Health April 2009

The Case Against Breast-Feeding

In certain overachieving circles, breast-feeding is no longer a choice—it’s a no-exceptions requirement, the ultimate badge of responsible parenting. Yet the actual health benefits of breast-feeding are surprisingly thin, far thinner than most popular literature indicates. Is breast-feeding right for every family? Or is it this generation’s vacuum cleaner—an instrument of misery that mostly just keeps women down?

In the early ’90s, a group of researchers got together to revise the American Academy of Pediatrics’ policy statement on breast-feeding. They were of the generation that had fought the formula wars, and had lived through the days when maternity wards automatically gave women hormone shots to stop the flow of breast milk. The academy had long encouraged mothers to make “every effort” to nurse their newborns, but the researchers felt the medical evidence justified a stronger statement. Released in 1997, the new policy recommended exclusive breast-feeding for six months, followed by six more months of partial breast-feeding, supplemented with other foods. The National Organization for Women complained that this would tax working mothers, but to no avail. “The fact that the major pediatric group in the country was taking a definitive stance made all the difference,” recalls Lawrence Gartner, a pediatrician and neonatologist at the University of Chicago, and the head of the committee that made the change. “After that, every major organization turned the corner, and the popular media changed radically.”

In 2004, the Department of Health and Human Services launched the National Breastfeeding Awareness Campaign. The ads came out just after my second child was born, and were so odious that they nearly caused me to wean him on the spot. One television ad shows two hugely pregnant women in a logrolling contest, with an audience egging them on. “You wouldn’t take risks before your baby is born,” reads the caption. “Why start after?” The screen then flashes: “Breastfeed exclusively for 6 months.” A second spot shows a pregnant woman—this time African American—riding a mechanical bull in a bar while trying to hold on to her huge belly. She falls off the bull and the crowd moans.

To convey the idea that failing to breast-feed is harmful to a baby’s health, the print ads show ordinary objects arranged to look like breasts: two dandelions (respiratory illness), two scoops of ice cream with cherries on top (obesity), two otoscopes (ear infections). Plans were made to do another ad showing rubber nipples on top of insulin syringes (suggesting that bottle-feeding causes diabetes), but then someone thought better of it. The whole campaign is so knowing, so dripping with sexual innuendo and condescension, that it brings to mind nothing so much as an episode of Mad Men, where Don Draper and the boys break out the whiskey at day’s end to toast another victory over the enemy sex.

What’s most amazing is how, 50 years after La Leche League’s founding, “enlightenment from the laboratory”—judgmental and absolutist—has triumphed again. The seventh edition of The Womanly Art, published in 2004, has ballooned to more than 400 pages, and is filled with photographs in place of the original hand drawings. But what’s most noticeable is the shift in attitude. Each edition of the book contains new expert testimony about breast milk as an “arsenal against illness.” “The resistance to disease that human milk affords a baby cannot be duplicated in any other way,” the authors scold. The experience of reading the 1958 edition is like talking with your bossy but charming neighbor, who has some motherly advice to share. Reading the latest edition is like being trapped in the office of a doctor who’s haranguing you about the choices you make.

In her critique of the awareness campaign, Joan Wolf, a women’s-studies professor at Texas A&M University, chalks up the overzealous ads to a new ethic of “total motherhood.” Mothers these days are expected to “optimize every dimension of children’s lives,” she writes. Choices are often presented as the mother’s selfish desires versus the baby’s needs. As an example, Wolf quotes What to Expect When You’re Expecting, from a section called the “Best-Odds Diet,” which I remember quite well: “Every bite counts. You’ve got only nine months of meals and snacks with which to give your baby the best possible start in life … Before you close your mouth on a forkful of food, consider, ‘Is this the best bite I can give my baby?’ If it will benefit your baby, chew away. If it’ll only benefit your sweet tooth or appease your appetite put your fork down.” To which any self-respecting pregnant woman should respond: “I am carrying 35 extra pounds and my ankles have swelled to the size of a life raft, and now I would like to eat some coconut-cream pie. So you know what you can do with this damned fork.”

About seven years ago, I met a woman from Montreal, the sister-in-law of a friend, who was young and healthy and normal in every way, except that she refused to breast-feed her children. She wasn’t working at the time. She just felt that breast-feeding would set up an unequal dynamic in her marriage—one in which the mother, who was responsible for the very sustenance of the infant, would naturally become responsible for everything else as well. At the time, I had only one young child, so I thought she was a kooky Canadian—and selfish and irresponsible. But of course now I know she was right. I recalled her with sisterly love a few months ago, at three in the morning, when I was propped up in bed for the second time that night with my new baby (note the my). My husband acknowledged the ripple in the nighttime peace with a grunt, and that’s about it. And why should he do more? There’s no use in both of us being a wreck in the morning. Nonetheless, it’s hard not to seethe.

