The Big Letdown

by Kimberly Seals Allers

  This is extremely dangerous to the advancement of women and the promotion of breastfeeding. Limiting the maternal benefits of breastfeeding to only the medical advantages contributes to the dangerous “mother as martyr” and “sacrificial lamb” ideology that is attacked by modern-day feminists like Badinter. Instead, what if breastfeeding was touted for the pleasurable feelings it creates for mothers and the benefits of releasing the “love hormone” multiple times a day? Oxytocin is a multifunctional hormone. It regulates appetite through receptors in the brain. Oxytocin is a natural antibiotic, attacking hostile bacteria and decreasing susceptibility to uterine infection. Stress increases prolactin secretion, and excessive prolactin can enhance the risk of breast cancer, brain tumors, and leukemia. But oxytocin regulates the secretion of prolactin, so it has many health benefits.

  From a promotional perspective, every marketing expert will tell you that focusing on the feeling of the product or the experience of using it is how you engage audiences and create affinity. Instead of touting their own platitudes on the superiority of their product, even brand titans like Coke and Pepsi have shifted to focusing on the feelings users get from their beverages. “Coke is it!” changed into “open happiness.” What could it mean for the promotion of breastfeeding to talk more about the happiness and pleasure women experience while breastfeeding?

  Hollywood and the Breast

  A lot of this tunnel-vision view of breasts is perpetuated in advertising, on television, and in the media. The Hollywood entertainment industry, to be exact, has been very influential in shaping our ideas of beauty, sexuality, and most notably, our breasts, for years. Believe it or not, there was a time when Hollywood was concerned with “showing too much,” and breasts were just a tease. They were shimmying under sheer silk chemises. They were covered with the appropriately placed sequins. But by the 1960s, that all changed. Not to mention the growth of pornography. Then came Baywatch and the superstardom of Pamela Anderson, who built her Hollywood fame squarely on top of her DD breast implants.

  Television shows influence what people see as normal behavior; this we know. When people are exposed to a consistent set of messages on the television, they incorporate those messages into their understanding of the world around them. For example, one study showed that television portrayals tend to underrepresent older persons, which has led to people underestimating the size of the elderly population. On the other hand, I think we all can agree that television shows like Will & Grace and Modern Family have played a huge role in broadening acceptance of gay and lesbian lifestyles and normalizing same-sex marriage. Knowing its power to shape cultural norms, television has been strategically used to foster messages about smoking and wearing seat belts, helping to normalize these behaviors in subtle ways. The potential impact of television on public health goals is so significant that the Centers for Disease Control and Prevention helps fund the University of Southern California’s Hollywood, Health & Society program, which connects medical experts with screenwriters in an effort to minimize misinformation on screen. HHS has worked on various issues from promoting condom use to normalizing the disabled.

  What of breastfeeding? A study published in the journal Health Communication found many television characters are still often portrayed as uncomfortable in the presence of a breastfeeding mother. For example, there’s a scene in the sitcom Two and a Half Men in which one of the lead characters, Alan (played by Jon Cryer), dates a single mom who breastfeeds in the restaurant, causing Alan to have trouble eating. On a Sex and the City episode, Miranda breastfeeds her son, Brady, and Carrie can’t help shockingly exclaiming, “Your breasts are huge!” The study found fifty-three representations of breastfeeding, spanning from 1974 to 2012, with portrayals of breastfeeding clearly becoming more acceptable after 1998. (Forty-eight of the fifty-three examples were found since then.) The shows ran the gamut from dramas such as ER to sitcoms like Friends, The Big Bang Theory, and The Office. Most of the time, writers folded a “learning to breast-feed” plotline into stories about characters having babies. In The Office, for example, the characters Jim and Pam had their first child and had difficulty with nursing. This was played for laughs when their hospital’s lactation consultant was revealed to be male, making Jim uncomfortable. Characters almost never breastfeed in public, and, when they do, other characters comment on it with discomfort. For example, the study noted one episode of Friends where characters Joey and Chandler become uncomfortable when Ross’s ex-wife, Carol, breastfed her son. Ross berated Joey and Chandler for their insensitivity, but wouldn’t it be better to let public breastfeeding pass without comment? In most instances, breastfeeding is used as comic fodder—someone is squeamish or someone gets squirted with breast milk. The portrayal perpetuates the idea that women using their breasts for anything other than men’s pleasure is somehow wrong, uncomfortable, or worthy of note. Instead of the highly trumpeted “Breast Is Best” message, the more pervasive message emanating from big- and small-screen portrayals is more like “Breast Is Awkward.” The study also called out the cable network TLC, which has an array of baby-related programming, as “horrible” at conveying good breastfeeding information, citing large advertising dollars from formula companies.

