Moskowitz shattered a system that was based on searching for universals and showed us that the secret sauce is in the variability. Other fields have already embraced this concept. For example, now the great revolution in medical science is not just to understand how cancer works but to understand how cancer works specifically in my body, with my genetic code and my physiology. If we can understand the importance of variability in our sauces, what of motherhood? How do we actually create a society that embraces all the variabilities of motherhood and in turn, breastfeeding? Here are seven super important starting points:
1. Policy is paramount. We can’t continue to call ourselves a world leader when we are the biggest laggard when it comes to meaningful paid family leave and other supportive policies as a government-mandated right.
2. Science needs to step up. Scientists must level the playing field for breastfeeding research using breast milk as the normative behavior and setting funding limits on the infant formula industry. As a group, the scientific community has to be held to higher standards to effectively deal with conflicts of interest, opportunities for bias, and to be responsible for reporting openly and honestly to the public to make their work understood. This is the very least we should expect, particularly from research that impacts our youngest and most fragile citizens. Those scientists who dilute the body of scientific evidence with flimsy research, knowing that the research may be used to shape critical public policy that affects millions of Americans, must be held accountable.
3. Medicine must be separate from industry. The medical field needs to end their historic financial entanglement with the pharmaceutical industry, and work to rectify the damage this relationship has caused. That means holding our pediatricians accountable for being proficient in lactation management, and knowing how breastfeeding works. Medical schools must teach lactation as a basic biological function.
4. Policy is important but so are people. Ultimately policy change must lead to and be accompanied by cultural change—and that shift needs to be woman-powered, from the ground up. For the movement to be truly successful on a wide scale, we have to give women something to believe in and ensure that they feel seen, heard, and understood. Instead of focusing on building a case of scientific facts, build emotional affinity and a connection to the right to a better food system for infants. Yes, breastfeeding is already an emotional issue, but much of the emotional messaging we receive is the anger of so-called lactivists or the pain of shamed mothers. The positive messages we do see are connected to the act of breastfeeding (blissfully in a meadow) but not about the lived experience of breastfeeding in the context of modern-day America. Breastfeeding needs an empowerment message more akin to how Nike makes us feel we can do the impossible. Do not deny that breastfeeding is difficult and try to sell “easy.” Embrace the difficult—show women the personal pride and sense of accomplishment that comes from breastfeeding, just like running a marathon or scaling a mountain. I have never run a marathon in my life, and probably never will, but those Nike commercials make me believe that I can because I’m connected to their message of overcoming obstacles, defying stereotypes and naysayers, and female empowerment. We’ve done facts. Let’s get women connected to empowering feelings.
5. Disrupt the “choice” narrative and add context. The concept of choice is critical to our American and feminist ideals, but context is everything. The choices we actually have are framed by the context in which we live. For example, the so-called choice for women to quit their jobs and become stay-at-home mothers is shaped by the current U.S. tax code, which penalizes two-career married couples, and the high costs of child care, which for some families means that monthly day care costs are nearly equal to one month’s salary; when you factor in commuting, food, and work-clothing expenses, one parent might as well stay home. The “choice” to become a supermom is framed by a historically contingent cult of motherhood with roots in child psychology, an inner conflict between education and career and motherhood, and a conservative backlash against feminism. The “choice” to have cosmetic surgery to meet a porn-star ideal of beauty and to learn to striptease are produced by the commodification of a narrow range of sexual behaviors that are sold to women as sexual liberation. This is the fundamental problem with our infant feeding choice: it occurs within a context that appears fair and untainted but most definitely is not. Dismantling the language of choice by exposing all the ways it does not truly exist is the next step in the process.
