Breastfeeding

Breastfeeding

Breastfeeding is the feeding of breastmilk to babies via pumping and providing bottles, or straight from the mother's breast(s). The WHO recommends that babies are exclusively breastfed for a minimum of six months, and are ideally breastfed for two years and beyond while feeding supplementary, appropriate solid foods.

Historical and Evolutionary Context

By examining the historical and evolutionary contexts of breastfeeding, we can observe how a shift in human lifestyles (ie. from hunter-gatherer-foragers to predominantly sedentary, agrarian societies) has impacted the attitudes, behaviours, and practices surrounding human breastfeeding. This contextual background information is crucial in helping us understand why there has been a decline in breastfeeding in so-called Western nations. Unfortunately, as a result of a lack of recognition for the societal and cultural shifts that have impacted breastfeeding practices, mothers have often been criticized for choosing not to (or being unable to) breastfeed, with breastfeeding characterized as "natural" and "instinctual" . Some mothers have even been historically "openly critiqued and advised on their individual 'duty' to breastfeed" , reflecting a culture that places responsibility solely on mothers without recognizing the significant impact of partner, community, and societal support on breastfeeding.

"By observing the [behavioural] ecology of non-human primates, pre- and post-industrial feeding patterns, and models of optimal growth and development for contemporary infants and children, researchers have been able to approximate the human infant feeding ecology of our evolutionary past...the following were likely components of our evolutionary past: on-demand infant feeding, infant carrying, co-sleeping, initiation of breastfeeding within one hour of birth, exclusive breastfeeding for about six months followed by complementary feeding, continued breastfeeding until three years of age, reliance on social learning and support, and flexible weaning with a shift of care to allo-caregivers."

The purpose of exploring the evolutionary and historical context of breastfeeding is not to demonize, moralize, or prescribe behaviours to women regarding infant feeding. Rather, by learning about how shifts from hunter-gatherer-forager societies to capitalist agrarian societies, we can understand why and how breastfeeding practices have been affected. The decline of breastfeeding (and especially full-term breastfeeding, ie. weaning at 2-5 years of age) is not an issue of lazy or irresponsible mothers, but instead reflects a decline in the support for breastfeeding women and a shift in the values ascribed to breastfeeding practices.

Benefits of breastfeeding

Medical and scientific evidence supports positive outcomes for breastfed infants/children, as well as for breastfeeding mothers. Studies indicate that breastfed babies experience many physiological benefits including lower rates of diarrheal diseases, fewer ear infections, lower rates of SIDS, decreased risk of allergies and skin problems, decreased rates of obesity, and stronger immune systems when compared to formula-fed babies. Breastfeeding also provides babies and children with comfort and security. Although breastfeeding is widely viewed as the healthiest choice for both mother and infant, there may be personal, medical, and other reasons why some women choose not to breastfeed.

Formula Feeding

Breastmilk is considered to be the best choice for feeding babies. Formula (sometimes referred to as "artificial milk") is an approved alternative, supplement, or replacement for breastmilk. Infant formula is an important and sometimes necessary alternative to breastfeeding, particularly in cases of adoption, maternal death, maternal health problems or inability to breastfeed, and other scenarios.

Medicalized Breastfeeding

Along with the other reproductive issues (eg. childbirth, birth control, abortion) that primarily affect women, breastfeeding has become medicalized and politicized in North America and other parts of the world, particularly over the last couple hundred years. Although pregnancy, childbirth, and breastfeeding have physiological components that sometimes require medical support and intervention to ensure maternal/infant health and safety, these reproductive experiences extend beyond the physiological. Recognizing the complex sociopolitical and socioeconomic factors that influence infant feeding practices, scholars maintain that health care workers should be trained to "support reproduction as health, not illness" , and therefore empower women to make decisions based on adequate education, solid research, and support systems for parents. According to the global Baby-Friendly Initiative, emphasis must be placed on "respect for the woman, the baby, and their ability to breastfeed when given appropriate support. The midwife/nurse is 'with woman', rather than providing nursing management of a disease."

Breastfeeding and Feminism

Dialogues about breastfeeding vary widely among scholars and activists, varying from activism regarding public breastfeeding rights to concerns about the use of medical evidence to encourage breastfeeding. One scholar notes that "feminists who devalue medical evidence of the health benefits of breastfeeding tend to see a breastfeeding-friendly culture, while those who see evidence for the health benefits of breastfeeding tend to see a culture friendlier to bottle-feeding" . Following this pattern, some scholars critique the use of medical information to "emphasize maternal responsibility," suggesting that ideologies about motherhood are sometimes used to "moralize and circumscribe women's breastfeeding behaviour." The myth of "choice" is also of concern, as the concept of choice must be viewed within the contextual framework, including limitations/restraints on choice. "Choice" as a concept is complex, and is often compromised by the confines, restrictions, limitations of a society. Therefore, many feminists argue that choice to breastfeed is not an individual one, but can be determined - or at least influenced - by the frameworks of society. Regardless of individually varied perspectives on breastfeeding, the health, safety, security, and support for women and their offspring should remain the primary intention regarding maternal and breastfeeding research and education.

