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Beyond Health, Beyond Choice

Beyond Health, Beyond Choice: Breastfeeding Constraints and Realities

Paige Hall Smith
Bernice L. Hausman
Miriam Labbok
Copyright Date: 2012
Published by: Rutgers University Press
Pages: 356
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  • Book Info
    Beyond Health, Beyond Choice
    Book Description:

    Current public health promotion of breastfeeding relies heavily on health messaging and individual behavior change. Women are told that "breast is best" but too little serious attention is given to addressing the many social, economic, and political factors that combine to limit women's real choice to breastfeed beyond a few days or weeks. The result: women's, infants', and public health interests are undermined.Beyond Health, Beyond Choiceexamines how feminist perspectives can inform public health support for breastfeeding.

    Written by authors from diverse disciplines, perspectives, and countries, this collection of essays is arranged thematically and considers breastfeeding in relation to public health and health care; work and family; embodiment (specifically breastfeeding in public); economic and ethnic factors; guilt; violence; and commercialization. By examining women's experiences and bringing feminist insights to bear on a public issue, the editors attempt to reframe the discussion to better inform public health approaches and political action. Doing so can help us recognize the value of breastfeeding for the public's healthandthe important productive and reproductive contributions women make to the world.

    eISBN: 978-0-8135-5316-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Preface and Acknowledgments
    (pp. xi-xvi)
  4. Introduction: Breastfeeding Constraints and Realities
    (pp. 1-12)
    Bernice L. Hausman, Paige Hall Smith and Miriam Labbok

    Recently there has been an explosion of feminist attention to breastfeeding, in addition to increased activity in public health and medical research. Our collected volume,Beyond Health, Beyond Choice: Breastfeeding Constraints and Realities, contributes to this diverse field of research, policy, and practice by drawing on women’s voices, feminist theory, public health, and novel interdisciplinary conceptualizations. Our aim is to expand the understanding of women’s experiences of breastfeeding and to provide insight for public health policy and planning.

    Our title indicates the main elements of our approach. Current public health promotion of breastfeedingper forcerelies heavily on health messaging...

  5. Part I Frames

    • Chapter 1 Feminism and Breastfeeding: Rhetoric, Ideology, and the Material Realities of Women’s Lives
      (pp. 15-24)
      Bernice L. Hausman

      The current popular feminist critique of breastfeeding advocacy and promotion is unhelpful at best and destructive at worst. Its overall effect is to anger breastfeeding supporters rather than to encourage them to different approaches, and it puts feminism in an antagonistic, rather than collaborative, relation with public health. Yet feminism has much to contribute to an improved and more effective public health approach to breastfeeding.¹

      My aim in this chapter is to demonstrate how feminist analysis could be used to improve public health approaches to breastfeeding, infant health, and maternal health, by focusing on three core feminist issues that, with...

    • Chapter 2 Breastfeeding Promotion through Gender Equity: A Theoretical Perspective for Public Health Practice
      (pp. 25-35)
      Paige Hall Smith

      The connection between gender inequality and women’s breastfeeding practice has been recognized since the early days of the breastfeeding movement. Numerous documents produced or endorsed by the breastfeeding movement have articulated the link between women’s status and breastfeeding practice. Breastfeeding advocate Ted Greiner, for example, parallels the desired agendas of the breastfeeding movement with those of the women’s movement: “improved working conditions and maternity benefits for working women; help with the burdens of child care and household tasks, especially during the first weeks after delivery; health care that is more sensitive to the needs of women; the opportunity to space...

    • Chapter 3 Breastfeeding in Public Health: What Is Needed for Policy and Program Action?
      (pp. 36-50)
      Miriam Labbok

      Breastfeeding, especially exclusive breastfeeding, has been shown to be the most important infant and child survival intervention in terms of its potential impact on mortality. Increased exclusive breastfeeding could prevent about 13 percent of all preventable child deaths worldwide, including at least nine hundred infant deaths annually in the United States, and reduce the rate of many infectious and chronic diseases in both industrialized and developing country settings.¹ However, active support for breastfeeding is rarely a central component in public health programming.

      Concerns about alternative feeding filled the health literature in the nineteenth century, and the response was to try...

  6. Part II Studying Breastfeeding across Race, Class, and Culture

    • Chapter 4 Breastfeeding across Cultures: Dealing with Difference
      (pp. 53-63)
      Penny Van Esterik

      Feminism refers to theories and actions that reduce (and ultimately eliminate) inequality and discrimination on the basis of gender, race, class, and ethnicity. As with all “isms,” feminisms have histories. In South Asia, local feminism emerged out of nationalist fights against colonial imperialism. Western feminisms began not with a demand for national independence, but with a concern for discrimination against women. More recently, Western feminists have acknowledged that gender cannot be separated from other dimensions like race, ethnicity, class, or sexual orientation, for example. Queer theory forced feminist theory to grapple with the relation between sex and gender to add...