6. Lactating may be biological, but breastfeeding is behavioral. Studying behaviors is different from studying breasts. Does the movement need a better understanding of lactation or a better understanding of women and how they truly live and experience breastfeeding? I’d argue for the latter. Understanding behaviors deepens our knowledge of decision making. For example, we tend to believe that these decisions are exhaustively researched. We view decision making as a scale, with evidence and reasons weighed equally on each side. The side with the weightier proof wins. This feels more normal for us. But, increasingly, the research about how our brains work indicates that because of this process we’re likely to miss the connection between cause and effect when there is a mismatch in size—when the less heavy side of the scale actually wins. A better understanding of behaviors can help the movement improve its messaging. Which leads me to …
7. Sweat the small stuff. While the big ideas about breastfeeding are important, we can’t forget some of the smaller areas of life that ultimately impact the social acceptance of breastfeeding. Our ideas about breastfeeding aren’t shaped solely by our knowledge of the medical benefits or scientific findings. Sometimes they are shaped by our sense of self, body ideals, sexual history, and cultural influences. Increasingly behavioral scientists, mathematicians, and other researchers are opening up our understanding of how we make decisions, and what they are finding supports the idea that the small things—whether they are body-image issues or school curriculums that don’t teach how human mammals feed their young—may be just as important as the next blockbuster study in regards to how women view breastfeeding. And so the following things that may seem small really aren’t: an entire market of baby dolls that only come with bottles; the formula-maker-provided growth chart at pediatricians’ offices; swag bags from the maternity ward with free infant formula inside and coupons for more; the coffee mug or pen with the infant formula company logo at your ob-gyn’s office that we begin seeing at age fifteen. Are these truly small? Our attitudes about mothering and breastfeeding do not occur in a vacuum or in the space of forty weeks of pregnancy; they are part of a continuum of life that is influenced by our family structure, community, and societal norms. We need a long-term approach to changing cultural norms about breastfeeding, not just to target women during the nine months of pregnancy and expect change. As we learned in this book, the formula companies are also targeting them during pregnancy so we need to start sooner. This includes rethinking what children are taught in biology and nutrition classes and teaching the next generation how human mammals feed their young.
* * *
These are important starting points. Ambitious, yes, but not unattainable. Moskowitz’s work democratized the concept of taste—proving that there is no one way to be. Perhaps this could happen for breastfeeding. It, too, could be democratized to include the full spectrum of each woman’s varying breastfeeding experience with varying layers of support. Everyone will find their chunky! Such that, whether your motherhood experience is a metaphorical garden chunky or three cheese, there is easily accessible education and multilayered support on the policy, hospital, medical, and community levels, just waiting on the shelf for you. When society embraces the broad diversity of our mothering experiences and our breastfeeding experiences, then we will win. Our children will win with healthier lives. Society wins with reduced rates of diet-related disease and chronic illnesses. Ultimately, every woman wins the freedom to actually, truly choose her mothering exp
erience. Then and only then will we be able to finally end the big letdown.
Acknowledgments
Books, like breastfeeding, require a lot of support. Thankfully, I received so much in so many ways. First, I’d like to thank the tireless breastfeeding advocates who, armed solely with their passion, skills, and love for mothers and babies, have achieved amazing success against remarkable odds. I applaud you and thank everyone who shared their thoughts, ideas, time, sources, and research with me. This work is yours as much as it is mine. I want to thank my children, Kayla and Michael-Jaden, my two greatest cheerleaders and my two favorite teachers, who continue to support my work—even when it takes me away from them—and continue to motivate me to be my best self. For the moments I was not fully present, dinner was not fully cooked, or you were not exactly on time for a practice or lesson and you did not complain, thank you. Mothering you two is my greatest joy. I hope you see the beautiful struggle of chasing a dream as you embark on your own one day with everything you’ve got.
I’m very grateful to my wonderful parents, Alma and James Seals, who have come to my rescue over and over again to give me writing time, mental breaks, child care on work trips, and everything in between. Thank you for always supporting my interests, even as a kid who was into bird-watching, taping my own radio show where I played the host and guest, writing poems, and playing violin—you never let me think I was weird. (I’m not exactly sure how you pulled that off, but thank you.) My brother, Jeffrey Seals, and my sister, Katrina Seals Ruiz, thank you both for always having my back. My uncle James Billy and my cousins Schmoll Reaves-Bey and Khalebo Harris, thank you for believing in me and for the unconditional support. I want to thank my secret brain trust for generously sharing your genius with me when needed: Shadan Deleveaux, Dionne Grayman, Julian Curry, Simran Noor, and Marion Rice. My fellow Food & Community Fellows—an incomparable group of food advocates who welcomed and embraced me and my work and gave me a most incredible two-year lesson about friends, food, and food systems. Our time together inspired the seeds of the book, and I want to give a special thanks to Raj Patel, for early feedback that helped set me on the right course, and to Nina Ichikawa, who was never too busy to send me a link to an article she thought was relevant. Thank you, Tonya Lewis Lee for the check-ins and empathy. Ken, Keiva, Asim, Owen—the laughs and encouragement was always right on time. And to Matthew, who reminded my heart how to skip a beat.
