The Conflict (5 page)
Authors: Elisabeth Badinter
As far as the LLL is concerned, all mothers should be able to breast-feed. There are no naturally insurmountable difficulties, physical or psychological. There is no such thing as maternal ambivalence and women who balk at submitting are simply reckless or bad. Although the LLL has toned down its mission in certain countries, like France, to make it more palatable, the credo has nonetheless gained ground over the last twenty years, thanks to some unexpected supporters.
A Far-Reaching Political Strategy
Since its creation, the La Leche League has been adept at forming alliances with other movements that do not necessarily share all its claims. It has even succeeded in passing itself off as a progressive force. These alliances have extended the league's influence far beyond the traditional suburban women who were its original followers and has allowed it to give the impression that its message is universal and applies to all women.
In the 1960s, the league joined forces with the counterculture movement advocating a return to nature. According to historian Lynn Y. Weiner, “League founders believed that the âhippie movement' aided in the popularization of the league ⦠because their rebellion against the establishment included the medical establishment.”
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But tensions emerged in the 1970s when militants asked the league to take a stand on sensitive questions like family planning, ecological politics, and abortion. The league stubbornly refused, arguing that its message of good motherhood through breast-feeding should not be diluted with other causes, which would cause it to lose followers.
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But tensions emerged in the 1970s when militants asked the league to take a stand on sensitive questions like family planning, ecological politics, and abortion. The league stubbornly refused, arguing that its message of good motherhood through breast-feeding should not be diluted with other causes, which would cause it to lose followers.
A more profitable alliance was formed with those parts of the medical community that supported new birthing techniques and the theory of bonding and rejected the medicalization of motherhood. In 1968, the
Journal of Paediatrics
published “A Salute to the Leche League International,”
wishing it well. In 1974, the American Medical Association accredited the league to provide continuing medical education, and T. Berry Brazelton, the baby guru, was one of its closest allies. In 1997, it received the supreme sanction: the American Academy of Pediatrics recommended breast-feeding for at least the first twelve months of a baby's life. The league had won the support of the full American medical fraternity.
Journal of Paediatrics
published “A Salute to the Leche League International,”
wishing it well. In 1974, the American Medical Association accredited the league to provide continuing medical education, and T. Berry Brazelton, the baby guru, was one of its closest allies. In 1997, it received the supreme sanction: the American Academy of Pediatrics recommended breast-feeding for at least the first twelve months of a baby's life. The league had won the support of the full American medical fraternity.
Finally, by presenting themselves from the outset as feminists, militantly fighting for women's right to control their bodies, the LLL made common cause with the new movement of maternalist feminists. Both groups opposed intrusive medical intervention in maternity wards, and both advocated natural childbirth and breast-feeding. Even though there were disagreements, particularly over abortion and working mothers, the two groups shared a core vision of women as being “by nature” more in tune with the needs of others, more social and peaceable than men. In their view, maternalism was a liberating form of humanism. On basic questions, then, the league identified closely with the feminist ethics of care.
In addition to its policy of forming alliances, the league managed to adapt its views without losing sight of its first principles. By advising the use of breast pumps, it maintained a connection to the increasing number of women working outside the home. Through flexibility and compromise, an organization that looked like a sect in its early days succeeded in turning itself into a powerful network of national significance.
An ideology convinced of its contribution to the good of mankind does not stop at its own borders. The league set up branches in Quebec in 1960, France in 1973, and Switzerland in 1981. Today it has a presence in almost sixty countries. Princess Grace of Monaco was one of the first public figures to support the league and promote it across Europe in the early 1970s. Having identified the causes of decline in breast-feeding (lack of information and support for mothers; opposition by hospitals and health professionals; and aggressive marketing of milk substitutes, bottles, and pacifiers), league branches in different countries formed a common plan of attack.
The first enemy to tackle was the formula industry, which had expanded its won market share throughout the 1960s and 1970s. The league scored a decisive victory when the disastrous effects of using formula in poor countries were exposed. Unsafe water, poor hygiene, and high temperatures turned formula into a killer potion.
35
When the World Health Organization and UNICEF investigated the problem, the league gained unexpected support. As early as October 1979, the league sent representatives to Geneva for a joint colloquium of the WHO and UNICEF, which concluded that breast-feeding was a vital activity. Two years later, the league secured the status of consultant to UNICEF and worked to make breast-feeding a global health issue.