    • Chapter 5 The Dangers of Baring the Breast: Structural Violence and Formula-Feeding among Low-Income Women
      (pp. 64-73)
      Nancy Chin and Ann Dozier

      Athena is a twenty-six-year-old single mother who lives alone with her five children. After a high-risk pregnancy and premature delivery, she fully breastfed her newborn, Clifford, for four months while attending a community college full time and caring for her four other children. She did this absent a partner or family support while relying on the supplemental nutrition program Women, Infants, and Children (WIC), public transportation, and day care. After four months, she added solid foods to Clifford’s diet. At seven and a half months, she switched Clifford over to formula and discontinued breastfeeding. She said of formula, “Yeah, I...

    • Chapter 6 Racism, Race, and Disparities in Breastfeeding
      (pp. 74-84)
      Joan E. Dodgson

      Discussions of racism and race are uncomfortable for most Americans who idealize equality of all peoples, yet individual and institutional racial discrimination abound. It has been called the elephant in the room, in part due to collective social guilt surrounding historical injustices that now can be openly discussed, and in part to a collective desire to feel that we have moved beyond the social and structural embeddedness of racism. Racism is evident in the framing of issues surrounding breastfeeding disparities, manifesting as the continuing overreliance on race as the defining identity categorization. Although racism and racial categorizing have been widely...

  7. Part III Medical Institutions and Health Education

    • Chapter 7 Pediatrics, Obstetrics, and Shrinking Maternal Authority
      (pp. 87-97)
      Jacqueline H. Wolf

      When physicians do not allow mothers to breastfeed immediately after giving birth, when hospitals house newborns in nurseries apart from their mothers, and when nurses feed breastfed newborns formula without their mothers’ explicit permission, it becomes obvious that the medicalization of birth and infant feeding impede breastfeeding. What is less apparent is how the historical development of the two medical specialties that interact most with mothers and their babies, pediatrics and obstetrics, has shaped attitudes toward breastfeeding. Since the late nineteenth century, mothers have sought infant feeding advice from pediatricians and obstetricians. Ironically, women began doing this in earnest just...

    • Chapter 8 New Professions and Old Practices: Lactation Consulting and the Medicalization of Breastfeeding
      (pp. 98-109)
      Aimee R. Eden

      Professional breastfeeding knowledge in the United States today is embodied by the lactation consultant.¹ Lactation consulting emerged on the global scene in 1985 as a new and highly gendered health care profession specializing in the clinical management of breastfeeding. Twenty-five years later, at the 2010 International Lactation Consultant Association (ILCA) conference, the more than fifty booths in the exhibit hall were a clear indication of how much the profession had matured. On display were breast pumps of different levels of complexity, plastic nipple shields, silicone breast pads, creams, milk storage systems, bras, clothing, pillows, herbal teas, and supplements—all designed...

    • Chapter 9 Preparing Women to Breastfeed: Teaching Breastfeeding in Prenatal Classes in the United Kingdom
      (pp. 110-120)
      Abigail Locke

      The seemingly paradoxical construct of breastfeeding as a “natural skill that needs teaching” has been examined in detail elsewhere and is evident by the plethora of books written by those who have been successful, giving advice to other mothers reflecting on their own experiences.¹ In these breastfeeding texts, breastfeeding is represented as the ideal way to feed one’s baby, and women are encouraged toward making the “informed choice” to breastfeed.² But most women learn how to breastfeed from health care workers, many from teachers in prenatal classes. This chapter examines the teaching of breastfeeding to understand if something in the...

  8. Part IV Roles and Realities

    • Chapter 10 “Are We There Yet?” Breastfeeding as a Gauge of Carework by Mothers
      (pp. 123-132)
      Chris Mulford

      On my lifetime Social Security record, there are two gaps filled in with zeroes. They mark the years—three after the birth of each child—when I left the paid labor force to be a full-time mother. During these periods when my official record says I contributed nothing to the economy, I produced literally a ton of milk. I was not paying into our national pension scheme, but I was making a lifetime investment in two people’s health and development, building human capital.

      As far back as the 1930s, econometrician Simon Kuznets wrote that to calculate national income without including...

    • Chapter 11 Breastfeeding and the Gendering of Infant Care
      (pp. 133-143)
      Phyllis L. F. Rippeyoung and Mary C. Noonan

      Human reproduction is inherently gendered: women, not men, give birth, lactate, and breastfeed.¹ Domestic work and child care are also highly gendered activities, but not necessarily inherently so. Among two-parent families with children, wives perform about twice as much domestic labor and routine child care (such as feeding and dressing them) as their husbands.² Couples are particularly likely to take on gender-specialized roles during the transition to parenthood: women take on the majority of unpaid work in the home, and men spend more time in paid work. Research has clearly documented this pattern, but it has not fully accounted for...