The Bitch in the House, published in 2002, reframed The Feminine Mystique for my generation of mothers. We were raised to expect that co-parenting was an attainable goal. But who were we kidding? Even in the best of marriages, the domestic burden shifts, in incremental, mostly unacknowledged ways, onto the woman. Breast-feeding plays a central role in the shift. In my set, no husband tells his wife that it is her womanly duty to stay home and nurse the child. Instead, both parents together weigh the evidence and then make a rational, informed decision that she should do so. Then other, logical decisions follow: she alone fed the child, so she naturally knows better how to comfort the child, so she is the better judge to pick a school for the child and the better nurse when the child is sick, and so on. Recently, my husband and I noticed that we had reached the age at which friends from high school and college now hold positions of serious power. When we went down the list, we had to work hard to find any women. Where had all our female friends strayed? Why had they disappeared during the years they’d had small children?

The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing.

That brings us to the subject of pumping. Explain to your employer that while you’re away from your baby, “you will need to take breaks throughout the day to pump your milk,” suggest the materials from the awareness campaign. Demand a “clean, quiet place” to pump, and a place to store the milk. A clean, quiet place. So peaceful, so spa-like. Leave aside the preposterousness of this advice if you are, say, a waitress or a bus driver. Say you are a newspaper reporter, like I used to be, and deadline is approaching. Your choices are (a) leave your story to go down to the dingy nurse’s office and relieve yourself; or (b) grow increasingly panicked and sweaty as your body continues on its merry, milk-factory way, even though the plant shouldn’t be operating today and the pump is about to explode. And then one day, the inevitable will happen. You will be talking to a male colleague and saying to yourself, “Don’t think of the baby. Please don’t think of the baby.” And then the pump will explode, and the stigmata will spread down your shirt as you rush into the ladies’ room.

This year alone I had two friends whose babies could not breast-feed for one reason or another, so they mostly had to pump. They were both first-time mothers who had written themselves dreamy birth plans involving hot baths followed by hours of intimate nursing. When that didn’t work out, they panicked about their babies’ missing out on the milky elixir. One of them sat on my couch the other day hooked up to tubes and suctions and a giant deconstructed bra, looking like some fetish ad, or a footnote from the Josef Mengele years. Looking as far as humanly possible from Eve in her natural, feminine state.

In his study on breast-feeding and cognitive development, Michael Kramer mentions research on the long-term effects of mother rats’ licking and grooming their pups. Maybe, he writes, it’s “the physical and/or emotional act of breastfeeding” that might lead to benefits. This is the theory he prefers, he told me, because “it would suggest something the formula companies can’t reproduce.” No offense to Kramer, who seems like a great guy, but this gets under my skin. If the researchers just want us to lick and groom our pups, why don’t they say so? We can find our own way to do that. In fact, by insisting that milk is some kind of vaccine, they make it less likely that we’ll experience nursing primarily as a loving maternal act—“pleasant and relaxing,” in the words of Our Bodies, Ourselves and more likely that we’ll view it as, well, dispensing medicine.

I continue to breast-feed my new son some of the time—but I don’t do it slavishly. When I am out for the day working, or out with friends at night, he can have all the formula he wants, and I won’t give it a second thought. I’m not really sure why I don’t stop entirely. I know it has nothing to do with the science; I have no grandiose illusions that I’m making him lean and healthy and smart with my milk. Nursing is certainly not pure pleasure, either; often I’m tapping my foot impatiently, waiting for him to finish. I do it partly because I can get away with breast-feeding part-time. I work at home and don’t punch a clock, which is not the situation of most women. Had I been more closely tied to a workplace, I would have breast-fed during my maternity leave and then given him formula exclusively, with no guilt.

My best guess is something I can’t quite articulate. Breast-feeding does not belong in the realm of facts and hard numbers; it is much too intimate and elemental. It contains all of my awe about motherhood, and also my ambivalence. Right now, even part-time, it’s a strain. But I also know that this is probably my last chance to feel warm baby skin up against mine, and one day I will miss it.

Hanna Rosin is an Atlantic contributing editor and the author of God’s Harvard: A Christian College on a Mission to Save America (2007).
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Hanna Rosin, an Atlantic national correspondent, is the author of the book The End of Men based on her story in the July/August 2010 Atlantic.

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