35
When the World Health Organization and UNICEF investigated the problem, the league gained unexpected support. As early as October 1979, the league sent representatives to Geneva for a joint colloquium of the WHO and UNICEF, which concluded that breast-feeding was a vital activity. Two years later, the league secured the status of consultant to UNICEF and worked to make breast-feeding a global health issue.
What is noteworthy is how the recommendation to mothers in developing countries to breast-feed was extended to the rest of the world, and how it became increasingly dictatorial
and restrictive. In line with the goals of the league and its medical supporters, major international organizations began to highlight the damaging effects of formula in industrialized countries. Unquestioningly accepting the claims of inferior health in bottle-fed children, advocates failed to differentiate between the general health of a baby born in the Sudan and one born in Paris. Down with formula!
and restrictive. In line with the goals of the league and its medical supporters, major international organizations began to highlight the damaging effects of formula in industrialized countries. Unquestioningly accepting the claims of inferior health in bottle-fed children, advocates failed to differentiate between the general health of a baby born in the Sudan and one born in Paris. Down with formula!
In 1981, 118 member states of the WHO passed a resolution to restrict the marketing of breast-milk substitutes. It was recommended that advertising and the distribution of free samples be banned, and that any information about formula feeding mention that breast-feeding was better for the baby and include warnings about the risks and costs of using formula.
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As Dr. Viviane Antony-Nebout pointed out: “Having been a subject of interest to doctors and industrial corporations, baby food moved into the realm of diplomats and UN committees.” The worldwide goal stipulated exclusive breast-feeding for the first six months (no additional water, fruit juice or herbal infusions) and supplemented breast-feeding until at least the age of two.
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As Dr. Viviane Antony-Nebout pointed out: “Having been a subject of interest to doctors and industrial corporations, baby food moved into the realm of diplomats and UN committees.” The worldwide goal stipulated exclusive breast-feeding for the first six months (no additional water, fruit juice or herbal infusions) and supplemented breast-feeding until at least the age of two.
37
Faced with the inertia of some countries, such as France, international organizations called for more robust action. They turned to the United Nations Convention on the Rights of the Child (adopted on November 20, 1989), particularly Article 24,
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and asked each government to establish legislative, judicial, and administrative measures to support breast-feeding. On August 1, 1990, thirty governments, along
with the WHO, UNICEF, and various non-government organizations, signed the Innocenti Declaration, which reaffirmed the WHO's ideal length of time to breast-feed. Among the proposals to achieve this ideal was the appointment in each country of a national breast-feeding coordinator and committee; a directive that all maternity wards follow the WHO/UNICEF's recommendations
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for successful breast-feeding; implementation of the international code for the marketing of breast-milk substitutes; and protection of working mothers' rights to breast-feed their children.
38
and asked each government to establish legislative, judicial, and administrative measures to support breast-feeding. On August 1, 1990, thirty governments, along
with the WHO, UNICEF, and various non-government organizations, signed the Innocenti Declaration, which reaffirmed the WHO's ideal length of time to breast-feed. Among the proposals to achieve this ideal was the appointment in each country of a national breast-feeding coordinator and committee; a directive that all maternity wards follow the WHO/UNICEF's recommendations
39
for successful breast-feeding; implementation of the international code for the marketing of breast-milk substitutes; and protection of working mothers' rights to breast-feed their children.
A year later,
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the WHO and UNICEF launched the Baby-Friendly Hospital Initiative: hospitals and maternity wards that instituted specific Innocenti recommendations would receive an internationally recognized “Baby Friendly” designation. Since then, global organizations and associations have put continuous pressure on governments to implement the WHO/UNICEF directives. For its part, the EU twice (in 2004 and 2008) set up programs to promote and facilitate breast-feeding both politically and financially. The aim was to inform the public about breast-feeding and train health professionals to encourage mothers in the practice, and also to assess and monitor the nursing success rate.