    • Chapter 12 Working out Work: Race, Employment, and Public Policy
      (pp. 144-156)
      Jennifer C. Lucas and Deborah McCarter-Spaulding

      It is simple enough—breastfeeding is the biologic norm, and it is good for babies and mothers. On this point, most would agree. However, like many other relationships in women’s lives, maintaining a breastfeeding relationship can be complicated. Many factors influence both initiation and duration of breastfeeding, including the employment of the breastfeeding mother.¹

      Women’s employment is also influenced by many factors, including race, education, and economic conditions.² Seldom, however, have the factors that influence both employment and breastfeeding been addressed together in research studies, either in the health or public policy literature. In keeping with the Social-Ecological Model, this...

    • Chapter 13 The Impact of Workplace Practices on Breastfeeding Experiences and Disparities among Women
      (pp. 157-166)
      Amanda Marie Lubold and Louise Marie Roth

      Since a majority of mothers of infants are in the labor force, work organizations play an important role in facilitating women’s ability to breastfeed.¹ In most workplaces ideal worker notions assume male career patterns and treat women’s reproductive activities as deviant.² Workplace “accommodations” of breastfeeding mothers are then based on deviations from a male standard.³ Until passage of the 2010 Affordable Care Act, American law and policy did little to promote breastfeeding-friendly workplaces, thereby leaving it up to the workplace to decide whether it wanted to accommodate workers’ reproductive activities, placing the burden on the employees to advocate for themselves...

  9. Part V Making and Marketing Mothers’ Milk

    • Chapter 14 Marketing Mothers’ Milk: The Markets for Human Milk and Infant Formula
      (pp. 169-179)
      Linda C. Fentiman

      Today, breastfeeding, human milk, and its substitute, infant formula, are commodities. “Mother’s milk” is marketed both literally and figuratively, as a good for sale, a normative behavior, and a cure for a variety of contemporary social and medical problems. Like previous exploitations of women’s bodies, including their eggs and uteruses, the idea that human milk is a valuable good that can be given away, traded in a market, or subjected to scientific experimentation raises important ethical, moral, and policy questions. This chapter examines the emerging markets in human milk and the competing market in infant formula through a feminist lens....

    • Chapter 15 Empowerment or Regulation? Women’s Perspectives on Expressing Milk
      (pp. 180-190)
      Sally Johnson, Dawn Leeming, Steven Lyttle and Iain Williamson

      Recent research suggests that expressing breast milk may be an increasingly common practice during early infant feeding, yet relatively little is known about the reasons for this practice.¹ Moreover, there is little explicit analysis of early milk expression in the feminist infant feeding literature. That which does exist suggests contradictory theorization. It has been suggested that expressing represents a type of regulation, in that it imposes an external form of control upon breastfeeding. Thus, milk expression offers a way of managing future expectations about returning to work or normal life and activities while continuing to breastfeed. In addition, the use...

  10. Part VI Morality and Guilt

    • Chapter 16 Feminist Breastfeeding Promotion and the Problem of Guilt
      (pp. 193-202)
      Erin N. Taylor and Lora Ebert Wallace

      It is difficult to have a conversation about breastfeeding in any setting without raising the specter of guilt. From the point of view of the mother who does not breastfeed and says she resents being made to feel guilty about her feeding method, to that of the former head of the American Academy of Pediatrics, who urged that breastfeeding “should be a nurturing sort of experience; we should not use guilt,” breastfeeding and breastfeeding promotion are clearly associated with the induction of guilt.¹ What is less clear is how breastfeeding promoters—particularly if they are feminist—ought to carry out...

    • Chapter 17 Breastfeeding in the Margins: Navigating through the Conflicts of Social and Moral Order
      (pp. 203-212)
      Danielle Groleau and Lindiwe Sibeko

      The moral tone implied in breastfeeding knowledge is rooted in power relations that also affect the identity of mothers. We present our arguments with examples of women living in poverty, since this is a population whose breastfeeding experiences are rarely addressed in the literature. Building from critical concepts developed by French thinkers Pierre Bourdieu and Michel Foucault, we examine closely how issues of power, morality, and identity are embedded in public health promotion of breastfeeding, and how that promotion might be changed to better address women’s practices and needs.

      Medical anthropology demonstrates that the reproductive behaviors of women are heavily...

  11. Part VII Media and Popular Culture

    • Chapter 18 Reinstating Pleasure in Reality: Promoting Breastfeeding through Ars Erotica
      (pp. 215-225)
      Fiona Giles

      In 2010 the Department of Health and Aging in Canberra released a ten-point Australian National Breastfeeding Strategy for stakeholders and government agencies. The first point reads, “Monitoring and surveillance” and the last, “Education and awareness, including antenatal education.” Between these are items relating to dietary guidelines, growth charts, the WHO’s code of marketing, training in breastfeeding support for health professionals, research into milk banks, and other worthy projects.