  In the movie The Hangover there’s a scene when a stripper played by Heather Graham is nursing her baby while talking to the three leading men—all of whom appear visibly uncomfortable yet at the same time unable to look away from her exposed breasts. Mostly, it’s the extended breastfeeding that takes the brunt of the joking. On an episode of Two Broke Girls, the staff at the diner are disgusted by the fact that a customer is breastfeeding her son, who is certainly older than the age when American moms typically stop nursing. “Some mothers tend to breastfeed for a lot longer these days. It’s called attachment parenting,” waitress Caroline explains to Max, Han, and Earl, who were watching the mom and child. Max then says, “When the kid’s that big, it’s called dating.” This trend of public shaming parental decisions about breastfeeding, as depicted in this scene, only adds to the stigma. In the movie Grown Ups, Maria Bello’s character breastfeeds her four-year-old son, inciting judgmental looks, jokes, and comments from the other parents. Her nursing is a source of tension between the mom and her husband, who later hands his son a carton of milk to make him “wean.”

  More recently, a spate of “housewife” and other reality shows that feature younger mothers and a new sitcom preoccupation with family has created new avenues for talking and laughing about breastfeeding. Snooki talked about breastfeeding. Kim Kardashian is seen on reality television breastfeeding. Before her, her sister, Kourtney, was also frequently seen breastfeeding. There were episodes where breast milk was tasted and the infamous “pump and dump” episode after Kourtney had a few drinks. And I’ll never forget Kim Zolciak-Biermann on the Real Housewives of Atlanta, who was filmed pumping while driving. A later RHOA cast member, Phaedra Parks, famously carried her breast-pump bag to all the “girls” outings, bragging about her “liquid gold.”

  While breastfeeding is getting more reality airtime, the bigger-is-better idea about breasts still prevails. Breast augmentation still ranks as the number one surgical procedure among women, according to the American Society of Plastic Surgeons—a position it’s held since the FDA ended the silicone-gel implant moratorium in 2006. However, in 2012, the number of women undergoing this procedure declined 7 percent from the year before, with just over 286,000 breast enhancements performed compared to 307,180 in 2011. Women deserve to have their bodies accepted as they are and to not feel compelled to go under a surgical knife to reach some ideal body.

  For most of these women, how the quest for big breasts affects breastfeeding is not even a thought—until years later when they become mothers. Some women can breastfeed after augmentation surgery, while others cannot. Plastic surgeons are quick to tell women that they can still breastfeed with implants, depending on where the implant is placed. As one board-certified plastic surgeon explained, the key is to av
oid a nipple incision and instead put the implants under the breast crease or under the muscle of the chest wall. Nipple incisions are usually preferred by surgeons because it’s very cosmetic and because it’s right where the pigment of the skin changes so the scar is not as noticeable. But that is also where all the milk ducts that drain the different lobes or sections of the breast convene. And there’s a risk of accidentally cutting milk ducts or the nerve that sends the signal to your brain to release more hormones that then helps you produce more milk. Cutting a nerve accidentally during a breast augmentation surgery could also result in the nipple’s becoming oversensitive, which would also make breastfeeding difficult no matter how much milk a woman is able to produce.

  According to Dr. Miriam Labbok, breastfeeding after breast implants is not always easy. The less pressure that is put on a woman’s mammary glands by an implant, the better the chances to produce milk later. “The mammary gland, like any other gland, performs normally when it has blood supply and space to grow,” Labbok said in an interview. “But when you put continued pressure on any gland in the body you risk it malfunctioning and compromising lactation.”

  Once again, lactation is compromised by cultural notions about breasts. Women are taking the risk of surgical augmentation out of dissatisfaction with how their breasts look because we have a culture where men judge a woman’s value based on the size of her breast. Add to that a widespread misunderstanding of the primary function of the breast, and breastfeeding ends up being viewed in a sexual context. Women are told they must choose their sexual body or their maternal one. Can’t we have our cake and eat it too? The costs of these cultural beliefs, in terms of maternal health and self-esteem and infant health, are too high to pay.