40
the WHO and UNICEF launched the Baby-Friendly Hospital Initiative: hospitals and maternity wards that instituted specific Innocenti recommendations would receive an internationally recognized “Baby Friendly” designation. Since then, global organizations and associations have put continuous pressure on governments to implement the WHO/UNICEF directives. For its part, the EU twice (in 2004 and 2008) set up programs to promote and facilitate breast-feeding both politically and financially. The aim was to inform the public about breast-feeding and train health professionals to encourage mothers in the practice, and also to assess and monitor the nursing success rate.
There is no denying that the La Leche League has won the ideological battle.
41
With the support of major international organizations, the league succeeded in convincing politicians and institutions of the superior benefits of breast-feeding. But for all that, have mothers themselves been convinced to
breast-feed exclusively for six months and then continue with supplemented breast-feeding until the child is two?
41
With the support of major international organizations, the league succeeded in convincing politicians and institutions of the superior benefits of breast-feeding. But for all that, have mothers themselves been convinced to
breast-feed exclusively for six months and then continue with supplemented breast-feeding until the child is two?
Overall, Western countries have seen breast-feeding rates rise since the 1970s. Today the majority of womenâvirtually all women in some countriesâbreast-feed during their time in the maternity ward. Under close surveillance from nurses (or family), it is almost impossible not to. On the other hand, once mothers return home, the period of continued breast-feeding varies a great deal from one country to another and depends on the mother's sociocultural circumstances.
Spectacular Results
In North America, breast-feeding has made significant gains, but these are still deemed inadequate by pro-breast-feeding associations. In the United States, only 26 percent of mothers spent any time breast-feeding in the 1970s. In 1982, the figure had risen to 62 percent and in 2011 to 75 percent. Only fourteen states, however, reached the federal government's target of 60.6 percent of mothers still breast-feeding at six months, while the national average stood at 44 percent.
In fifteen states, 25 percent of women breast-fed for twelve months, compared to 22.4 percent nationally.
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In Quebec the increase is on a similar scale. At the beginning of the 1970s, only 5 percent of Quebec women breast-fed for six months.
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By 2010, 84 percent of women began breast-feeding while in the maternity ward, and 22 percent still exclusively breast-fed at six months. In 2001, a survey by the Australian Bureau of Statistics showed that 87 percent of Australian children aged 0â3 years had been breast-fed at some point. By the age of six months, the percentage of infants being breast-fed stood at 48 percent; this dropped off to 23 percent for children around one year of age.
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By 2010, 84 percent of women began breast-feeding while in the maternity ward, and 22 percent still exclusively breast-fed at six months. In 2001, a survey by the Australian Bureau of Statistics showed that 87 percent of Australian children aged 0â3 years had been breast-fed at some point. By the age of six months, the percentage of infants being breast-fed stood at 48 percent; this dropped off to 23 percent for children around one year of age.
44
In Europe the statistics vary considerably from one country to another. In 2002, Scandinavians were at the top of the class, while the failures were the French, as the following tables show.
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45
BREAST-FEEDING INITIATED AT BIRTH OR BEFORE LEAVING MATERNITY UNIT
BREAST-FEEDING RATE AT 3 OR 4 MONTHS
BREAST-FEEDING RATE AT 6 MONTHS
BREAST-FEEDING RATE AT 12 MONTHS (BREAST-FED ONLY)
In Sweden and Norway, the breast-feeding rate has shown a spectacular U curve since the 1950s.
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The trough was in the years 1972â1973, when just 30 percent of Swedish women breast-fed at two months and 6 percent at six months, while in Norway, only 5 percent still breast-fed at six months. Since 1993â1994, the rate has risen continuously.
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In 2010, 99 percent of babies in Norway were breast-fed when they left the maternity ward; for Swedish babies, the figure was 98 percent, and the Finnish statistics are similar.
48
Babies in Scandinavian countries are also breast-fed the longest. Only the Austrians (93 percent)
49
bear comparison, although the rates for Spain, Poland, Romania, and the Czech Republic are all above 90 percent.
50
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The trough was in the years 1972â1973, when just 30 percent of Swedish women breast-fed at two months and 6 percent at six months, while in Norway, only 5 percent still breast-fed at six months. Since 1993â1994, the rate has risen continuously.
47
In 2010, 99 percent of babies in Norway were breast-fed when they left the maternity ward; for Swedish babies, the figure was 98 percent, and the Finnish statistics are similar.
