactating, he still has to be celibate. I was told of one man whose two wives had their babies within nine days of each other five times in succession so that he had a couple of years' abstinence between each bout of lovemaking and was the subject of some good-humoured teasing in his village. He survived this ordeal without becoming neurotic. A friend in Mozambique had made his own taboos, that he must abstain from sex with anyone until his baby was three months old and then he could have sex with another woman, but not with his wife until the baby was seven months. The idea of restraint in the first period was due to the concept that after sexual intercourse the body gives off heat and this could damage the baby. There are numerous beliefs from many societies, and contrary to western prejudices it seems that often the more 'primitive' the society the more restraints there are on sexual intercourse. Women in Mozambique laughed at my attempts to generalise about people, and the phrase 'it depends on the person' put paid to my attempt to herd individuals into a cultural box. When I asked midwives what lactating women felt about enforced celibacy they said that they accepted it un-questioningly. Who knows how frustrated the women felt? Sexuality is so culturally dominated that often the individual feels what she or he is conditioned to feel and this domination leads people to give 'acceptable' answers to intrusive questions. It is hard enough for those drawn into the western cult of the priority of personal fulfilment to discover their own true desires.

Breastfeeding in industrialised society is closely bound up with perceptions of sexuality. The very reason it is frowned upon in public is that breasts are perceived exclusively as objects of sexual attention. The extremity of this attitude was brought home to me when a male friend, responding to my statement that I could not see any good reason for women not being able to leave their breasts showing, stated that after all men did not walk about with their penises hanging out.

The fact that such abhorrence is absent in some other societies may have another foundation. Few of us in industrialised society can remember suckling our own mothers. Many women have denied themselves the experience of reproduction because they know what a handicap it can be in the economic and career stakes. Others have children but do not breastfeed for the same, reason or because it went wrong in the hopelessly unsupportive medical and social systems. When we see a suckling pair it does not summon up associations of tenderness and pleasure, but of rejection, failure and pain both in our relationships with our own mothers and with our babies if we have them. Men who are jealous of their partners' breastfeeding may have had damaged feeding relationships with their own mothers and seeing the same scene in public may be too inexplicably painful. Women who have not fed their own children, especially if they had wanted to, may feel terrible seeing a breastfeeding pair. My sister taught me this when she admitted how angry she felt whenever she saw a breastfeeding couple. She could not feed her first baby because, as she realised when she was helped with her second, she had never been taught to position him properly. Until she understood her own experience better she had unconsciously projected her anger at failure, and betrayal by those who should have helped her, on to other, luckier women.

When I trained as a breastfeeding counsellor, I was taught that one could avert milk leaking by holding the heel of the hand to the breast for at least one minute, and I solemnly absorbed and disseminated this 'new fact'. In Africa I noticed women unconsciously performing this action just as I might obliviously scratch my ear. In Papua New Guinea there are very few breastfeeding problems because women's knowledge has not been taken away from them, and it is one of the few countries that managed to pre-empt the tragic effects of bottle-feeding by restricting it by law at a stage of development when traditional skill was still thriving. Many infant lives have been saved as a result.