The Big Letdown

by Kimberly Seals Allers

  Bettina and Danielle say yes.

  If it becomes attractive enough, then women will push to make it attainable, they assert. Every day we want things we can’t afford or seem unreachable for our life circumstances, but many times we make it happen. Mothers will begin to demand the “luxuries” that should be rights that allow celebrities to breastfeed with ease and leave many everyday women struggling. Perhaps what we need is not more celebrity moms endorsing breastfeeding but more celebrities taking a cue from Snooki and speaking candidly about their challenges, setbacks, and fears. The way to normalize breastfeeding includes normalizing the challenges of breastfeeding. Then, perhaps, we have to begin to ask more of the celebrities. Breastfeeding does not happen in a vacuum. What about lending their star power to the myriad of complementary issues that directly affect breastfeeding, particularly paid family leave? What if they used their celebrity to get an audience on Capitol Hill to promote better child care options, flexible work schedules, and more viable part-time work opportunities for women?

  My fear is that the movement will never be able to leverage the scores of breastfeeding mothers in Hollywood because standing up for women and babies in America can be a dangerous and career-limiting move by Hollywood standards. Standing up for sick babies in Africa and other underdeveloped countries is socially acceptable and applauded. But in the United States, the infant feeding conversation is so wrapped up in the idea of individual choice that any advocacy is often misconstrued as an attack a woman’s freedom.

  Brazilian supermodel Gisele Bündchen experienced this firsthand when, soon after giving birth to her son, Benjamin, in December 2009, she suggested that breastfeeding for six months should be a law. “Some people here don’t think they have to breastfeed, and I think, ‘Are you going to give chemical food to your child when they are so little?’” she said in an interview in the U.K. Harper’s Bazaar. “I think there should be a worldwide law, in my opinion, that mothers should breastfeed their babies for the first six months.”

  Gisele’s use of the word “law” was a direct affront to American women’s strong connection to freedom and choice, and they let her have it. There was no context that if there was a law, there would also have to be the means and support to comply with it. The media dug it. Gisele became just the latest scapegoat for the cable news networks and the blogosphere. I was one of the women on national television discussing the controversy, attempting to explain the spirit of what Gisele was saying. But the idea of the government interfering with a woman’s feeding choice sounded like tyranny, even though state and local governments mandate other areas of infant health such as immunizations all the time. But what women heard was, How dare you with your supermodel body and your Super Bowl husband (she is married to NFL quarterback Tom Brady) talk of imposing laws on everyday women. Gisele was forced to take to her blog and clarify. The damage was done. Gisele never spoke publicly about breastfeeding again.

  Powerful celebrities—the ones whose lives and accessories we so dearly want—are silenced by the same forces that stifle conversation and prevent building the kind of momentum that would benefit us all. And I’m not sure that any celebrity is willing to take that on.

  The problem of getting it right with breastfeeding messaging goes back to the early 1900s. By 1910, infant deaths reached alarming rates as severe bouts of diarrhea and digestive diseases among artificially fed infants spawned widespread recognition, prompting some of the first breastfeeding promotion campaigns. The culprit was unclean cows’ milk, which was being used in many artificial substitutes. What happened next may have changed the course of breastfeeding engagement for decades to come. Two sets of public health campaigns ensued. One designed almost solely by local public health officials urged mothers to breastfeed for as long as possible. The other—involving public health departments and a much wider array of supporters, including concerned citizens, municipal governments, medical charities, settlement houses, private physicians, and newspapers—crusaded for clean cows’ milk. Both campaigns had noble and useful goals, but the latter, with its broader array of supporters, had greater exposure. It also created an unintended consequence to the breastfeeding culture.

