By Sayantani DasGupta

I could hardly believe it when I saw the headlines:

“The pressure to breastfeed is getting out of hand”! and “Sorry – You can’t guilt trip me about bottle feeding my kids”!

It’s not that I’m surprised by anti-breastfeeding attitudes in the U.S. After all, this is a country where, women are still prohibited from breastfeeding in public in many places, where the broader culture fetishizes women’s breasts, and a lack of family leave and on-site daycare make breastfeeding, even when initiated, very difficult to continue.

What shocked me was that the anti-breastfeeding articles appeared on Jezebel.com, a site which I had previously considered feminist or at least woman friendly. I, like this blogger, had to ask myself: Why does a supposedly feminist site keep posting anti-breastfeeding articles, articles which only, like that recent infamous Time Magazine cover about prolonged breastfeeding, fan the flames of the so-called “mommy wars”?

These Jezebel articles are similar to many op-eds, FB posts and personal essays I’ve read recently that equate breastfeeding friendly initiatives like Mayor Bloomberg’s new “Latch On NYC” program with “breast feeding bullying.” Many of these articles are by mothers, who actually tried to breastfeed but found – for a variety of reasons – that they couldn’t.  And, understandably, they don’t want to be made to feel guilty for their parenting choices.

Parenting in general, and breastfeeding particularly, are touchy subjects, I get that. No one wants to think that they did less than “best” for their child – and that’s exactly what “breast is best” type campaigns seem to communicate to some women. Yet, to me, this trend in personal essays/articles is part of a larger phenomenon, a perspective that tends to focus blindly on the issue of free will and “choice” (ie. this essay which urges “Breastfeeding is a choice, let’s treat it as such”) – approaching issues like breastfeeding from an individualistic perspective rather than a systemic one.

These incessant articles about “breastfeeding bullying” are creating a dangerous problem (that might not actually be there), and feeding into the destructive notion of “mommy wars.”  “Bullying” implies power. Yet, despite the American Academy of Pediatrics’ recommendations to breastfeed until 12 months, per the CDC, less than 50% of babies in the U.S. are breastfeed through 6 months and more like 25% are breastfed through 12 months. The long and the short of it is, unlike almost every other Western country, many more babies in the U.S. are formula fed in the first 12 months of life than not. So where does the “bullying” coming in?

So let’s talk Baby Friendly Hospitals, which seem to be the target of a lot of this recent anger. Bloomberg’s policy suggests that all of New York City’s many hospitals (where I had my two children as well!) voluntarily become Baby Friendly institutions. What does that mean? Well, among other points (see my previous post here on Adios for a full list), Baby Friendly Hospitals help mothers initiate breastfeeding within one hour of birth, give newborn infants no food or drink other than breastmilk unless medically indicated, practice “rooming in” – allowing mothers and infants to remain together for 24 hours, and encourage breastfeeding on demand.

And this isn’t something that Bloomberg made up, people. It’s a global public health issue. Despite being recommended by Michelle Obama’s “Let’s Move Campaign,” the Centers for Disease Control, the World Health Organization, the American Academy of Pediatrics and others, as of May 2012, the United States has only 143 baby friendly hospitals, or less than 3%. Compare this to approximately 100% of hospitals in countries such as Sweden, Mongolia, Eritrea, and Namibia (and increasing numbers in many other countries) and it’s pretty embarrassing.

But the critical issue here is that Baby Friendly Hospitals are a systemic way that breastfeeding initiation can be enhanced. People complaining about “breastfeeding bullies” keep talking about the issue of choice. Yet, the ways that most maternity wards operate in the U.S. actually reduce all women’s choices across the board – whether you ultimately choose to breastfeed for any amount of time or not.

The truth of the matter is, issues such as insufficient milk production, a failure to latch on properly, and resultant problems such as infant weight loss are often tied to immediate post-birth practices — practices that are determined by the policies of the particular maternity ward. These are systemic failures, NOT the so-called “failure” of individual women.

For instance, critical to latching on in babies and milk let down in mothers is immediate post-delivery skin to skin contact, rather than the minutes and up to hours of post-birth weighing, measuring, examining and washing that occurs in most U.S. maternity wards. Similarly beneficial is babies sleeping in the same room as mothers.  (See this hysterical “skin to skin” breastfeeding rap song for a rundown of these issues.) Yet, this is not the policy of most U.S. maternity wards. Why? Because it’s easier for staff to have all newborns housed in a central location, weighed and examined and cared for assembly-line style. These are staff-centered policies, not mother- or baby- centered ones. (Believe me, I know. As a pediatrician in training I often, wrongheadedly, resented having to go into mothers’ rooms to examine babies – which took a heck of a lot longer and required I actually – gasp – TALK to parents!)

And what about the free bags of “swag” that formula companies give to new mothers? Well, like any kind of product placement, the point is to influence parents to buy not only formula for their babies, but a specific brand of formula. Isn’t that prohibitive of “choice”? Consider that many medical centers prevent pharmaceutical companies from giving their doctors “swag” – from expensive dinners and trips to inexpensive pads of paper and pens, pharmaceutical company gifts are found to inappropriately influence doctors’ decision making. Such “swag” is designed to eliminate, or at least deeply impact, “choice” – and the same principle applies to maternity ward goodies including free formula, logo-embossed bibs, diaper bags and the like.

And forget about the fact that most hospitals have insufficient or undertrained staff to help new mothers breastfeed during those critical post birth hours. Too often, breastfeeding becomes an individual mother’s problem to figure out, rather than a goal for the health care team.

So, sure, breastfeeding is a choice. It’s a choice supported by research and medical recommendations, a choice with profound individual and public health consequences. And more importantly, it’s a choice many more women could make if systems in this country supported breastfeeding.

Now, does this mean if you bottle-fed your child you are a terrible mother, that your child is doomed? Or if you breastfed your child you are the best mother in the world, with a near perfect baby? Of course not. But that’s not the level of conversation we should be having anyway

Let’s not talk about choices that women make without examining the systemic limitations to those choices. The conversation isn’t about “bad mothers” and “good mothers”– it’s about “bad systems” and “good systems.” And please, please, let’s retire notions such as “breastfeeding bullying” – ideas which only increase divisions between women, and keep us from seeing the real broad scale issues of oppression that affect us all.

Ultimately, maybe those of us who already have babies beyond the breastfeeding/bottle feeding stages should stop justifying what our individual choices were and rather, talk about how to free up the choices of the mothers (and families) who come after us. After all, aren’t those the sorts of conversations pro-woman communities (I’m looking at you, Jezebel) are supposed to have anyway?

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