The Big Letdown

by Kimberly Seals Allers

  Even if families could figure out how to survive with one part-time salary, the market for meaningful part-time work is virtually nonexistent. In recent years, the number of part-time jobs has increased a paltry 1 percent or less per year—with no mention of the actual wages for these part-time jobs. Meanwhile, a study of working mothers by the Pew Research Center showed that 74 percent work full-time while only 26 percent work part-time. Of those working mothers, 62 percent say that they would prefer to work part-time, and only 37 percent say they prefer full-time work. Only about one in ten moms (12 percent) say that having a mother who works full-time is the ideal situation for a child. By contrast, most working fathers (79 percent) would prefer to work full-time, while only 21 percent say that they would prefer working part-time. Mothers are under pressure to work when they would prefer to do the job of mothering, but they are by and large being forced into other so-called choices and denied the life they desire. Feeling up against the wall, many women simply quit their jobs, which impacts Social Security benefits and career growth. These kinds of roadblocks and forced decisions breed anxiety and frustration—both of which are highly incompatible with a successful breastfeeding experience.

  Meanwhile, any mental health expert worth his or her copay can tell you that feeling physically competent is essential to a person’s overall self-esteem. So, of course, failing at something as basic as feeding one’s own child can affect a woman’s psyche and the rest of her motherhood journey. And for every actual failure there are fears of failure in triplicate. Therefore, is our failure at breastfeeding really a biological or physiological failure or a psychological one brought on by social or cultural triggers? And if our instincts about breastfeeding have gone awry, it is plausible and quite probable that they have gone awry for a very specific and consistent set of reasons.

  And those reasons aren’t just the oft-mentioned problems of a lack of education or even the absence of federal paid maternity leave. Mothers in the UK enjoy up to twelve months of paid maternity leave, yet the country still suffers from some of the lowest breastfeeding rates in the world. Only 0.5 percent of children in Britain are breastfed for twelve months, compared to 27 percent in the U.S, 35 percent in Norway and 92 percent of children in India. There is more afoot than just policy—although that is a very critical starting point for the U.S. But, as economic pressure mounts and migration and immigration patterns change, mothers are increasingly without their extended family and traditional support circles. A study by two economic researchers at Washington University in St. Louis found that among U.S. couples with college degrees, more than 50 percent live more than thirty miles from both their mothers and only 18 percent live within thirty miles of both mothers. With limited work options and economic demands scattering family members, women are often, literally, on their own at their most vulnerable time as new mothers. With breastfeeding becoming a lost art among women, very few have family members to turn to for help in the absence of sound medical advice. The formula companies know exactly who they are while they are pregnant and are more than happy to fill the gap with their infant feeding information and “community of support.”

  Fixing America’s broken system to be more family-friendly will take some serious political will. Even the proposed federal family leave policy is being criticized by some politicians as bad for business. This isn’t the first time that the interests of business have butted heads with what’s best for mothers and babies. In fact, America’s thirteen-year refusal to sign the World Health Organization’s UNICEF International Code of Marketing of Breast-Milk Substitutes (known as the WHO code) was all about economics and political will. Although the Carter administration was generally procode, things changed under Reagan. American industry came out forcefully against the code, saying it was highly restrictive and would “virtually eliminate legitimate competition and promotion of infant formula even to the medical community.” As 118 countries approved the code at an infamous meeting in Geneva, the United States was the only opposing vote, sparking outrage among Americans. In this case, despite the voices of its citizens and the advice of the country’s top medical experts, the political will of the U.S. government was clearly in the hands of the lobbyists paid handsomely by the baby food corporations. The interests of corporations were put ahead of the health interests of infants. The political climate, which was focused on getting government out of the corporate suites, became the dominant concern despite the public outcry of its own citizens. President Reagan repeatedly refused to meet with a congressional delegation to discuss it further.

  The symbolism was catastrophic to women and babies around the world. Though the United States has only one vote, it dominates the world economy and sets the tone for global political priorities. Therefore, when the United States voted to put profit making ahead of mothers and babies, it sent a message that strict enforcement of the voluntary code was not required.

  It wasn’t until May 9, 1994, when President Bill Clinton reversed course and made the WHO code worldwide policy, joining the other member nations at the World Health Assembly in Geneva. For the first time, there was worldwide unanimity that, in the infant health area, profit should not come before public health.

  But agreement doesn’t always equal action. The WHO code lacks punitive measures and, in most cases, breastfeeding advocates are the only ones who know what the code really is. As factors such as cultural norms take on greater influence, many health care professionals are even wondering if the WHO code is still relevant, and if so, what is the smartest way to influence compliance. A proprietary report by a large U.S.-based foundation assessed a multidisciplinary group of stakeholders on perceptions of the WHO code and what might be done to spark a conversation about marketing breast-milk substitutes. The report found that most of the stakeholders interviewed did not view the WHO code as a key driver compared to other social and cultural factors influencing infant feeding decisions, that code compliance has lost its urgency among other issues, and that the code is confusing, which contributes to implementation challenges. Even many advocates can’t easily state what falls under the code (pumps don’t, but the bottles and teats needed when using pumps do). It’s very hard to mobilize women around a confusing concept that many professionals don’t fully understand.