  Public health officials around the country hung posters in urban neighborhoods urging mothers to breastfeed or to avoid feeding their babies the spoiled, adulterated cows’ milk that pervaded U.S. cities. The language on the posters was direct and to the point. One commanded, “To lessen baby deaths let us have more mother-fed babies. You can’t improve on God’s plan. For your baby’s sake—nurse it!” Another, which explained the importance of home pasteurization and keeping cows’ milk on ice if a mother did not breastfeed, pleaded, “Give the Bottle-Fed Baby a Chance for Its Life!” The campaign efforts focused on immigrant communities, and posters appeared in English, Bohemian, Croatian, German, Italian, Lithuanian, Polish, Serbian, Swedish, and Yiddish.

  But the broader “clean up the milk” efforts had deeper media support. Calling pure cows’ milk “one of the essentials of daily living,” urban newspapers decried “the diluted, adulterated, and harmful quality of milk” common in U.S. cities. As the country’s infant death rate garnered unprecedented concern, journalists charged that cows’ milk “plays no small part in this colossal crime of infanticide.” A Chicago Tribune headline from September 1892 read “Scarcely Any Pure Milk” and another “Stop the Bogus Milk Traffic.” Reformers fought for more than thirty years for pasteurized milk gathered from healthy cows, processed under sanitary conditions, sealed in individual bottles, and shipped in refrigerated railroad cars. While urban reformers focused on cleaning up cows’ milk, human milk advocates concentrated on keeping babies at the breast.

  By the late 1920s, with laws in most municipalities mandating the pasteurization and hygienic handling of cows’ milk, the urban breastfeeding campaigns disappeared. The outcry that unclean cows’ milk was the culprit for the high number of infant deaths drowned out the need to breastfeed regardless of the quality of cows’ milk. Although low breastfeeding rates continued to generate public health problems, the link between human milk and infant health was less obvious. As a result, breastfeeding never became the cornerstone of preventive medicine that so many early-twentieth-century physicians recommended. Instead, the lay and medical communities came to believe that pasteurization nullified the differences between human and cows’ milk. With readily available clean cows’ milk, breastfeeding crusades and breastfeeding itself seemed antiquated and unnecessary, as mothers sought artificial milks as they continued to work more outside the home. By the early 1930s, a new generation of doctors belittled human milk as “nothing … sacred.” Unlike their breastfeeding-activist predecessors, these pediatricians never witnessed the rampant death of infants by spoiled and adulterated cows’ milk and so came to place more faith in the efficacy of cows’ milk than human milk.

  By presenting breast milk as the best and safest compared with cows’ milk, the true benefits of breast milk were lost in the messaging. Breast milk should not have been compared with anything. With the advent of pasteurization, cows’ milk was considered safe. And human milk substitutes made from cows’ milk were also considered safe. But safe does not mean better. Technically, Spam, the canned, precooked meat product made by Hormel, is safe. But no one would tout its health benefits and agree that children should be fed a steady diet of the factory-manufactured stuff. Yet with cows’ milk being technically safe, the fundamental reason why health officials told mothers to breastfeed had now disappeared. Breast milk lost its competitive advantage and never regained its rightful place as the best nutrition for infants—hands down—and its rightful determination as preventive medicine. Instead, artificial milks were viewed as “as good as” breast milk.

  The results were disastrous. From 1930 to the early 1970s, after several failed attempts at breastfeeding marketing campaigns and with the collusion of physicians, not only did mothers continue to supplement their breast milk with cows’ milk and wean infants in the f
irst few weeks and months of life, but more and more mothers did not breastfeed at all. Breastfeeding in America was nearly eradicated. It was a low point for the movement. By 1966, just 18 percent of babies were breastfed when they left the hospital—an all-time low in the United States—and fewer for more than a few weeks after that. Not until later in the 1970s did the women’s health reform movement rekindle interest in breastfeeding. Even as more women in the 1970s nursed their infants, the medical community never deemed breastfeeding as the gold standard of care. Instead, formula feeding became the norm and nursing became the “best” thing to do—a nice cost-effective choice, but not necessary. Between 1984 and 1989, breastfeeding initiation rates declined 13 percent from almost 60 percent to 52 percent. Not until 1995 did these rates return to a high of 60 percent. In 2001 69.5% of U.S. mothers initiated breastfeeding.

