The central conceit of organized efforts at breastfeeding promotion such as the Baby Friendly Hospital Initiative (BFHI) is that we can best support breastfeeding by recapitulating the experience of our ancestors. The most obvious difference is technology. Hence lactivists have focused their efforts on depriving women of access to technological innovations like formula supplementation, pacifiers and well baby nurseries. Remove these “unnatural” additions, so the reasoning goes, and women will be inspired/pressured to make breastfeeding work.
But what if the obvious difference isn’t the most important one? What if we’re doing postpartum breastfeeding support all wrong because the critical difference is in our philosophy, not our technology?
A defining feature of postpartum care in nearly all other cultures is that mothers are NOT expected to exclusively care for their infants.
We live embedded in a neoliberal society. Neoliberalism is primarily an economic philosophy but it has important implications for the way that we think about families and individuals.
According to We Need to Talk about Family: Essays on Neoliberalism, the Family and Popular Culture:
Neoliberalism is usually defined as the expansion of economic thinking in all spheres of human activity, including the family, with emphasis on individualism and practices of extending and disseminating market policies to all institutions and forms of social action…
The individualistic conception of selfhood central to neoliberalism accepts that an individual is both an ideal locus of sovereignty and a site of governmental intervention. The individual is a rational, calculating unit, looking after her or his own needs. Moral responsibility is equated to rational action…
Neoliberalism places a premium on individual responsibility and minimizes the value of collective action. We see this in contemporary political philosophies that venerate private industry and derogate goverment support. But we also see its impact in mothering philosophies that place a premium on individual maternal action and ignore the impact of the family and “the village.”
In many ways, the philosophy of intensive parenting, aka attachment parenting, is an expression of neoliberal values.
Intensive parenting refers to a style of parenting defined by tremendous energy, time, money and financial resources being devoted to children and rationalised through the discourse of acting “in the best interest of the child.”
Although theoretically either parent can undertake intensive parenting, in practice it is nearly always the mother. Intensive mothering minimizes or ignores the value of grandparents, aunts, friends and neighbors. It is assumed that ONLY a mother working alone can meet a child’s needs. Because we live immersed in neoliberal culture, we forget that it is a relatively new philosophy that differs dramatically from the traditional philosophy that “it takes a village to raise a child.”
The closing of hospital well baby nurseries is a paradigmatic expression of neoliberal philosophy. In order to “promote breastfeeding,” new mothers are being forced to room in 24/7 with their newborns. It doesn’t matter that these women are exhausted, in pain and often taking sedating medications. Promoting breastfeeding is considered to be more important and neoliberal philosophy places responsibility squarely on the mother.
The results, not surprisingly, are deadly. Interventions Intended to Support Breastfeeding Updated Assessment of Benefits and Harms and in Unintended Consequences of Current Breastfeeding Initiatives, both published in JAMA in October 2016, attest to the growing number of preventable injuries and deaths that occur because babies, instead of being in the well baby nursery, are being smothered in and falling from their mothers hospital beds.
Moreover, the insistence of immediately placing full responsibility for childcare on postpartum mothers is in direct contradiction to everything we know about postpartum practices in other societies.
According to Traditional postpartum practices and rituals: a qualitative systematic review:
Organized support, usually in the form of family members caring for the new mother and her infant for a specified period of time, is almost universally provided in the early postpartum period by the mother, mother-in-law, other female relatives or husband. Respected elder female community members, traditional birth attendants or young women from the community may also be involved in providing care for the mother. The support often includes practical assistance (e.g., household chores or cooking), as well as information for the mother regarding how to care for herself and the infant…
Organized support typically corresponds to a prescribed period of rest, during which the mother is prohibited from performing her usual household chores. In most cultures, the rest period spans between 21 days and 5 weeks, and is considered a period of vulnerability for future illness.
In other words, a defining feature of postpartum care in nearly all other cultures is that mothers are NOT expected to exclusively care for their infants and are assumed to need assistance for WEEKS. New mothers can rest when and as often as they need to because others are there are always others available to care for the baby. In a very real sense, we’ve missed the critical difference between our ancient foremothers and contemporary mothers; the difference is not technology, it is support.
It’s very similar to the bizarre BFHI policy banning formula supplementation. As I’ve written previously, the practice of prelacteal feeding spans time and culture. Odds are high that it reflects the fact that 5-15% of women (or more) have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration. With pre-lacteal feeds, babies lived who would otherwise have died. We’ve ignored those insights about supplementation, ascribing them to ignorance, in favor of our preferred belief that women in indigenous cultures breastfeed early and exclusively. Once again we’ve missed the critical difference between our indigenous foremothers and ourselves. Early supplementation of breastfeeding itself is not harmful; it only looks harmful when the only available prelacteal feeds are contaminated with bacteria.
In a very real sense, the BFHI is cargo cult science.
Physicist Richard Feynman coined the expression in his 1974 commencement address at CalTech.
…In the South Seas there is a cargo cult of people. During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now. So they’ve arranged to imitate things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas –he’s the controller– and they wait for the airplanes to land… So I call these things cargo cult science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.
Lactivists know that our ancient foremothers breastfed exclusively. They want the same thing to happen now. So they’ve arranged to imitate the lack of technology and they wait for women to breastfeeding exclusively. It’s cargo cult science because they follow what they think are the precepts and forms of ancient breastfeeding support, but they are missing the most essential insight since the BFHI doesn’t appear to increase breastfeeding rates.
The most essential insight is that supporting breastfeeding does not require banning technology; it requires providing care. In closing well baby nurseries, lactivists imagine they are copying nature but they’re doing the exact opposite!
Lactivists don’t understand this because they are prisoners of neoliberal philosophy that places all responsibility for outcomes on mothers and accuses them of moral laxity for failing to comply with breastfeeding injunctions.
If lactivists really want to increase breastfeeding rates they’d stop trying to recapitulate the absence of technology in nature and concentrate on recapitulating the different philosophy in nature: it takes a village offering a tremendous amount of support to raise a child. Instead of closing well baby nurseries, they’d be demanding that they stay open.