48
Babies in Scandinavian countries are also breast-fed the longest. Only the Austrians (93 percent)
49
bear comparison, although the rates for Spain, Poland, Romania, and the Czech Republic are all above 90 percent.
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To explain this quasi unanimity in Scandinavian countries, the International Pediatric Association
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cites a combination of factors: very active pro-breast-feeding organizations supported by political cooperation at the highest level. “Rather than representing breast-feeding as a duty for women, it is by claiming it as a right that mothers have reestablished how natural breast-feeding is ⦠. This right is associated with another, the right to benefit from adequate maternity leave and a re-adaptation to the world of work.”
52
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cites a combination of factors: very active pro-breast-feeding organizations supported by political cooperation at the highest level. “Rather than representing breast-feeding as a duty for women, it is by claiming it as a right that mothers have reestablished how natural breast-feeding is ⦠. This right is associated with another, the right to benefit from adequate maternity leave and a re-adaptation to the world of work.”
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Anyone can appreciate the significance of the positive shift from a “duty” to a “right.”
But a doubt remains: What does this unanimity mean within a democracy? If breast-feeding is a right, then is not
breast-feeding also a right? Are Norwegian and Swedish women able to exercise their freedom of choice and refuse to conform to this moral and social norm? The notion of 100 percent of women wanting to breast-feed is as troubling as 100 percent of women not wanting to do so.
breast-feeding also a right? Are Norwegian and Swedish women able to exercise their freedom of choice and refuse to conform to this moral and social norm? The notion of 100 percent of women wanting to breast-feed is as troubling as 100 percent of women not wanting to do so.
Bad Mothers
Ireland and France are at the bottom of the class, the shame of breast-feeding Europe. In 1999, only Irish women seemed to perform worse than the French: 45 percent
53
against 60 percent breast-fed at birth. However, as Ireland rarely provides statistics, French women are the ones who usually bear the brunt of failure. And yet French organizations advocating breast-feeding are far from inactive, and support from the press increases with each passing year. The French La Leche League, set up in 1973, now has close to 200 local branches.
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It publishes two quarterly reviews
55
and, in addition to Co-Naître, which promotes natural childbirth and breast-feeding, contributes to training health professionals. Its militant stance has borne fruit, judging by the growth curve in breast-feeding rates at birth: 40.5 percent in 1995, 55.4 percent in 2003, and 60.2 percent in 2010.
56
53
against 60 percent breast-fed at birth. However, as Ireland rarely provides statistics, French women are the ones who usually bear the brunt of failure. And yet French organizations advocating breast-feeding are far from inactive, and support from the press increases with each passing year. The French La Leche League, set up in 1973, now has close to 200 local branches.
54
It publishes two quarterly reviews
55
and, in addition to Co-Naître, which promotes natural childbirth and breast-feeding, contributes to training health professionals. Its militant stance has borne fruit, judging by the growth curve in breast-feeding rates at birth: 40.5 percent in 1995, 55.4 percent in 2003, and 60.2 percent in 2010.
56
Granted, French women who choose to breast-feed are still fewer than other European countries, but the figures are rising. The real blot on their record is that French women still breast-feed for a hopelessly short time. Only 42 percent
of babies are breast-fed after eight weeks (compared to 86 percent at three months in Norway).
57
To put it bluntly, French mothers balk at playing the role expected of them, and successive governments over the last thirty years have dragged their feet in bringing the country into line with the WHO requirements conveyed by European guidelines. It took more than seventeen years
58
for France to implement the international code for marketing breast-milk substitutes. And unlike Great Britain, it did not sign the 1990 Innocenti Declaration.
of babies are breast-fed after eight weeks (compared to 86 percent at three months in Norway).
57
To put it bluntly, French mothers balk at playing the role expected of them, and successive governments over the last thirty years have dragged their feet in bringing the country into line with the WHO requirements conveyed by European guidelines. It took more than seventeen years
58
for France to implement the international code for marketing breast-milk substitutes. And unlike Great Britain, it did not sign the 1990 Innocenti Declaration.
