Introduction for Breast Intentions by Allison Dixley

Friday, 21 November 2014  |  pinterandmartin

Introduction

‘Like tears, milk is functional; but it also has a lot to say about us’.
Fiona Giles, 2003, Fresh Milk: The Secret Life of Breasts[1]

The issue of breastfeeding vs formula feeding is under the media lens now more than ever. The tabloid press prints stories of alpha mums who – shockingly – breastfeed well beyond the eruption of their baby’s first tooth. Broadsheets roll out schizophrenic arguments that extol the virtues of breastfeeding one day and diminish them the next morning. Television shows invite ‘breastfeeding experts’ to lecture the public on the perils of jealous husbands and what to do when your milk ‘runs out’. Academic journals pour over the physiological, societal and even philosophical aspects of a mother’s infant-feeding choice. Google the phrase ‘giving up breastfeeding’ and the internet explodes.

Many women having babies today were formula-fed as infants. And the world around them is dominated by perceptions of infant feeding that can only be described as regressive: as a species, we have moved from the uncostly, self-regulating and environmentally friendly breast to the unquenchable industrial teat – a capitalist’s dream. In essence, the human race has rejected a wholesome, biologically normal way of nourishing its young and replaced it with an illusion of normalcy built on the consumption of synthetic goods (well, okay, not the entire human race, just the so-called ‘developed’ sector of the species). In the UK for instance, only 23 percent of six-week-old babies are receiving the optimum nutrition for their species by being exclusively breastfed according to the NHS Infant Feeding Survey (2010). The rest have been removed – quite abruptly in evolutionary terms – from their mothers’ breasts and are fed instead via plastic breast replicas containing the milk of an alien species. Consequently, the sight of a mother suckling her offspring – once common in our collective consciousness – is now foreign, and often framed as a vision of repulsion. The bottle has become culturally synonymous with infancy; it symbolises our exchange of natural excellence for man-made mediocrity.

Even if a mother can defy this culture, deciding to breastfeed does not ensure success. At six months of age, just 34 percent of British babies are receiving some breast milk, the same survey tells us; most of them, in conjunction with formula. Why? You might think research instruments like the NHS Infant Feeding Survey could tell us. But their focus is on breastfeeding initiation, and while their research is quantitatively useful, it provides little qualitative understanding of women’s unique experiences and conflicts – of why they take up or give up nursing. The truth is that breastfeeding is not, for a woman, simply a means of getting nutrition into a baby; it is part of her psychosocial transition to motherhood.[2] The nebulous nature of breastfeeding makes answers to why it is so difficult elusive and strategies for change evasive.

The contemporary mother-child relationship is characterised by tension from the very start – some studies describe early motherhood as ‘a moral minefield’.[3] Why the wartime language? Because infant feeding has become an increasingly probed domain; rightly so, considering its vital importance to the healthy development of babies. Exclusive breastfeeding for six months provides numerous protective factors for both baby and mother. Chief among these is protection against infant gastrointestinal infections, observed not only in developing but also industrialised countries. Adults who were breastfed as babies are slimmer. Children and adolescents who have been breastfed are smarter, even when confounding factors are accounted for.[4] Indeed, most women know breastfeeding is ‘better’ for baby,[5] and as the saying goes, ‘When you know better, you do better’. So why aren’t women translating their knowledge about breastfeeding’s supremacy into action?

SOCIETY VS WOMAN

Since most contemporary women fail at breastfeeding, society readily accepts the idea that mothers are in no way to blame for the failure – if everyone is failing, this must be down to the difficulty of the task. Such reactive explanations convey the idea that breastfeeding is something women have little control over. This idea is now so taken for granted that it pervades mainstream opinion and prevents us from obtaining a deeper and truer understanding of women’s breastfeeding experience. Currently, women are expected to fail at breastfeeding; it fits in with our pro-formula society’s self-fulfilling raison d’être. The argument that individual women aren’t responsible for their failure to breastfeed appears plausible, comprehensible and consistent with the timeless and persistent world-view of women as the weaker sex. Some commentators (ironically defining themselves as feminists) are so bent on over-framing breastfeeding as a sociological issue, that they have taken to describing the biological process of lactation as a ‘reproductive ritual’ (notice the hyper-cultural word ‘ritual’, implying that nursing one’s baby is some sort of man-made ceremony),[6] while others describe lactation as bordering on a patriarchal conspiracy, a misogynistic net in which to snare women, tethering them to their babies and thus to the often-ridiculed domestic sphere.[7]

Yet this response to a normal bodily function is needlessly reactive and awkwardly paternal. A blame-free breastfeeding culture infantilises women, framing them not as active agents capable of controlling their destiny and achieving their goals, but as passive wallflowers at the mercy of forces they are powerless to defy. I concede that social influences play a role in breastfeeding, but I believe they are merely a small part, not the whole, of a woman’s breastfeeding journey. Culture may predict aspects of a woman’s breastfeeding performance, but not its totality.