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  Ending the Letdown: The Way Forward

  In the end, we are all looking for solutions. But what if the solution is actually the problem? In fact, what exactly is the bigger issue here: the problem itself or the solution it requires? This is not my attempt at some Yogi Berra approach to fixing the broken breastfeeding landscape but, rather, at offering what is perhaps a critical insight into understanding the way forward, courtesy of some recent research. In November 2014 a study in the Journal of Personality and Social Psychology delved into why people can often be so divided over a particular issue, especially in the face of a solid body of scientific proof. Scientists have long suggested that psychological motivations often direct reasoning. But in this study, researchers Troy Campbell and Aaron Kay, of the Duke University Fuqua School of Business, explore a new dimension of this “motivated skepticism,” showing the source of the motivation is not necessarily an aversion to the problem, per se, but an aversion to the solutions with the problem. This “solutions aversion” model says that people will be skeptical of the evidence supporting the existence of a problem, if it “directly implies solutions that threaten a person’s cherished beliefs and ideological motives.” The model suggests that certain solutions associated with the problem are more aversive and threatening to individuals who hold an ideology that is incompatible with the solution. News of the study went viral. National media and social media went wild covering this latest development. The study directly applied the theory to the issue of climate change, and the extreme polarization across Republican/conservative and Democratic lines. Yet immediately the study’s findings were applied to technology, education, social movements, and everyday life. “Have you ever thought about going on a run but then thought, ‘Cardio isn’t that important’? This may be Solution Aversion,” one blog post said.

  What does this have to do with breastfeeding? Well, imagine for a moment that all of the players in the infant feeding theater are suffering from solution aversion. Medical doctors don’t want to accept that they are not above the influence of infant formula education and sponsorship and that they are indeed woefully ignorant about an important biological process. The feminist movement doesn’t want to acknowledge forty years of misdirecting women and undermining motherhood to the detriment of infant health. Pharmaceutical companies and other profit makers certainly don’t want to let go of their fat bottom lines. Scientists don’t want to admit that funding has corrupted their objectivity and that they have put out bad science at the expense of vulnerable women.

  And what of women? Are women battling, belittling, and denying the scientific evidence of breastfeeding because fighting on the Internet is easier than doing the important work of dismantling the many structural barriers that seem insurmountable? We continue fighting over our choices instead of fighting for better options from which to choose. Fighting over choice is easy. We can do that online from the comfort of our home computers—posting comments on blogs, signing petitions, retweeting catchy maxims, or clicking the LIKE button on social media pages that empower us. The alternative is much messier. That’s because choice occurs in relation to other people—your mother, your spouse, sisters, friends, colleagues. We don’t have to be at odds with our mother who didn’t breastfeed, our sister who only breastfed one week, or our friend who breastfed for three years. We are freed from potentially damaging relationships with people we love and care about. By not articulating our opinions, judgments, observations, and conclusions, we avoid conflict.

  Not only does hiding behind choice offer us an easy way out of conflict with others, we are also offered an easy out from the conflict we experience within ourselves. We are relieved of the burden of being consistently feminist or “empowered” ourselves: We do not have to struggle to bring our own lives into line with a demanding set of principles. We do not have to deal with the inner conflict we may feel around choosing motherhood versus a career or the guilt of having to leave our babies six to eight weeks after birthing them. We don’t have to articulate the frustrations of modern motherhood and modern partnership when we simply and dangerously convince ourselves that what we have done is just a matter of free choice. Is “choice” our solution-aversion mechanism? Fighting for better options would require the hard work of changing the fundamental structure of our society and, quite frankly, women are overburdened with responsibilities and expectations as it is.

  Given that backdrop, perhaps the problem of breastfeeding is not the problem at all. The true problem is the sheer monstrous nature of the multilevel solutions needed to effectively shift the landscape. I admit, the “fix” is daunting. Therefore, it is critical that any blueprint that has any real potential at finally righting the course and discourse of breastfeeding must include strategies that abate resistance or skepticism about the solutions.