Activism and Organizations Supporting Breastfeeding

Breastfeeding movements

There are many movements that aim to support breastfeeding mothers, especially by destigmatizing public breastfeeding, normalizing full-term breastfeeding (ie. 2-5 years and beyond at weaning, sometimes referred to as extended breastfeeding), and the promoting more flexible work hours/provisions to allow women to pump or breastfeed in their workplaces. Some of the efforts to promote a breastfeeding-friendly culture include breastfeeding symposiums, conferences, and policies aim to normalize breastfeeding and "reposition breastfeeding as a valued part of women's reproductive rights and lives."

Breastfeeding Committee for Canada

The Breastfeeding Committee for Canada provides support for breastfeeding mothers, infants, partners, and families. They make recommendations for infant feeding based on current research and best practices, including a Q&A section to help answer questions from parents, health care providers, and others. Their website states that: "The BFHI offers an evidence-based standard of care to all women, regardless of their choice of infant feeding methods, while working to ensure that staff are able to provide the information and help that will maximize breastfeeding outcomes."

Breastfeeding Rights in Canada

According to INFACT (Infant Feeding Action Coalition) Canada, the right to breastfeed anywhere, anytime is protected by the Canadian Charter of Rights and Freedoms. In Canada, each province and territory has its own Human Rights Code. These codes protect women from discrimination on the basis of sex. To date, only Ontario and British Columbia have specifically detailed the rights of breastfeeding feeding mothers. These provisions include time, access, and accommodation in the workplace and in public.

Federally, the Canadian Charter of Rights and Freedoms provides protection in the form of gender equality without discrimination based on race, national, ethnic, origin, colour, religion, sex, age, or mental, or physical disability. Pregnancy discrimination is directly linked to sex discrimination. Therefore, pregnancy includes the post-natal period, which includes breastfeeding. Breastfeeding is a natural part of child-rearing, and so is integrally related to the ground of sex, as well as to family status. Women should not be disadvantaged in services, housing or employment because they have chosen to breastfeed their children. Nor should they be harassed or subjected to negative treatment because they have chosen not to breastfeed their children. When this policy refers to discrimination based on pregnancy, it includes discrimination based on breastfeeding.

If one is harassed for breastfeeding their baby, the incident should be reported to the Human Rights Commission in the respective province. Sometimes women are discouraged by others from breastfeeding in public places because of concerns that it is indecent. Breastfeeding is really a health issue, and not one of public decency. Women should have the choice to feed their babies in the way they feel is most dignified, comfortable and healthy.

UNICEF Baby-Friendly Hospital Initiative

The UNICEF Baby-Friendly Hospital Initiative was established in 1991 as a plan to promote breastfeeding and breastfeeding support. The Baby-Friendly Initiative empowers women, emphasizes the importance of support for new moms and babies, places value on breastfeeding, and provides a "woman-centred" approach to providing care for mothers. The initiative has had a "measurable and proven impact, increasing the likelihood of babies being exclusively breastfed for the first six months."

The Social Role of Breastfeeding

Breastfeeding is about more than nutrition and survival; breastfeeding plays an important social role in all primates, especially in the lives of humans and their young. However, breastfeeding is also social in that it requires partner, familial, community, and societal support in order to make it possible. Humans rely upon social learning and support to care for their infants. Because of this important social element, feminists, scholars, and activists maintain that parental (especially maternal, in the context of breastfeeding) support must take place at all levels - including individual/family, community/cultural, organizational, and policy levels.

Intersectional Perspectives on Breastfeeding

Breastfeeding is an element of the health and "reproductive continuum" which emphasizes the freedom to reproductive choice, access to abortions, family planning services, pregnancy, health care, and childbirth for all women, regardless of their socioeconomic status. When discussing breastfeeding, it is important to examine the intersectional factors that affect a mother's decision and ability to breastfeed (and, alternatively, to opt for formula feeding, or a combination of breastmilk and formula). Although breastfeeding is generally considered to be one of women's inalienable human rights, socioeconomic factors may impede a mother's choice to breastfeed. However, it is important to deconstruct the concept of choice, as "choice nor practice is a simple concept, being contingent on at least our education, suburb, peers, race, corporeality, and personal histories." Not having access to paid maternity leave, lack of adequate education, and stigmatization are a few of the factors that may eliminate breastfeeding as an option for many women, in additional to many others. Social determinants of health and access to services may impact a woman's actual ability to exercise her reproductive rights and freedoms. "The decision to breastfeed is not a 'real choice' for many women if not supported by policies and programs that provide all women, regardless of their social position, with education, opportunity, and control over their bodies and lives."