Of course, none of this would have been possible without the ongoing support of my agent, Stacey Glick from Dystel & Goderich, who responds to all of my high-energy calls and e-mails with coolness and steadiness and is a great strategic partner. To my editor, Nichole Argyres—this has been a true journey and I thank you for pushing me to be a better writer and helping me get to where I needed to be. You believed in this project from the beginning and I deeply appreciate your vision and stewardship.
Lastly, I want to thank “the process.” The process of writing a book often seems sexy to outsiders, but it is a decidedly un-sexy marathon—a don’t-stop, long-haul, sweaty, want-to-give-up, do-it-over-and-over-again marathon. Even on your fifth book. And just as a marathon refines you, clears your mind, takes your mental acumen to another level, I am aware of and grateful for how the process of writing this book has helped me grow as a writer, mother, human, and a voice for women. Like a marathon, the process can be painful and overwhelming—there are sores, scars, and stretched muscles—but when I reflect on my personal growth and character refinement, I will be forever grateful to the journey. And everyone I met along the way.
Notes
Please note that some of the links referenced in this work are no longer active.
Introduction
data available from the Centers for Disease Control Center for Disease Control, “Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences: United States, 2000–2008 births,” Morbidity and Mortality Weekly Report 62, no. 5 (2013): 77–80; Center for Disease Control, “Breastfeeding Report Card: United States/2014,” National Center for Chronic Disease Prevention and Health Promotion, 2014.
Compare that to Sweden, where the exclusive breastfeeding rate K. M. Michaelsen, L. Weaver, F. Branca, and A. Robertson, “Feeding and Nutrition of Infants and Young Children: Guidelines for the WHO European Region with Emphasis on the Former Soviet Countries,” WHO Regional Publications, European Series 87 (World Health Organization, 2000).
treating water as a universal human right http://action.storyofstuff.org/sign/nestle_water_privatization_push/.
1. Doctor Who? The Medical Field’s Influence on Mothers
Then researchers set to find out if this should be classified as some K. G. Dewey, M. J. Heinig, L. A. Nommsen, J. M. Peerson, and B. Lönnerdal, “Growth of Breast-Fed and Formula-Fed Infants from 0 to 18 Months: The DARLING Study,” Pediatrics 89, no. 6 (1992): 1035–41.
One key study by DARLING K. G. Dewey, M. J. Heinig, L. A. Nommsen, and B. Lönnerdal, “Adequacy of Energy Intake among Breast-Fed Infants in the DARLING Study Relationships to Growth Velocity, Morbidity, and Activity Levels,” Journal of Pediatrics 119, no. 4 (1991): 538–47.
“Arguably, the current obesity epidemic in many developed countries “Child Growth Standards: How Different are the New Standards from the Old Growth Charts?” WHO.int, last modified 2016; see also http://www.who.int/childgrowth/faqs/how_different/en/.
Every year Perrigo Nutritionals “Survey Finds Infant Feeding Tops List of Questions New Parents Ask Pediatricians,” PerrigoNutritionals.com, last modified August 13, 2014; see also http://www.perrigonutritionals.com/press.aspx?ID=418.
despite the fact that the American Academy “Divesting from formula marketing in pediatric care,” Resolution 67SC (2012).
A 2000 study published in Obstetrics and Gynecology C. Howard, F. Howard, R. Lawrence, E. Andresen, E. DeBlieck, and M. Weitzman, “Office Prenatal Formula Advertising and Its Effect on Breast-Feeding Patterns,” Obstetrics and Gynecology 95, no. 2 (2000): 296–303.
In a study of obstetricians and patients at a multispecialty A. Stuebe, “The Risks of Not Breastfeeding for Mothers and Infants,” Reviews in Obstetrics and Gynecology 2, no. 4 (2009): 222–31.
Most medical schools don’t have L. S. Davis, “Is the Medical Community Failing Breastfeeding Moms?” healthland.time.com, last modified January 2, 2013.
Every year, the Abbott Nutrition Institute “Conference Summaries,” ani.org, last modified 2016.
Researchers at the Robert Wood Johnson L. Feldman-Winter, L. Barone, B. Milcarek, K. Hunter, J. Meek, J. Morton, T. Williams, A. Naylor, and R. A. Lawrence, “Residency Curriculum Improves Breastfeeding Care,” Pediatrics 126 (2010): 289–97.
The Big Letdown Page 23