  Today, the movement is faced with a different, but still troublesome, challenge. While initiation rates have reached 75 percent in the United States, only about 13 percent of babies are exclusively breastfed for six months, according to the Centers for Disease Control and Prevention. Compare that to South Asia, where 44 percent of babies are exclusively breastfed for six months. Meanwhile, supplementation rates continue to rise, with an increasing percentage of mothers introducing formula just days after leaving the hospital. Fifty-three percent of lactating mothers introduce formula before their babies are a week old, 68 percent do so by two months, and 81 percent by four months, according to the latest CDC data.

  Well-intentioned health organizations and government agencies have spent considerable time, money, and effort trying to fix the breastfeeding problem. In 2000 the Department of Health and Human Services (HHS) published a bold booklet titled HHS Blueprint for Action on Breastfeeding. The first sentence said it all: “Breastfeeding is one of the most important contributors to infant health.” The language was reminiscent of the early-twentieth-century public health campaigns’ insistence that having been breastfed was the single most powerful predictor of an infant’s ability to survive childhood. HHS called the lack of exclusive and prolonged breastfeeding in the United States “a public health challenge” and urged health care providers, employers, and child care facilities to formulate policies supportive of extended breastfeeding. HHS also called for a social marketing effort to explain to the public the importance of human milk and the dangers of formula feeding.

  In early 2011, U.S. Surgeon General Regina M. Benjamin issued “Call to Action to Support Breastfeeding,” an unprecedented report urging mothers to breastfeed longer and pushing for the removal of key barriers to breastfeeding. Dr. Benjamin, a MacArthur “Genius” Grant recipient, was a rising star in the medical community. In 1995 she was the first African-American woman to be elected to the American Medical Association board of trustees. She gained notoriety following Hurricane Katrina as one of the only physicians treating patients in her Katrina-ravaged community of Bayou La Batre in Alabama. Her nomination was a boon for family medicine. “Call to Action” laid out steps for hospitals, physicians, nurses, and lactation consultants for community engagement. Advocates cheered that “America’s Doctor” was a breastfeeding ally and rallied around “Call to Action,” but the report was directed more toward policy makers and institutions. And a call to action is not a mandate or law. Yes, it provided more evidence to push for policy change, but without the groundswell of women demanding change, policy can seem like a solution to an issue with no problem.

  Forget the Feminine Mystique; for years breastfeeding has been the problem without a name. The problem that was not a problem. Infant formula companies heralded the nutritional quality and safety of their products—creating no reason to complain. By promoting the idea that babies were just fine and mothers were just fine, there was no outrage and no need to fix anything. This is very dangerous from the perspective of shifting cultural norms. Social movements are, by definition, collective actions in which the populace is alerted, educated, and mobilized, over time, to challenge the power holders to redress social problems or grievances and restore critical social values. Sometimes social problems are as blatantly obvious as police brutality or domestic violence. Those are problems people actually see with vivid images, bruises, bloodshed, and, in these days, footage from a cell phone camera posted on YouTube. Though the Internet did not yet exist in the 1970s, similar tactics were used then to mount one of the most successful movements in breastfeeding history, created in response to the unnecessary deaths of infants in Africa and other developing nations, where babies were literally dying from infant formula. In 1974 the British charity War on Want published The Baby Killer, in which the journalist Mike Muller wrote a dramatic account of the tactics used by formula companies to capture their market. The Baby Killer had a powerful cover picture, showing a severely malnourished child trapped inside a baby bottle. The report also included other tragic images of impoverished and malnourished infants. Other reports and studies followed, including a critical Consumer’s Union investigation of food and pharmaceutical industries and a book, The Nutrition Factor, by the Brookings Institution scholar Alan Berg. These damning reports prompted the World Health Organization to call for a review of corporate sales practices and to advise member governments to consider action in 1974. In 1975 a documentary called Bottle Babies was released. Filmed in Kenya, it was filled with powerful visual images of starving, malnourished, bottle-fed infants. In one scene, a mother is shown scooping water from a filthy puddle and mixing it with baby formula. Another scene showed a graveyard full of infants with their graves marked with bottle and formula cans. In Kenya, as in other parts of the world, it is customary to bury the infant with their most valued possession—and the formula was it. The film was a critical step in the global movement to curb inappropriate marketing of infant formula and was a highly effective tool in creating awareness of the health problems created by bottle feeding.