  Politicians will be critical to advancing necessary policy changes to limit infant formula marketing and level the playing field for breastfeeding. But there has to be political will. And political will is often connected to funding. And it’s hard to get political commitments to limit infant formula marketing from politicians who receive sizable donations from infant formula companies. In 2016, Abbott Labs contributed $516,625 to various members of the House and Senate.

  When not paying politicians directly, infant formula companies invest heavily in influencing politicians and policy with large payments to lobbyists. In 2015, Abbott Labs spent $2.4 million on various lobbying firms, according to the Center for Responsive Politics.

  And in the political world, government funding is allocated to finding cures and providing services, not preventive health measures, such as breastfeeding. As one political analyst explained to me, “There’s no politics in prevention. Once you have a disease, people want services and a cure and there is a lobby developed to push for that.”

  And the political discourse around breastfeeding is that the government should stay out of a very private matter instead of looking at it as a public health issue. The government mandates and supports vaccinations and other activities that it deems to be in the interest of public health, but in political circles breastfeeding remains a private issue. In 2012, at an intimate press conference kicking off the second year of her Let’s Move campaign to fight childhood obesity, First Lady Michelle Obama stressed the importance of early intervention. And in highlighting steps parents can take, she recommended that women breastfeed their babies, because “kids who are breastfed longer have a lower tendency to be obese.” It seemed harmless enough. But the first lady’s
comments came shortly after the IRS announced that, after lobbying from lawmakers, breast pumps—which can cost upward of $300—and related supplies could now be paid for with pretax Flexible Spending Accounts, or deducted from one’s taxes as a medical expense, if one’s total out-of-pocket medical costs added up to more than 7.5 percent of one’s income. The IRS has already approved other deductible medical expenses, including contact lenses, acupuncture, and vasectomies.

  Shortly after, Tea Party darling Michele Bachmann slammed the first lady and the IRS on the Laura Ingraham radio show: “I’ve given birth to five babies, and I’ve breastfed every single one of these babies,” Bachmann said. “To think that government has to go out and buy my breast pump for my babies, I mean, you wanna talk about the nanny state—I think you just got the new definition of the nanny state.” To be clear, the government isn’t “buying” anything for anyone, but the political discourse around breastfeeding remains provocative and volatile.

  Next, conservative pundit Michelle Malkin, who also says she breastfed her two kids, chimed in through a blog post and column, attacking the first lady and the federal government for telling women how to live their lives, dubbing the initiative “Big Bosom.”

  The loud and clear political message that breastfeeding is a private matter prevents movement on the very public and necessary issues of paid family leave, stronger laws to protect pumping in the workplace, and the state of infant health in America. Ironically, breastfeeding is viewed as a private matter until you attempt to do it in public. Then it becomes everybody’s business. Venturing out of doors to dare to nurse in public remains another issue, even though the law explicitly protects moms who breastfeed in public in almost all fifty states. Forty-seven states, D.C., and the Virgin Islands have laws that specifically allow moms to breastfeed in any public or private location. Two of the remaining states—South Dakota and Virginia—exempt breastfeeding moms from public indecency or nudity laws, and Idaho is the only state that has yet to pass any similar laws. But the frequency of media stories of women being asked to leave retail stores or airplanes makes it clear that breastfeeding is still considered a public indecency issue rather than a public health issue.

  The system is broken. Or the system is fixed, depending on how you look at it. While all women suffer under the weight of the complexities of breastfeeding, some are more overburdened than others, usually because of racial and socioeconomic factors. For over forty years, rates of breastfeeding among African-American women have significantly lagged those of non-Hispanic white women. When it comes to the gold standard of infant nutrition, twelve months of exclusive breastfeeding, rates among black women are about half that of white women. While all women struggle with the structural barriers, the African-American community also battles a host of cultural barriers when attempting to breastfeed. The implications are severe. In the United States the African-American infant mortality is 2.4 times the rate of white non-Hispanic babies. One main reason for these infant deaths is that African-American babies are disproportionately born too small, too sick, or too soon. Black women have some of the highest rates of preterm births and low birth weight babies—the ones who need the protective benefits of breast milk the most. Breast milk is easier to digest for underdeveloped digestive systems and has been proved to reduce the risk of necrolitis, a leading cause of death among preemies. For a large percentage of black infants, access to breast milk can be a life or death matter.

