I read a couple of articles about breastfeeding recently which got me thinking about infant feeding more generally, and the messages that society and professionals give about it. This is not a post detailing the benefits of breastfeeding (although I happen to think breastfeeding is great when it works, and would be my personal choice if possible, it’s not always that simple, and there are plenty of other places where that is debated), but is more about the judgment that other people make on women’s choices.
First up, this News Shopper article from Bromley, about a breastfeeding mother who was made by a Job Centre worker to leave the meeting she was in because she was breastfeeding. I don’t have much to say about the actual story – I happen to think that the Job Centre worker was absolutely out of order, and if they found breastfeeding really that disgusting they should have left and found someone (a manager?) who could continue the meeting. What I found more interesting/depressing were the comments that follow the article. There is a lot of class judgment being expressed (the mother is on benefits, and has 5 children), but also a lot of pro/anti-breastfeeding posts – asking if she’s “one of these militant breastfeeders, that whip it out and stick it on, with the aim of shocking as many people as possible”, and referring to her as “a breeding machine” and “an exhibitionist”. One of the comments says that given the circumstances she should have expressed her milk into a bottle in advance (as if it were always that simple), and another asks if those supporting and promoting breastfeeding in public are the same people objecting to the objectification of women and the display of their breasts (for example on Page 3) in the media (as if taking these two stances somehow makes the person hypocritical, as breasts in public – whether for feeding or for titillation – are the same thing).
Quite apart from the obvious sexist and classist judgments being made here, what on earth gives people the right to pass comment on a mother’s choice of how to feed her baby in public? I am aware of people who wanted to breastfeed but for various reasons were unable, who have also faced such judgment and disapproval when they took the bottle out to feed their baby, so it is not just breastfeeding women who deal with this issue. I hope when I was health visiting that I was supportive of people’s choices and not judgmental – whilst there are certain milks on the market that I think are less than optimum, and I wouldn’t have a problem suggesting more appropriate milks for a young child, choices about which milk to feed a child are about so much more than the milk, personal hopes or beliefs about the milk’s effects, or financial issues. Family habits/pressures, societal dis/approval, advertising messages and professional messages all play their part, and I do think that as both a health professional, researcher, woman and member of the general public I need to reflect on the messages I give (verbally and non-verbally) conveying my dis/approval, judgments or opinions, and take real care to be sensitive and non-judgmental.
Secondly, I saw this post retweeted a few times a few weeks ago, in response to this New York Times opinion piece by a columnist called Nick Kristof about a young mother in Mali he introduced to a doctor and who taught her to breastfeed, thus allegedly saving the baby’s life. The blog post critiques Kristof’s column beautifully, and I couldn’t really add much to her points (and of course I am glad that the child in the story appeared to thrive, although the quick recovery does strike me as a bit too Hollywood), but I do want to reiterate what she says about the economics of breastfeeding – it is only free in the sense that money doesn’t (usually) have to change hands in order to get the milk. I’ve worked with enough families in my time where breastfeeding has taken weeks of hard work and a hell of a lot of lost sleep to be established (or not, in some cases) to know that it isn’t a bed of roses, and doesn’t come without cost, whether that be to the mother’s time, relationships, job, ability to plan activities in public (see case above) and all the rest of it. Proclaiming it as “free”, no-cost, easy, and the obvious choice, makes no acknowledgement of all the myriad of factors which can affect whether it happens or not, or that it is the woman that bears the bulk of the burden. Again, whether approving or disapproving of breastfeeding, it is a woman’s choice which is judged by outsiders, and again as a health care professional I need to check myself and make sure that I’m not just adding to the chorus of dis/approval but actually enabling women to make the best choice for them and their baby/ies.
I’m not sure that the professional focus on “breast is best” is always helpful in the debate. As I started to write this post I saw a BBC article on twitter, about a health authority’s bid in England to tender for an infant feeding service. I do think that such services are really helpful, and it’s great if women who want to breastfeed have access to professional support rather than being left to sink or swim on their own. But Dr Ellie Lee’s concerns expressed in that BBC piece need to be heeded – the problem with a lot of health education/professional messages are that they are a list of benefits, regardless of the evidence, and any attempts to find out more about the evidence-base are shouted down or assumed to be dangerous and anti-breastfeeding. I don’t think the health services do themselves any favours by shouting about claims for breastfeeding, some of which have more questionable evidence bases than others, and ultimately the impact will be in increased cynicism and reluctance to try, and increased suspicion of those of us keen to promote breastfeeding where it is possible. Surely it can’t be that difficult for us health professionals to be more nuanced and balanced, more academically critical of the claims of evidence, and less judgmental of women and their choices?