Category Archives: parenting

Barriers to Breastfeeding: Disappointing but Not Surprising

Debbie says:

I was born in 1951. My mother wanted to breastfeed me, but breastfeeding was completely out of fashion among affluent white people. Her doctor said, “Well, go ahead, I guess, but I can’t help you. I don’t know anything about it.” So when she ran into issues, she asked the the Black women at the bus stop, waiting to go home from their jobs as cleaning ladies and maids in the Jewish neighborhood of Baltimore where I was born. They apparently thought she was kind of dumb, but were very helpful. (I never asked her why she didn’t ask her mother …)

Breastfeeding_paolopatruno9Photo by Paolo Patruno.

Things change. Now breastfeeding is what affluent White mothers do, and harder for working, unemployed, or impoverished Black mothers. And bearing in mind that not every mother can breastfeed, and not every  mother wants to breastfeed, there’s no doubt that parents and babies are well served by having breastfeeding as an option.

According to the United States Breastfeeding Committee, one of the leading experts
on the current state of breastfeeding in the U.S., breastfeeding is the “most effective
global public health intervention for child survival.” Breast milk provides critical
nutrients to babies when they need them the most, supporting a variety of early
developments in the body, including brain development. It also transfers necessary
antibodies from mother to child that protect against disease, and wards off other early
childhood dangers such as SIDS and asthma.
The Center for Social Inclusion has released a long, detailed report in .pdf form, detailing the issues that contribute to making breastfeeding challenging. Two things make this report especially important: first, the focus on structural racism:
Often, when we think about racism, we focus on individual attitudes or behaviors,
which is important. Sometimes, we look at how particular institutions treat people of
different races differently, which is also important. But to truly understand the root
causes of racial inequity and thereby produce solutions that work for everyone, we
need to take a structural race approach. That means looking at the First Food system
through the lens of policies, institutions, and people—together.
and second, the storytelling style, focusing on three fictional mothers:
Sarah is White and lives in a suburb of Detroit. Her husband is a doctor at the nearby
hospital, and she volunteers full-time for a local nonprofit. Nicole is Black and lives in a
small town in Alabama. She is a teacher at the middle school and her husband is earning
his MSW through online classes at the University of Alabama. Lara is Latina and lives in
Los Angeles with her husband and mother. She and her husband both work for (and met
through) the city’s transit agency; her mother runs the home and receives Social Security.
The report follows all three women through their breastfeeding journey, interlacing their stories with statistics and information about breastfeeding in their various communities. The information is detailed, clear, and excellent, and the conclusions are convincing.
At each stage, smart policy interventions with robust implementation can make it easier
for all women to choose to breastfeed if they want to.
We seek policy interventions that truly address the root causes that are linked to
breastfeeding outcomes, especially lower rates for women of color. We know that
no single policy alone can dismantle structural inequity. This takes reform, including
diversification of the medical sector and those providing services, as well as changes to
and better implementation and promotion of existing policies like the ACA breastfeeding
provisions. But it also takes transformation, including directing funding streams to
challenge all barriers at the neighborhood level. We therefore need a variety of policy
and practice interventions that support women and communities of color to truly achieve
higher breastfeeding rates for all mothers.
The report goes on to detail these interventions; read the whole thing.
Why is breastfeeding a body image issue? For me, it’s because breasts have been fetishized, banned, turned into objects of the male gaze, commodified, judged, and generally objectified, often at the expense of remembering their biological function. So it’s important to me to remember what breasts do and more important that anyone who wants to be able to provide food for their babies from their breasts should be supported in doing so.

Choosing Midwives: Science Is Not Exclusively Male

Laurie and Debbie say:

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One of the many ways male hierarchies keep women’s skills at bay is by associating myths with women, and facts with men, magic with women and science with men. In this context, Therese Oneill detailed and informative essay at Jezebel on the tension between doctors/men and midwives/women tension helps reveal the persistent and culturally accepted myth which associates men, science, doctors and hospital births with cleanliness, safety, and infant survival.

There was nothing wrong in wanting those who attended birthing to be clean, educated and accountable, but the doctors were going for self-interested gatekeeping. Requiring official licensing was the first step in shoving women out of the field all together. You couldn’t get licensed from just an apprenticeship, which was the norm for midwifery. Official training and state licensure cost money, an expense passed on to clients. It undermined the centuries-old purpose of the midwife as an affordable option to assist births. Instead, went the parallel argument, physicians wanted the poor to give birth in charity hospitals—where tired, apathetic attendants and untold diseases and infections awaited them. …

[The 1906 study of 500 interviewed New York midwives, described in Oneill’s article] included only one, one, “West Indian Negress.” It seems unlikely that an urban population the size of New York had so few black mothers as to warrant only one midwife. It is possible that white midwives served black mothers, but highly unlikely in an era and place where ethnocentricity was king. It is more likely that black society, North and South, experienced far less interference from campaigns intended to improve society.

Women could, of course, go to medical school to become fully licensed obstetricians. But the number was minuscule clear into the 1980s. According to the Journal of the American Osteopathic Association, in the 1970s, only 9 percent of enrolled medical students in any field were women.

[Side note: Lots of factors kept women out of medical school. Debbie’s mother was admitted into medical school in the 1930s, defying quotas on both women and Jews. But her parents, who could easily afford it, refused to pay for it, reserving the money “to educate their two sons,” one of whom never went past high school. ]

But that changed, and it changed fast. According to The US National Library of Medicine, female residency in Obstetrics and Gynecology quadrupled from 1978 to the present. Women now account for 71.8 percent of OB/GYN residents….

It’s not just that there are more female obstetricians, either. Midwifery, far more sanitary and scientific than its ancient ancestor, is booming again after a near 200-year lag. The difference between the two is most salient in terms of their technical training: obstetricians have gone through medical school, are able to perform C-sections, suturing, circumcision, and are skilled in handling high-risk pregnancies. Midwives come in different flavors, but the majority are medically trained and licensed in all things related to normal pregnancy and birth.

None of this is new information to people who follow this kind of history. The persistent, deep belief that doctors are better than midwives is not just about pregnancy  and birth (so much of history is about men trying to figure out how they can own children!), but about how Western science was created and defended as a male domain. Science was developed (mostly) by men, promulgated (mostly) by men, and made available (almost exclusively) to men. Thus science became male, despite the fact that there are no “insert penis here” slots in any scientific test or accomplishment we’ve ever heard of.

In the last few decades, the presence of women in the sciences has shifted substantially (though we may be losing ground). In the same period,  the perception of science as male has shifted less.

If men “own” science, then whatever women do, by definition, isn’t science. That’s how you get to Teresa Oneill’s husband’s reaction:

“Yes! A midwife!” … “Because I was thinking to myself, ‘Who are we going to get to wave burning sage over your stomach and chant to Gaia while the baby dies?’ CLAP IF YOU BELIEVE!!”

While it seems very likely that some significant percentage of early midwives worked in filthy conditions, as Oneill points out, hospitals were filthy then also. Yet, the discussion implies men=science=clean and women=ignorance/magic=dirty.  We’d bet the rent that a good history of midwifery would point out many instances where midwives figured out sanitation and disinfection issues on their own, through experience and observation.

The association of women solely with magic and myth is one way that male culture uses its own myths to denigrate and trivialize those who work outside it. Let’s hope that this one remains dead for two centuries and more, while midwives continue to use science and intuition, caring and disinfectant to combat the risks of pregnancy and birth.