The aforementioned sociological stance on understanding breastfeeding – that the likelihood of success is as fickle as the flip of a coin – is clearly not working. The best conclusion sociological studies have come up with for mothers quitting breastfeeding is that the reasons ‘lie buried deep within our culture’.[8] Even the statistics emerging from sociological studies are not clear-cut. In some, older mothers are found to have higher breastfeeding rates;[9] in others, younger women out-breastfeed their elders.[10] In some studies, women with relatively high levels of education have stronger breastfeeding performances;[11] in others, the lower Mum’s educational attainment, the likelier she is to breastfeed,[12] while in more studies maternal education has zero bearing.[13] Sociological fetishes like age, education and socio-economic status paint only a cursory picture of what is really going on. To illustrate, consider this universal fact: when mothers are given the exact same opportunities and the exact same constraints, some will succeed while others fail. Why? Previous scholarly discourse hypothesising the ‘cause’ has tended to look to habits and customs. But one piece of the puzzle has so far evaded the discourse – personality.

A mother’s personality has a direct effect on how she interprets and transforms her circumstances. Rather than adopt the same old defeatist and paternalistic ‘society is to blame’ rhetoric, in this book I will argue that a mother’s responses to breastfeeding are acutely idiosyncratic. Until now, personality has been neglected and downplayed in the infant-feeding debate. Neglected because its varied nature makes personality difficult to study; downplayed because looking at personality arouses uncomfortable thoughts and emotions that hinge on ‘anti-collectivist’ notions, such as personal responsibility and individual determinism. Mothers being responsible for their actions? Who’d a thunk it!

AN INDIVIDUALISTIC APPROACH

I contend that all behaviour begins with a mother’s personality and ripples outwards. These ripples often take the form of emotion. Maternal emotion is of pivotal importance to a mother’s breastfeeding performance, acting as it does as an intermediary between her personality and the culture surrounding her. Yet the emotional world of women’s interactions with regard to infant feeding remains largely unacknowledged – it represents a ‘private’ sphere, and private experiences are not easy to discern. Nevertheless, an awareness of the emotions that arise during the infant-feeding journey is pivotal if we are to understand mothers’ behaviour, and thus make sense of the infant-feeding statistics. Why aren’t mothers in contemporary society coping well with breastfeeding? This question has been hypothesised to death. Sociological theories[14] would have us believe the answer lies in factors beyond the mother’s control – fetishism of the breast, formula-company advertising, vague notions of ‘lack of support’ and ‘a disabling social environment’ – in other words, we are led to believe that individual mothers are not responsible for the outcome of their attempts at breastfeeding. This assumption is defeatist and disempowering.

‘Social support’ is the buzzword of this apologetic era and dominates breastfeeding discourse. Yet social support is a broad umbrella term that can be conceptualised in so many different ways that it becomes redundant as a definition. Even so the term persists, hanging around like a fart trapped in an elevator. And, like a fart, the ‘support’ rhetoric functions as a comforting if elusive scapegoat, nifty at deflecting attention from other salient issues – issues I will cover in this book. On the occasions that attention drifts away from the support rhetoric, it stagnates on the outcomes of breastfeeding failure rather than on how that failure came about. Restricting dialogue to breastfeeding outcomes rather than processes reflects our preoccupation with a medical model of health. The medical model paints women as passive; indeed, the existence of the medical model relies on it. The model assumes that an expert ‘professional’ (health practitioner or formula company) is serving an inexpert mother, and thus depends on a hierarchical relationship based on often-biased knowledge gained from textbooks. It focuses on atomised mothers and babies, places them in a clinical setting and separates them from their personal ‘cognitions’: their thoughts, their emotions, their dreams and their nightmares. By religiously adhering to this model, we neglect part of the story – a huge part, an essential part – women’s voices. In defiance, this book adopts a radically different approach, looking at the topic of breastfeeding through the lens of the individual. It aims to unpack the murky depths of a mother’s emotional life and to reveal the complex, often conflict-ridden reality it obscures. The ways in which mothers interact with one another are fascinating. As we look at them closely through the chapters of this book, we will see a peculiar mixture of behaviour, involving intersecting agendas and a creative flair for improvisation. Mothers’ interactions reveal how clever and discerning they sometimes are, yet how biased and simple-minded they can also be. For too long we have been living in the dark, not understanding the deeper network of a mother’s psychosocial life – the way her thought processes interact with her social environment and entwine with those of other mothers. It is imperative that we explore the underbelly of these relationships if we are to fully understand how breastfeeding lives and breathes – or more likely, is choked.