  This makes the racial disparity in breastfeeding rates, which has been closing ever so slightly in recent years, even more unacceptable. The reasons for this disparity, which spans socioeconomic status, are varied and nuanced. They range from lack of support from medical professionals to a lack of role models to the historical trauma of black women being used as wet nurses during slavery. Black women in slavery were forced to stop nursing their own children to provide breast milk for the children of the slave owner. “On the one hand, wet nursing claimed the benefits of breastfeeding for the offspring of white masters while denying or limiting those health advantages to slave infants. On the other hand, wet-nursing required slave mothers to transfer to white offspring the nurturing and affection they should have been able to allocate to their own children,” writes the historian Wilma A. Dunaway in The African-American Family in Slavery and Emancipation. And since breastfeeding reduces fertility, slave owners forced black women to stop breastfeeding early so that they could continue breeding, often to the detriment of their infants’ health, Dunaway notes.

  This stunted breastfeeding experience created a stunted mothering experience and the commodification of black women as breeders and feeders. As such, white women were crucial to creating a market for black enslaved mothers’ breast milk and the nutritive and maternal care black women provided to white children. Through slavery and dynamics of race and class, an enslaved mother’s ability to suckle became a form of invisible skilled labor. This led to exploitation. It meant that not only were black women being exploited on the basis of race, they were also being exploited as women who could breed more skilled labor and as tools to enhance the health of the slave owners’ children and the quality of life of his wife.

  A white woman’s decision to borrow, hire, or buy enslaved wet nurses often broke the already fragile yet sacred bonds enslaved mothers had with their children and must have caused familial trauma beyond our imagination. A black enslaved mother’s child could be sold at any time, leaving her bereft. She could be prevented from feeding her own child—stripping from her her key role as mother. This structural interference into a black woman’s role as mother is critical to consider. As slaves, black women were never allowed to fully participate in the protecting and nurturing aspects of motherhood, including the act of breastfeeding. Slave mothers often fought for their motherly rights—the same rights white mothers naturally took for granted—and often lost against their domineering slave masters. The power dynamic and the two distinct definitions of motherhood were clear. White women were granted ownership of their children as one of their God-given rights as a mother. This ownership could only be lost through divorce or death. White mothers never lived with a constant fear of separation. On the other hand, the ownership of motherhood was not the right of black slaves and they were consistently deprived of the true meaning of motherhood because they did not “own” their children. As historian Michele Mock notes, “maternal instinct is corrupted when viewed in the context of slavery. For a slave cannot ‘own.’” White middle- and upper-class women were able to choose whether to breastfeed their children or turn them over to a wet nurse when they viewed breastfeeding as beneath them. They had a choice that black women did not have. Whatever “sacred” bond was created through breastfeeding one’s own child or using your agency to choose to have someone else to do it for you—none of this was possible to achieve for enslaved black women. In the process, African-American babies and children were dehumanized, a de facto necessity in order to legitimize the denial of maternal rights, maternal bonds, and the nurturing that was taken from black babies and given to white children. Devaluing black children also allowed them to be violently disciplined and ultimately sold or otherwise separated from their parents.

  Either way, the possibility for a legacy of historical trauma due to the dysfunctional nature of black women’s motherhood experience is clear. Over the years since slavery, black women have continued to be perceived as good caretakers for other people’s children but distrusted as mothers of their own children. This stereotype also gave rise to the “mammy” archetype, followed by the stereotypes of welfare queens and domineering women. The role of black women as caretakers of white people’s children is reinforced in popular culture as seen in the bestselling book and movie The Help and a litany of movies and television shows, including Gimme a Break, starring Nell Carter, and Gone with the Wind, featuring Hattie McDaniel as Mammy (McDaniel became the first African American to win an Academy Award because of that role). These media stereotypes create negative asso
ciations with black mothers, and since breastfeeding is generally associated with “good” mothering, there is often an assumption by medical professionals that black women don’t breastfeed. Therefore, black women repeatedly overreport that physicians and other health professionals did not educate them about breastfeeding or only mentioned it in a cursory way.

  Moreover, the negative association of breastfeeding with slavery and mammy-ism is still very present among the grandmothers and other family matriarchs who are highly influential in modern black family structures. These grandmothers and great-aunts often pass on a cultural legacy of viewing breastfeeding as something that African Americans were forced to do for others. This leaves black women with a disproportionate lack of multigenerational support and means that, in addition, they receive negative cues about breastfeeding.

  Body politics also loom large for African-American mothers when it comes to breastfeeding. They face a particular legacy of embodied exploitation, in which their sexuality and reproduction were appropriated by white men or demonized as dangerous and out of control, exotic and primitive. Black women and their bodies have been the subject of much scrutiny—viewed as a threat to the fragile white woman during slavery and the antithesis of white and wafer-thin standards of beauty. The act of breastfeeding cannot be separated from the narrative of black women’s bodies. This is only the tip of the iceberg of the many cultural nuances of breastfeeding. The river of historical trauma among women of color runs deep and wide. Yet there is often a one-size-fits-all message that ignores the nuances of breastfeeding for different ethnic groups. As a result, racial disparities still linger.