  To do that, solution-aversion theorists agree, requires the strategic messaging and communication to accomplish three things: reducing ambiguity, reducing threat, and offering people a reason to want to believe. Solution aversion runs high when ambiguity is high. There needs to be irrefutable facts to help reduce any wiggle room for debate. That means leveling the playing field of scientific research to make sure breastfeeding is used as the normative behavior.

  Reducing threat means helping people be less averse to the solution by making the problem appear more solvable in a nonaversive way. That means simplifying the solution and removing the individualistic nature of breastfeeding that leaves women burdened with both the problem of and the solution for breastfeeding. Instead, we need a framework for collective action. The truth is, there is little evidence that isolated initiatives are the best way to solve the many social problems in today’s complex and interdependent world. No single individual or organization has ever been responsible for solving any major social problem. However, women collectively, as a social organization of sorts, can build relationships in a systemic approach based on a shared objective—a truly level playing field for all infant feeding decisions. Breast. Bottle. Or whatever lies in between. In this scenario, collective responsibility is also joint responsibility, meaning that each member of the group is individually and morally responsible for the outcome of the joint action and that responsibility is shared with others. In effe
ct, I am my sister’s keeper. With this mind-set, women could actually harness their collective will to solve today’s most serious public health problem with the resources we already have at our disposal. Instead of creating more options that are not really options, we can work collectively to transform the experience of all mothers.

  * * *

  To start, we should take a lesson from spaghetti sauce. Or, more specifically, what Howard Moskowitz learned about spaghetti sauce. Moskowitz, a Harvard-educated psychophysicist who had a penchant for measuring things, made his mark in market research. One of his first client assignments came from the beverage giant Pepsi. As the legend goes, most famously told by Malcolm Gladwell, author of Blink and The Tipping Point, around the time that aspartame was becoming popular, Pepsi was looking for the perfect formula for Diet Pepsi. How much aspartame should be in each can of Diet Pepsi in order to create the perfect diet soda? Pepsi thought it was somewhere between 8 and 12 percent and wanted Moskowitz to figure it out exactly by creating an experimental batch of Pepsi at every degree of sweetness, taste testing it among thousands of people, and taking the most popular concentration. It sounded simple, until Moskowitz’s expectation of a bell curve of results showing the most popular concentration never materialized. In fact, the data was all over the place. Moskowitz wasn’t satisfied with merely making an educated guess somewhere right in the middle, and the question lingered with him for years. As Gladwell relates the story (as he does frequently in speaking engagements), one day the answer hit Moskowitz like a lightning bolt. The Pepsi folks were asking the wrong question in their experiment, he concluded. They were looking for the perfect Pepsi, when they should have been looking for the perfect Pepsis, he declared. At the time, everyone thought this was sheer lunacy, but his thinking turned out to be one of the most brilliant breakthroughs in food science. Moskowitz traveled the country telling his story, and nobody would listen to him or hire him. Until he got a big break with Campbell’s Soup, makers of Prego spaghetti sauce, which at the time was struggling next to Ragú—the dominant sauce of the industry for much of the ’70s and ’80s. They asked Moskowitz to fix the Prego problem. And he did, by first creating some forty-five varieties of spaghetti sauce and varying them in every conceivable way—by sweetness, by garlic flavor, by sourness, and by tomatoey-ness, and so on and so on. Several months and tons of data later, Moskowitz had his “Aha!” moment, which is especially relevant to the topic of breastfeeding. He realized that most Americans fall into one of three groups—you either like your spaghetti sauce plain, spicy, or extra chunky. The chunky discovery was particularly significant because at the time you could not find extra chunky on the shelves of the supermarket. Prego went back and reformulated their sauces and came out with a line of extra chunky sauces that immediately and completely took over the spaghetti-sauce business, earning over $600 million over the next ten years. This was revolutionary because it showed the food industry that they didn’t really understand their consumers and had been approaching them all wrong. In his quest to transform spaghetti sauce, Moskowitz knew that companies worked off the flawed premise that you need to ask a consumer what she or he wants. But he realized that consumers didn’t actually know what they wanted. They didn’t know that chunky spaghetti sauce was their preference until someone gave it to them. Their choices were based on what they knew, what they had in front of them. And I’m convinced that our approach to motherhood has been equally flawed strategically. Women only see the options in front of them and society has yet to show us the chunky. Nor have we fully imagined the “chunky” for ourselves. This is our work—to reimagine the world and then go make it happen. We did it before and we can do it again.