  One researcher defines social movements as the “collective enterprises to establish a new order of life.” In that regard, the push to limit infant formula marketing in developing countries was a success. But by that same rubric, we also see the gaping hole in the U.S. breastfeeding movement. For if you to want a new order, you have to see something wrong with your current order. Here in the well-heeled U.S.A., it was hard to frame the problem of breastfeeding. Babies weren’t visibly dying. There were no heart-wrenching optics of sick and malnourished babies. No picture of an American mother collecting dirty water with which to feed formula to her baby. On the contrary, technological advances made milk substitutes safer. Formula-fed babies were plump. In fact, the infant formula companies made sure of that by creating and sponsoring infant growth charts based on typical weight gain for formula-fed babies, often making breastfed babies look underweight. Women couldn’t see a problem. Most mothers today still do not. This was particularly difficult since the framing of the problem had long been co-opted by the physicians and pharmaceutical companies, who made the unpredictable nature of breastfeeding the problem.

  But there was a very serious public health problem. However, instead of making women aware of the structural barriers and the very real dangers of having a commercial entity control what you feed your baby, women were messaged about the benefits of breast milk. The movement saw educating women with medical information instead of rallying them around the structural barriers to breastfeeding as the solution to the problem. Many of the barriers are so woven into the fiber of our existence that we no longer recognize them as odd. We take them as normal. Karl Marx called on workers to become aware of their oppressed status and to develop a class consciousness. He also held that a social movement would require leaders to sharpen the awareness of the oppressed. They would need to help workers overcome feelings of false consciousness, or attitudes that do not reflect workers’ objective position, in order to organize a revolutionary movement. Similarly, one of the challenges faced by women’s liberation activists of the late 1960s and early 1970s was to convince women that the
y were being deprived of their rights and of socially valued resources.

  But breastfeeding isn’t viewed or framed as a societal problem. As we discussed in the previous chapter, breastfeeding has not been included in the reproductive rights conversation. As women fought to figure out how to have control over when they have children, there was never any conversation about the right to feed the children that we did have.

  What will it take to transform breastfeeding into a broadly supported social movement? Social scientists say mobilizing people for action requires three main characteristics. To start, there needs to be a level of discontent with the way things are, based mainly on how people perceive their situation. Then, people must feel that they have a right to their goals, that they deserve better than what they have. And lastly, there needs to be a shared perception that members can end their relative deprivation only through collective action.

  Gopal Dayaneni knows something about movement building. He also knows about breastfeeding. In his native India, he was breastfed until he was four years old, and he remembers the experience. Gopal is on staff of MovementGeneration.org and serves on the board of the International Accountability Project. He is considered one of the key architects of the modern-day art of strategic movement building. He has a long career, a highly regarded reputation, and several active roles providing strategic communications to progressive organizations looking to win the battle of ideas. Gopal, who is a work-at-home dad to his two daughters, says that, despite his vast expertise in the field, he finds the current state of breastfeeding affairs in the United States very confusing. It wasn’t long into our conversation before Gopal identified the fatal flaw in breastfeeding messaging. “The surest way to inoculate a social movement is to keep it embroiled in the matter of choice. It’s precisely how to keep a social movement stuck in the cultural space. And it masks what actually is going on,” he says. So, to be clear, from a movement building experts’ opinion, the pro-breastfeeding efforts are in the worst state possible.