Introduction
Shortly after learning I was pregnant in early 2000, I headed to the bookstore and promptly purchased What to Expect When You are Expecting by Murkoff, Eisenberg and Mazel (1998). This book is one among many adorning local bookshops offering advice to the soon-to-be mother. Now in its fourth edition, I owned the expanded and revised second edition published in 1998. What this book and others like it do is guide the first-time mother through the month-by-month changes their body is experiencing as their baby grows inside them. While its intention is to reassure, inform and advise the first-time mother on how to handle various situations, the bookâs detailed attention to what can go wrong in pregnancy was sometimes unnerving. Nevertheless, this book was constantly referenced and read throughout my entire pregnancy as I engaged in what sociologists call an anticipatory socialization process. Even though I was not yet a mother, I was anticipating motherhood by learning what my new role involved and preparing for life with my newborn child. In effect, as a pregnant woman, I was already preoccupied with the responsibilities of caring for a child, and this book helped me navigate both the prenatal and postnatal phases of my pregnancy.
The truth is this book was just one among many. Before my first child was even born, I read well over a dozen books on pregnancy, breastfeeding, motherhood and parentingâand since then dozens more parenting books have been added to my bookshelvesâwhile pretty well all of my books on the early years of childrearing have been re-gifted to first-time mothers and fathers. In fact, many of my first childcare books made their way onto my bookshelf via friends and colleagues whose children had outgrown their advice. What I have come to realize about parenting is that the learning curve is steep, and what you need to know and do is ever changing. Quite simply, the advice on how to parent, teach and guide your child is highly dependent on your childâs stage within the life course.
During the prenatal phase of a babyâs life, the primary agenda is to carry a healthy baby to full-term. To this end, most expectant mothers are learning to transform their lifestyles, diets and exercise habits to meet the needs of the growing baby. In effect, mothersâ bodies are being âgivenâ over to and being âtakenâ over by the unborn child. And if you opt to breastfeedâwhich I didâthis process can last much longer than three trimesters. As Bendefy (2012, p. 25) argues âbreast-feeding is ⊠the âfourth trimesterâ in terms of [a] babyâs brain growth and developmentâ.
Even if the production of breast milk is a biologically, evolutionary and ecologically sound infant feeding strategy that ânaturallyâ follows childbirth, for many mothers and newborns, breastfeeding involves a steep learning curve. It is a skilled activity that requires a significant amount of patience, trial and error and effort on the part of mother and child. Not all mothers and newborns take to breastfeeding easily. And while mothering books may teach pregnant women and new mothers the benefits and mechanics of breastfeeding, until you actually start breastfeeding your knowledge remains purely theoretical. It is when you start nursing your newborn that you begin to apply your abstract knowledgeâsome nursing mothers may experience instantaneous success, while others may experience a series of challenges, and still others may, for a number of reasons, never succeed at breastfeeding or never attempt to breastfeed. This relationship between theory and practice is referred to as praxis.
Praxis captures what we do, and how our everyday activities create and re-create the social world, cultural patterns and social expectations. Social policies, including health policies, are closely related to praxis in that a policy lays out a governmental plan of action (Lightman 2003). But policymakers cannot ascertain in advance to what extent a policy agenda will succeed. Likewise, during pregnancy, mothers may plan to initiate breastfeeding, but whether or not they do, and the duration they nurse, can only be measured after the child is born and infant feeding is proceeding.
This chapter explores infant feeding, in particular the first months of life before solid foods are introduced. It does so through a sociological lens and the use of autoethnography. Sociologists study the relationships between an individualâs life experiences and the larger social world in which our biographies unfold. Autoethnography reflects on the relationship between oneâs individual life and the larger social context in which it is lived. This agenda fits well with sociology, which aims to recognize that personal troubles and decision-making processes are embedded in larger social contexts or what C. Wright Mills (1959, 2000) called public issues. This is certainly the case when it comes to breastfeeding. As this chapter will illustrate, a motherâs decision on how to feed her infant child is not simply a private matter; throughout the last decades, breastfeeding has become a public health issue that pits human milk against formula, breast against bottle and ânatureâ against science.
The chapter begins with a brief overview of breastfeeding practices over the past century. Then it considers the range of options available to families to meet the nutritional needs of their newborn. The third section reflects on the larger socio-economic, political and cultural context within which infant feeding decisions are madeâspecifically it considers policy initiatives that support breastfeeding and the concurrent backlash against breastfeeding. The chapter concludes with a discussion of the role human milk plays in supporting and building a local, sustainable, food system.
Breastfeeding Practices During the Last Century
At the beginning of the twentieth century, breastfeeding was the norm with more than two-thirds of mothersâ exclusively breastfeeding their infants (Wright and Schanler 2001, p. 421S). But between 1930 and 1960, breastfeeding in North America declined dramatically from one decade to the next (Fomon 2001, p. 409S), and breast milk was steadily replaced with cowâs milk and infant formulas. Interestingly, this replacement of ânaturalâ milk with âartificialâ milk occurred during first the Depression years, then the war years, and finally as women increasingly entered the paid labor force. Even so, as Fomon (2001) documents, commercially prepared formulas were available at the end of the nineteenth century, but the uptake was not there at that point in history.