Weary of this political inertia, associations that offer breast-feeding support and information came together in 2000 to form a new organization, COFAM,
59
the French Committee for Breast-feeding Mothers, to fill the role of national coordinator. COFAM organizes the annual World Breast-feeding Day, facilitates dialogue between professionals and associations, and circulates a great many brochures. It oversees the Baby-Friendly Hospital Initiative and has obtained support from the Ministry of Health. In 2001, the member associations succeeded in including breast-feeding as one of nine objectives of France's first National Nutrition and Health Policy. In the second policy, launched in 2006, the objective was to increase exclusive breast-feeding at birth from 56 percent to 70 percent.
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the French Committee for Breast-feeding Mothers, to fill the role of national coordinator. COFAM organizes the annual World Breast-feeding Day, facilitates dialogue between professionals and associations, and circulates a great many brochures. It oversees the Baby-Friendly Hospital Initiative and has obtained support from the Ministry of Health. In 2001, the member associations succeeded in including breast-feeding as one of nine objectives of France's first National Nutrition and Health Policy. In the second policy, launched in 2006, the objective was to increase exclusive breast-feeding at birth from 56 percent to 70 percent.
The battle is still not over, however. According to Antony-Nebout, “There is a general lack of determination to allocate sufficient funds to initiatives that favor breast-feeding
mothers, and in particular to the Baby-Friendly Hospital Initiative.”
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Although there were 20,000 Baby-Friendly Hospitals globally in 2007, with 650 in Europe, France at that time was lagging in last place, with only five
61
as shown by the table below drawn up from 2007 UNICEF figures.
62
Even Ireland was doing better.
mothers, and in particular to the Baby-Friendly Hospital Initiative.”
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Although there were 20,000 Baby-Friendly Hospitals globally in 2007, with 650 in Europe, France at that time was lagging in last place, with only five
61
as shown by the table below drawn up from 2007 UNICEF figures.
62
Even Ireland was doing better.
Â
The indifference at the government level is a clear reflection of the indifference of French society in general and, more particularly, of French women. Until relatively recently, breast-feeding was presented as a choice, a right, and a pleasure. But in the absence of satisfactory results, breast-feeding promoters have stepped up efforts to make women feel guilty. Now the rhetoric tends to be more vigorous. There is less talk of a right and more of a duty. The National Academy of Medicine is now fiercely in favor of feeding newborns at the breast.
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The message is clear: a good mother breast-feeds. Significantly, this good mother shares a sociocultural profile with women in other developed countries: she is over thirty, is a high-earning professional, does not smoke, takes prenatal classes, and benefits from long maternity leave.
65
63
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The message is clear: a good mother breast-feeds. Significantly, this good mother shares a sociocultural profile with women in other developed countries: she is over thirty, is a high-earning professional, does not smoke, takes prenatal classes, and benefits from long maternity leave.
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Unspoken Resistance
There are many women who resist the breast-feeding trend, but they go unheard or underground. In developed countries, only a rare few would risk challenging the need to breast-feed, and it takes a lot of nerve for a newly delivered mother to defy instructions from nurses and doctors. Rare too are the medical experts who make a clear distinction between the proven benefits of breast-feeding and the many other claims suggested by various studies but subsequently disproved.
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A 2005 report by the French Society of Pediatrics emphasized: “On condition that it is exclusive and lasts more than three months, breast-feeding reduces the incidence and gravity of digestive, ENT, and respiratory infections. This is the primary benefit of breast-feeding and is responsible for a reduction in morbidity and mortality in breast-fed babies, including those in industrialized countries.”
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A 2005 report by the French Society of Pediatrics emphasized: “On condition that it is exclusive and lasts more than three months, breast-feeding reduces the incidence and gravity of digestive, ENT, and respiratory infections. This is the primary benefit of breast-feeding and is responsible for a reduction in morbidity and mortality in breast-fed babies, including those in industrialized countries.”
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However, these broad claims for the benefits of breast-feeding were challenged in an article published in the October 2007 issue of the
British Medical Journal
. In a sweeping study of 17,046 Belorussian infants carried out over six years, Michael Kramer of Canada's McGill University concluded that breast-feeding does not offer greater protection against asthma or allergies, contrary to what we have been repeatedly told.
British Medical Journal
. In a sweeping study of 17,046 Belorussian infants carried out over six years, Michael Kramer of Canada's McGill University concluded that breast-feeding does not offer greater protection against asthma or allergies, contrary to what we have been repeatedly told.
