We hear endlessly that breast-feeding is optimal. Our doctors tell us this, and decades of scientific evidence overwhelmingly prove that breast milk is important for our babies. What remains unclear is how we actually make it accessible for all mothers.
We live in the only industrialized nation that does not have a federal paid leave. One in four new mothers go back to work 10 days after childbirth. Many women have to move away from their family for economic reasons, leaving them without traditional circles of social support and generational wisdom about infant care. Racial disparities in breast-feeding rates because of inequities in support and cultural factors disproportionately affect black women. Culturally, partially exposed breasts are used to sell burgers and beer on a daily basis, but women are still kicked off airplanes and asked to leave pools and malls when breast-feeding.
I often say, “Women don’t breast-feed, cultures do.” We need to build a culture where breast-feeding thrives, and we need to not just target individual women for support. That means ensuring family-friendly policies are in place at both federal and local levels, starting with paid leave. Corporations across the employment spectrum need to provide parental leave, co-located child care and nursing rooms. We also need to ensure the physicians we trust are properly trained in lactation, and we need messaging that understands it is not necessarily the act of breast-feeding, but the experience of breast-feeding, that keeps women from reaching their goals.
We may be looking in all the wrong places for solutions. In my 10 years of developing community-partnered projects to improve birth and breast-feeding outcomes in marginalized communities across the United States, and three years of researching my most recent book, coupled with years of working with public health organizations and corporations as a maternal and infant health strategist, a few things have become crystal clear.
1. The answers are in the margins. Too often, the breast-feeding dialogue is centered around the mainstream — typically white, middle-class women — and their experiences. The picture of breast-feeding needs more hourly workers, retail employees and recognition of the unique challenges for schoolteachers and health-care professionals. We must also look at women’s lived experiences. What do we know about black, Latina and Native women that could help inform policy and advocacy? Solutions come from centering those most affected by disparities. In the United States, that means focusing on black women. (Black Breastfeeding Week is a good place to start.) We need to include supporting Native women to reclaim their breast-feeding tradition. I have recently been writing about the need to rethink our punitive culture and improve breast-feeding laws for incarcerated women — the fastest-growing prison population — while hearing some of their stories. Studies prove breast-feeding reduces recidivism, and we should reframe who deserves to breast-feed. Our country is being ravaged by an opioid epidemic. Every 25 minutes, a baby is born suffering from opioid withdrawal or neonatal abstinence syndrome (NAS). Yet studies prove breast-feeding helps mitigate the symptoms of NAS. If we don’t tell these stories, we won’t find real-life solutions that address real-life problems.
2. Focus on social stressors. Stress and breast-feeding do not mix. Studies prove significant and prolonged stress can inhibit the letdown reflex and milk production. When mothers are stressed about getting Instagram perfect, when mothers are stressed about being “productive” (as if mothering is not important work), when new mothers are stressed about returning to work in 10 days, it is no wonder American women report having insufficient milk. There is also lactation failure or dysfunction, which is a real thing the medical field needs more training on to properly diagnose. Either way, until we deal with the policy and societal gaps that increase the stress of early motherhood, more and more women will not be able to successfully breast-feed over time.
3. Anger and division won’t get us anywhere. I don’t give any credence to the so-called “mommy wars.” In my opinion, they were created and supported by commercial interests to sell us things. That includes pitting breast-feeding mothers against formula-feeding mothers on social media, or as an organizational practice. In my experience, the problem is physicians receive little to no lactation management education in medical school, so they cannot properly diagnose lactation failure. Mothers are then left to figure it out themselves. Hospitals are often understaffed with qualified lactation consultants. Our country is one of very few in the world where you do not receive a mandatory at-home postpartum visit as a standard practice of care. These are the real problems, and they should indeed make us angry. However, turning anger onto mothers who have had different experiences instead of turning that anger into coordinated action to help all mothers will not move modern motherhood forward. Insulting breast-feeding advocates and the organizations working to improve the birth experience in the United States is not helpful. If anyone, anywhere is selling fear, anger and divisions, mamas beware!
4. Formula is not the enemy: It’s the marketing. When I had my first child, she was briefly in the neonatal intensive care unit and was supplemented with formula for a few days until I could resume exclusive breast-feeding. I am grateful formula was there for her when she needed it. Everyone knows infant formula needs to exist. The issue is the unethical and inappropriate marketing of breast-milk substitutes that undermines women and puts corporate profits ahead of infant health. What began as a substitute, processed product for when a mother’s milk was not available is now a $70 billion growth industry that can only increase its market share by the failure of breast-feeding and by raising prices with clever marketing claims.
5. “Breast is best” is true, but lacking. Hopefully most breast-feeding advocates are no longer using this dated slogan without proper context. “Breast is best” is scientifically accurate, but where is the mother in that phrase? It focuses on the breast and the product it produces, but it does not acknowledge the mother or her challenges to deliver that breast to her baby. Breast-feeding advocacy must always include the mother’s experience and must not focus solely on the benefits to the baby.
6. About guilt and shame, pressure and privilege. Lastly, there is a dangerous thread in breast-feeding conversation that needs to be addressed head-on, big-girl-panties style. If someone talks about the perils of infant formula marketing or how the United States actually has poor quality infant formula compared with European countries that have banned certain sugary ingredients still allowed in U.S. formulas, there is someone saying that person is “shaming” formula feeders. Or that we shouldn’t talk about the risks of breast-milk substitutes so as to not make mothers feel bad. I don’t subscribe to the concept that mothers are too weak to understand credible information. This idea that mothers are too fragile for facts is rooted in patriarchal structures, and for those who complain of being pressured to breast-feed, please note that in my many years of working in marginalized neighborhoods in Detroit, Philadelphia and across the Southeast, I have never heard a black woman say she was pressured to breast-feed. Ever. I would love to hear that! The perceptions of who should breast-feed and who is encouraged to do so fall decidedly along racial lines, and it is usually only white women who have this response. This is privilege.
Until we have an honest reckoning about privilege, power, implicit bias and racism in birth and breast-feeding, every World Breastfeeding Week will come and go with the real world having not changed at all.