Formula or âartificialâ feeding options fell into two categoriesâthere were home-made formulas and commercially prepared ones. In fact, between 1880 and 1930, many corporations were making and perfecting infant formulas as alternatives to breastfeeding. They sought to create a product that was nutritionally equivalent to breast milk, but they found that formula-fed babies sometimes had poorer health and lacked nutrients when compared to breastfed babies (Fomon 2001). However, as science improved and formulas better met the needs of newborns, its adoption for infant feeding began to take off in the 1950s. At the same time, Fomon (2001, p. 412S) observes:
It was five years later, at the height of formula and bottle-feeding, that I was born. My introduction to food was corn-syrup-laced Carnation milk, and I am convinced it is responsible for the incredible sweet tooth I harbor to this day. But as my mother says, âI was just doing what the nurses and doctors told me to do. Everybody I knew was bottle-feedingâ. According to a source in Olverâs (2004) food timeline, in 1964, âone baby in five, usually those past three or four months of age, [was getting] whole cowâs milk. [While] only one in 10 [were] breastfed [even though breastfeeding was described as] still the safest, most convenient and least expensive method of nourishing an infantâ.considerations of convenience began to supersede considerations of cost, and the popularity of commercially prepared formulas increased dramatically ⊠[no doubt] accelerated by the introduction in 1959 of iron-fortified formulas and the vigorous promotion of these formulas by the formula industry and by pediatricians.
Breastfeeding did not, however, match the ideological framework of the day, which supported the strong belief in scientific intervention and âbetter living through chemistryâ. It is perhaps no coincidence that this is the same historical moment that the green revolution is gaining ground and dramatically transforming food production from small-scale family-oriented farms to commercially oriented, industrial farms (Roberts 2008). Nevertheless, by the 1970s, a pendulum shift occurs and breastfeeding once again starts to gain momentum. Fomon (2001, p. 415S) reports it is hard to identify the exact impetus for this swing back toward breastfeeding but notes it is a grassroots movement rather than one led by âhealth professionals, and may have been in part associated with negative publicity directed against the formula industryâ. It was during this period that North Americans and Europeans were learning of the negative impact aggressive marketing of infant formula in developing countries was having on infant mortality rates there (Fomon 2001; Brady 2012). It was also a period of Keynesian economics and the rise of the welfare state so policies were coming into play that supported breastfeeding. For example, it was in 1971 that Canadian women who had banked at least 20 weeks of insurable earnings could apply for 15 weeks of maternity leave benefits (Marshall 2003). At the same time, the World Health Organization (WHO) did, and continues to, recommend exclusive breastfeeding for at least the first six months of a childâs life (Heymann et al. 2013).
The global impact of these processes was more breastfed babies; even so the WHO (2015) would still like to see more babies breastfed for longer periods of time because of the positive outcomes of breastfeeding on infant health. In Canada, there was a steady increase in the number of women initiating and exclusively breastfeeding. Health Canada (2012) reports that in 2003, 37.3 percent of new mothers exclusively breastfed for the first four months, while 17.3 percent were continuing to do so at six months of age (whereas in 2009â10, the figures were 44.2 percent at four months and 25.9 percent at six months). So clearly supplementary feedings are often being introduced after the fourth month despite recommendations to continue exclusive breastfeeding until six months of age. Personally, I remember being pressured by family and friends to introduce solids earlier than six months, and while I did not do this for my first child, I think I did in the case of my second, in part because he seemed more interested in eating solid foods.
Infant Feeding and Breast Milk Production
Feeding a newborn involves two sets of decisions based on prior learning. First, parents must decide what kind of milk the child will consumeâwill it be human milk or formula, or some combination of both? Second, parents must decide how that milk will be deliveredâby breast or by bottle or by both breast and bottle? How these questions are answered presents a range of possibilities for feeding the newborn. At one end of the spectrum sits the newborn who is exclusively breastfed. In this case, the infant drinks human milk directly from motherâs breast. On the other end of the spectrum is the newborn who is exclusively bottle-fed with formula. In the middle, you have babies who are exclusively fed human milk by both breast and bottle. As well there are babies who are fed both human milk and formula from both breast and bottle, and still others who might be fed breast milk or formula exclusively by bottle. In short, a range of options prevails for meeting the nutritional needs of the newborn baby, but the choices made will depend on the parentsâ knowledge frames, their social situation, and the larger social support network in which their lives are embedded.
There is an extensive self-help literature available for expectant mothers to consult on the dynamics of successful breastfeeding. The Nursing Motherâs Companion (Huggins 2015), Breastfeeding Made Simple (Mohrbacher and Kendall-Tackett 2010), The Womanly Art of Breastfeeding (Wiessinger et al. 2010) and Work. Pump. Repeat. (Shortall 20...