The French Society of Pediatrics had gone one step further, linking breast-feeding to cognitive development. A year earlier, UK statistician Geoff Der
68
published a much-discussed study on the subject, along with the IQs of more than five thousand children and their three thousand mothers, and concluded that there was absolutely no link between the two. By observing families in which one child
had been breast-fed and the other not (particularly in the case of twins), he confirmed that the key factor contributing to the child's IQ was the mother's IQ, and that breast-feeding had no influence.
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These striking results have done nothing to stop breast-feeding activists from allowing us to believe the contrary.
70
68
published a much-discussed study on the subject, along with the IQs of more than five thousand children and their three thousand mothers, and concluded that there was absolutely no link between the two. By observing families in which one child
had been breast-fed and the other not (particularly in the case of twins), he confirmed that the key factor contributing to the child's IQ was the mother's IQ, and that breast-feeding had no influence.
69
These striking results have done nothing to stop breast-feeding activists from allowing us to believe the contrary.
70
Linda Blum, an American sociologist, is one of the few who dared to suggest that the advantages of breast-feeding in developed countries had been exaggerated; that a good many alleged benefits were far from established and required further research; and that formula was constantly being improved to reproduce the advantages of breast milk.
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These iconoclastic words drew little attention in the media. At present, bottle-feeding is viewed as a necessary evil and is synonymous with a selfish mother.
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These iconoclastic words drew little attention in the media. At present, bottle-feeding is viewed as a necessary evil and is synonymous with a selfish mother.
It is hard to know what women really think about breast-feeding when they keep their feelings of ambivalence to themselves. In France, it seems possible to identify three categories of mothers. For some, breast-feeding is self-evident and an incomparably fulfilling and happy experience. They tend to find breast-feeding easy and succeed at it almost instantly. They breast-feed for more than two months and, if they return to work, use breast pumps. Although some would have us believe that all mothers, with the right advice, can achieve the same results, the women in this category are a minority.
At the other end of the spectrum are the 40 percent of
French mothers who refuse even to try breast-feeding. They are not tempted by the image of a nursing mother, nor by the prospect of caring for their baby one-on-one, round the clock. But given how hard it is to withstand being called monstrously selfish, it is likely that, as the pressure mounts, more women will try to breast-feed, at least while they are in the hospital.
French mothers who refuse even to try breast-feeding. They are not tempted by the image of a nursing mother, nor by the prospect of caring for their baby one-on-one, round the clock. But given how hard it is to withstand being called monstrously selfish, it is likely that, as the pressure mounts, more women will try to breast-feed, at least while they are in the hospital.
The third category of women start breast-feeding in the hospital and stop soon after returning home. They rarely talk about not wanting to nurse or even feeling repelled by the idea. They instead put their decision down to exhaustion, or a poor milk supply, or the agony of cracked nipples, or the hours waiting for the baby to be sated. These mothers tried, but breast-feeding didn't work for them. Activists chorus in reply that none of these reasons is acceptable: every woman can breast-feed. A mother's ambivalence is of no consequence.
A few advocates of breast-feeding do recognize that mothers might feel trapped by political correctness and they challenge the movement's sentimental image of motherhood with its erasure of all the other aspects of breast-feeding: the loss of freedom and the despotism of an insatiable child. They recognize that a baby might be a source of happiness, but also a devastating tornado. On-demand breast-feeding can leave women feeling like “a walking meal”
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or a “giant pacifier”
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or a milk-producing “ecosystem,” of having lost their status as individuals with their own will and
desires.
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But these cries do not appear in the pro-breast-feeding literature, which claims that what is good for some is good for all. Even though psychologists
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object to the concept of innate mothering and the illusion of harmony between mother and baby, there is no place for such subtleties. The underlying commandment of the dominant new ideology is “Mothers, you owe them everything!”
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or a “giant pacifier”
73
or a milk-producing “ecosystem,” of having lost their status as individuals with their own will and
desires.
74
But these cries do not appear in the pro-breast-feeding literature, which claims that what is good for some is good for all. Even though psychologists
75
object to the concept of innate mothering and the illusion of harmony between mother and baby, there is no place for such subtleties. The underlying commandment of the dominant new ideology is “Mothers, you owe them everything!”
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