This book is provocative precisely because it focuses on the issues most relevant to the way mothers live and interact with each other. The decision to breastfeed or formula feed – whether from day 1 or day 21 – does not occur in an emotional and cognitive vacuum, and therefore should not be discussed in one either. We experience our choices through our emotions, and it is our emotions that give our choices meaning. In fact, our emotions are inseparable from our engagement with others, which begs the question why the support rhetoric has largely neglected them.

The philosopher Nietzsche warned that we are most clueless about what is closest to us. Our emotions are our most private, most intimate experiences. In this book I move away from the ‘cold’ analysis of statistics and the medical model and instead examine the effects of a mother’s emotions on her judgement, choice and conduct. Emotions drive our behaviour, yet we have a relatively ignorant understanding of them. If we want more women to choose breastfeeding in the ‘real world’, then we need to understand more about ‘real women’ – that is, women influenced by emotion. This book explores how mothers relate and respond to each other, how they understand themselves, and how they manipulate both themselves and others. The chapters examine, in turn, the most common emotions emerging from mothers’ experience of breastfeeding, from guilt through to sabotage. It reveals how emotions affect a woman’s concept of herself as a mother and the substantial impact they have on the dynamics of her interpersonal relationships.

Breast Intentions brings together various fields and disciplines, including psychology, biology, philosophy, anthropology, sociology and even economics to produce a new understanding of how women cultivate breastfeeding ‘success’ or ‘failure’ in their everyday lives. I have no intention of competing with any text already in print; rather, my goal is to create a dialogue I feel has not been available until now.

A word of warning: the ground covered is largely depressing. It also has the potential to be threatening, striking a chord of recognition in the reader that may trigger feelings of shame, embarrassment or unease. This book is about untruth, about deception and about lies, interior and ulterior. It lifts the veil on the way women pathologise their relationships in the quintessentially strategic arena of motherhood – where self-interest and manipulation reign supreme. As you plough through these chapters, your instinct will be to think, ‘How shocking! You’d never catch me behaving like that!’ Yet, many of the behaviours explored in this book do not involve conscious awareness or deliberate planning. For this reason, I cite academic studies to support my assertions. Many of these studies are the seedlings of long-established theories, subsequently tried and tested by exhaustive empirical research. In such cases, I aim to cite the founder of the theory. So for instance, when I discuss the psychological concept of ‘the ego’ I cite its creator, Sigmund Freud. Although some of these references are decades old, they are still valid, and some represent monumental breakthroughs in our understanding of human behaviour. I’ll say it again: in Breast Intentions you may read things you would prefer not to. Indeed, there is a darker, more malignant side to the breast vs formula debate, particularly concerning women’s relationships with each other. This book exposes the unforgiving and angry constituents of the maternal character, revealing a mother’s capacity to deprave as well as to nurture. In exploring the mechanics involved in deception, guilt, envy, contempt, defensiveness and sabotage, the book penetrates emotions that often feel too ugly or too unacceptable to talk about, particularly in such a feminine domain. Yet this dark and opaque side of motherhood is one we leave untreated at our peril.

In the infant-feeding context, the issue of corruption has typically been regarded by scholars and social commentators as an exclusively commercial phenomenon occurring between big business on the one hand and consumers on the other.[15] This approach is, of course, valid. It holds an important (albeit partial) key to the analysis of widespread breastfeeding failure – but it makes up only one strand of a far more complicated story. Focusing solely on the marketing of breast-milk substitutes – with the well-meaning intention of solving the breastfeeding drought – neglects a fundamental truth: corporate interests don’t operate in a vacuum. Until the demand is examined and addressed, there’s no point in fighting the supply; it’s an inadequate and wasteful endeavour. Our over-occupation (indeed preoccupation) with the macro reality of the infant-feeding debate overlooks the micro reality of what’s going on at grass-roots level, between mothers themselves. As my good friend James Akre, founder, chairman and CEO of the International Breastfeeding Support Collective and member of the Scientific Advisory Committee La Leche League France, has justly said:

‘A prescription for change in feeding behaviour that focuses primarily on commercial interests and is filtered through a regulatory prism is doomed to failure. The buying public is as responsible for creating, accepting and maintaining an artificial child-feeding status quo as are formula manufacturers themselves’.[16]

Indeed, it is women’s behaviour that needs to change rather than the so-called higher political or public-health authorities advising them. Commercial interests have long understood this reality: since women consumers decide, their objective is to convince women consumers. The process of grass-roots change begins with a deep understanding of what is going on in the lives of women and mothers that makes their attitude so incompatible with breastfeeding. In taking an individualistic approach to the infant-feeding debate, this book focuses on empowerment. Rather than being at the mercy of their environment, in this book mothers are shown (through phenomenological insight) engaged in the rational considerations that govern their infant-feeding choices. As such, these choices are open to mothers’ control. Breast Intentions argues that while ‘society’ provides the backdrop for mothers’ breastfeeding journeys and can structure the range of opportunities available, it is the mothers themselves who exploit or fail to exploit the opportunities available. Some researchers have given, at best, tentative acknowledgment of these murky waters, declaring that, ‘The process is much more complex than just women with positive experiences and conditions tend to breastfeed, whereas those less fortunate do not’.17

This book shows that mothers are not merely passive passengers on their breastfeeding journey, but quite active in picking out the route. A mother’s behaviour is determined by her intentions – her explicit plans or motivation regarding when to quit breastfeeding, and indeed, whether to begin in the first place. As we see in the first chapter, a mother’s motivation to breastfeed mostly, if not entirely, reflects her personal attitudes: the extent to which she perceives breastfeeding as desirable or favourable. In fact, intention is such a strong indicator of whether a woman will start to breastfeed and continue to nurse that it transgresses sociological factors such as education, age and that elusive holy grail of apologist rhetoric, ‘social support’.[18]

A CAVEAT ABOUT TERMINOLOGY

I use the terms ‘breastfeeding success’ and ‘breastfeeding failure’ not to be provocatively dichotomous, but because these are terms commonly used by women – indeed, they overwhelm their discussions of breastfeeding.[19] Yet success and failure are tricky to define. These are dynamic labels, deeply subjective and forever morphing, depending on which theoretical lens is used to view them and the era in which they are used.[20] To one woman, breastfeeding for two months is a noteworthy success, whereas to another it is an embarrassing failure. This subjectivity forms the bare bones of a mother’s perception of her reality – from which can spring guilt, pride or apathy. For my purposes, I use ‘failure’ in a fluid sense, to refer to a performance that falls below a certain standard, resulting in dissatisfaction. Said dissatisfaction and said standard may belong to an internal source (the mother herself), an external source (the media, health professionals, organisations) or indeed both, depending on the context.

WHO IS THIS BOOK FOR?

Besides the obvious answer – anyone with an interest in breastfeeding – Breast Intentions may be of particular use to:

  • Mothers, whether exclusive breastfeeders, veteran formula feeders or someone somewhere in between.
  • Family members, immediate, extended or estranged.
  • All those involved in counselling mothers.
  • Psychologists and professionals employed in preserving the mental health of women.
  • Policy-makers, particularly those with an interest in health-promotion and maternal and infant welfare.
  • Other social architects, including feminists and other activists, commercial regulators, academics and the media.

I recommend that you read the book in chronological order, starting with the first chapter, Deception. This beefy chapter lays the foundations for what follows. Deception begins at the very start of a woman’s breastfeeding journey and colours her entire narrative. The subsequent chapters – Guilt, Excuses, Envy, Contempt, Defensiveness and Sabotage – mirror a mother’s emotions as they flow in this largely linear fashion. This cycle becomes self-affirming. It begins with, and is facilitated by, the mother herself.

Extract from Breast Intentions (c) 2014 by Allison Dixley


References:

  1. Giles F. 2003. Fresh Milk: The Secret Life of Breasts. Simon & Schuster.
  2. Marshall JL, Godfrey M, Renfrew MJ. Being a ‘good mother’: managing breastfeeding and merging identities. Social Science & Medicine. 2007. Nov 65(10):2147–59. Epub 2007 Aug 6.
  3. Marshall JL, Godfrey M, Renfrew MJ. Being a ‘good mother’: managing breastfeeding and merging identities. Social Science & Medicine. 2007. Nov 65(10):2147–59. Epub 2007 Aug 6.
  4. World Health Organization. Fact sheet N°342. Infant and young child feeding. Available at: www.who.int/mediacentre/factsheets/fs342/en/
  5. Lupton D. ‘A love/hate relationship’: the ideals and experiences of first-time mothers. Journal of Sociology. 2000. 36(1):50–63.
  6. Groleau D, Sibeko L. Breastfeeding in the Margins: Navigating Through the Conflicts of Moral and Social Order, p203, in Hall Smith P, Hausman BL, Labbok M (eds.). 2012. Beyond Health, Beyond Choice. Breastfeeding Constraints and Realities. New Brunswick, NJ: Rutgers University Press.
  7. Wolf JB. 2010. Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood. New York: NYU Press.
  8. Kukla R. Ethics and Ideology in Breastfeeding Advocacy Campaigns. Hypatia. 21.2 2006. 157–18 p163.
  9. McDowel MM, Wang C, Kennedy-Stephenson J. Breastfeeding in United States, findings from the national health & nutrition examination survey, 1999–2006. Number 5, 2008.
  10. Perera PJ, Ranathunga N, Fernando MP, Sampath W, Samaranayake GB. Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study. International Breastfeeding Journal. 2012. Dec 22,7(1):21; Kaneko A, Kaneita Y, Yokoyama E, Miyake T, Harano S, Suzuki K, Ibuka E, Tsutsui T, Yamamoto Y, Ohida T. Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding. Journal of Epidemiology & Community Health. 2006. 16(2):57–63; Otsuka K, Dennis CL, Tatsuoka H, Jimba M. The relationship between breastfeeding self-efficacy and perceived insufficient milk among Japanese mothers. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2008. 37(5):546–555.
  11. Betoko A, Charles MA, Hankard R, Forhan A, Bonet M, Saurel-Cubizolles MJ, Heude B, de Lauzon-Guillain B. EDEN mother-child cohort study group. Infant feeding patterns over the first year of life: influence of family characteristics. European Journal of Clinical Nutrition. 2013. Jun 67(6):631–7; Dashti M, Scott JA, Edwards CA, Al-Sughayer M. Predictors of breastfeeding duration among women in Kuwait: results of a prospective cohort study. Nutrients. 2014. Feb 20;6(2):711–28.
  12. Al Juaid DA, Binns CW, Giglia RC. Breastfeeding in Saudi Arabia: a review. International Breastfeeding Journal. 2014. Jan 14;9(1):1; Perera PJ, Ranathunga N, Fernando MP, Sampath W, Samaranayake GB. Actual exclusive breastfeeding rates and determinants among a cohort of children living in Gampaha district Sri Lanka: A prospective observational study. International Breastfeeding Journal. 2012. Dec 22;7(1):21; Skafida V. Change in breastfeeding patterns in Scotland between 2004 and 2011 and the role of health policy. European Journal of Public Health. 2014. Mar 17.
  13. Thorisdottir AV, Gunnarsdottir I, Thorsdottir I. Revised infant dietary recommendations: the impact of maternal education and other parental factors on adherence rates in Iceland. Acta Paediatrica. 2013. Feb;102(2):143–8; Otsuka K, Dennis CL, Tatsuoka H, Jimba M: The relationship between breastfeeding self-efficacy and perceived insufficient milk among Japanese mothers. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2008. 37(5):546–555.
  14. Weitz.R 2013 The Sociology of Health, Illness, and Health Care: A Critical Approach. Boston: Wadsworth
  15. Palmer G. 2009. The Politics of Breastfeeding. London: Pinter & Martin.
  16. Akre J. 2006. The Problem with Breastfeeding: A Personal Reflection. Amarillo, Texas: Hale Publishing.
  17. Loof-Johanson M, Foldevi M, Edvard Rudebeck C. 2013. Breastfeeding as a Specific Value in Women’s Lives: The Experiences and Decisions of Breastfeeding Women. Breastfeeding Medicine. 8, 1. p39.
  18. Donath SM, Amir LH, ALSPAC Study Team. Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study. Acta Paediatrica. 2003. 92:352-356; also see: Forster DA, McLachlan HL, Lumley J. Factors associated with breastfeeding at six months postpartum in a group of Australian women. International Breastfeeding Journal. 2006. 1:18.
  19. Burns E, Schmied V, Sheehan A et al. A metaethnographic synthesis of women’s experience of breastfeeding. Maternal & Child Nutrition. 2010. 6:201–219.
  20. Hauck Y, Reinbold J. Criteria for successful breastfeeding: Mothers’ perceptions. Australian College of Midwives Incorporated Journal. 1996. Mar 9(1):21–7.