      In 2008 an Australian advertising firm released a tampon advertisement for U Tampons, manufactured by Kotex. In it an attractive young woman walks down the street with cheerful music in the background,...

    • Chapter 19 Breastfeeding in the “Baby Block”: Using Reality Television to Effectively Promote Breastfeeding
      (pp. 226-235)
      Katherine A. Foss

      The programBringing Home Babyopens with a typical schedule for the first days after a baby is born. Title slides read: “First 36 hours”; then, “Day 1: Newborn baby,” “Crying,” and “Diapers.” A second set of slides state: “Day 2: Feeding,” “Sleeping.” Images of real people performing these tasks accompany the slides. For the feeding slide, a father bottle-feeds his newborn. Similarly, the alternate opening of this program features baby items, including bottles, marching into a house. Because breastfeeding is not pictured, this opening presents bottle-feeding as the typical or default means of feeding a baby. This message is...

    • Chapter 20 Rethinking the Importance of Social Class: How Mass Market Magazines Portray Infant Feeding
      (pp. 236-246)
      N. Danielle Duckett

      Women go through intense role modification when they become pregnant and prepare for motherhood. From a sociological perspective, women typically begin a process of anticipatory socialization, or information-seeking practices, prior to giving birth. Women research the numerous aspects of pregnancy, childbirth, and childrearing.¹ Throughout this personal journey, women utilize widely varying sources of information, including popular and well-known texts likeWhat to Expect When You’re Expecting, obstetricians, mothers, print and television media, support networks like La Leche League, and what feminist psychoanalyst Suzie Orbach refers to as “visual muzak,” the pervasive media that people encounter on a daily basis without...

  12. Part VIII Sexuality and Women’s Bodies

    • Chapter 21 Breastfeeding in Public: Women’s Bodies, Women’s Milk
      (pp. 249-258)
      Sally Dowling, Jennie Naidoo and David Pontin

      Breastfeeding takes place within cultural contexts where women receive conflicting messages about their bodies, breastfeeding, and role as mothers. Although the public health message is “breast is best,” cultural associations between women’s bodily fluids, dirt, and pollution mean breastfeeding is often seen as dirty and not for public view. Women’s difficulties with breastfeeding in public may be a barrier to exclusive and long-term breastfeeding. We synthesize the relevant public health and feminist literature, considering how women’s understanding of their milk affects their experiences of breastfeeding in public so that public health practitioners may work to support them.

      Breastfeeding in public...

    • Chapter 22 Sexual or Maternal Breasts? A Feminist View of the Contested Right to Breastfeed Publicly
      (pp. 259-268)
      Carol Grace Hurst

      Breastfeeding mothers must cope with the dominant notion of the sexual breast that pervades the culture of the United States.¹ Even though laws have been passed clarifying the right to breastfeed in public in forty-four states as well as on federal property, breastfeeding in public is still debated, sometimes discriminated against, and is commonly perceived as embarrassing for many mothers.² This chapter explores mothers’ experiences of living with the sexual breast and the mother-led political struggle to establish a right to breastfeed. Ideological influences on individual and corporate behaviors are insidious, as most often they are not recognized on a...

    • Chapter 23 Intersections: Child Sexual Abuse and Breastfeeding
      (pp. 269-280)
      Emily C. Taylor

      At the 2010 Breastfeeding and Feminism Symposium, I asked the attending feminist scholars, activists, and clinicians, “How many of you practice with the assumption that mothers who were sexually abused as children will be difficult patients, for whom the best therapy is likely to give ‘permission’ to not breastfeed?” Not surprisingly, nearly all the clinicians in the room indicated that this was the case. I then argued, as I do in this chapter, that these assumptions are not based in fact. We can learn from women about the complex relationship between child sexual abuse (CSA) and breastfeeding, which includes opportunities...

  13. Conclusion: Beyond Health, Beyond Choice: New Ways Forward in Public Health
    (pp. 281-286)
    Paige Hall Smith, Bernice L. Hausman and Miriam Labbok

    The collected chapters in this work make it clear that pushing women to breastfeed for health reasons alone is a weak strategy. Such encouragement does not address the complexity of decision making that is created by the constraints and realities of women’s lives. In continuing to discuss breastfeeding as achoice, we fail to appreciate that most women do not have a source of unbiased information, or the economic, social, and clinical support and resources needed to freely choose whether or not they will breastfeed beyond the first few weeks of their babies’ lives. In and of itself, this is...

  14. Bibliography
    (pp. 287-326)
  15. Notes on Contributors
    (pp. 327-332)
  16. Index
    (pp. 333-338)
  17. Back Matter
    (pp. 339-340)