Kathy's Commentaries

The Cultural Context of Breastfeeding

by Katherine A. Dettwyler, Ph.D.

Department of Anthropology,
Texas A & M University

Excerpt from the conclusions of Katherine A. Dettwyler's "Beauty and the Breast: The Cultural Context of Breastfeeding in the United States," published in Breastfeeding: Biocultural Perspectives, edited by Patricia Stuart-Macadam and Katherine A. Dettwyler, Aldine de Gruyter, October 1995.

Cause for Optimism?

Unlike Kennell and Klaus (1983), I do believe that an understanding of the evolutionary background of the human species carries clear implications for cultural change in the United States. Nevertheless, I would be pessimistic about the potential for cultural change in the United States concerning attitudes towards breastfeeding were it not for the major changes I have witnessed in my own lifetime with respect to tobacco smoking. Like artificial infant feeding, the risks of tobacco smoking were difficult to pin down epidemiologically, and were not accepted by the medical establishment for many years. Like artificial infant feeding, an extremely powerful financial lobby worked very hard to counter the medical and public acceptance of the growing scientific literature on the health risks of tobacco smoking (see Fredrickson, 1993 for the genesis of this idea that there are striking similarities between the two issues). Despite these difficulties, public attit udes towards tobacco smoking have changed radically in the past twenty years. The number of people who smoke has dropped sharply during this time; many restaurants, including McDonald's, department stores, hospitals, public buildings, and work places have voluntarily banned smoking. Smoking is no longer allowed on most airplanes. Because of studies documenting the detrimental effects of second-hand smoke on non-smoking bystanders, especially children, President Clinton is currently considering legislation that would outlaw smoking in all public buildings, and the Food and Drug Administration is considering whether or not to classify nicotine as a drug. Because I have lived through this radical shift in public opinion, beliefs, and behaviors concerning smoking, I can imagine the same thing happening with bottle-feeding.

In the early 1990s, one can find evidence that we have reason to be optimistic that public attitudes toward breastfeeding are changing in the direction of more direct support. Two well-publicized cases in 1994 involved breastfeeding mothers being ejected from public buildings and even threatened with arrest for breastfeeding in public. They made the national news because the mothers did not slink home, embarrassed. The first case involved a New York shopping mall, where a woman breastfeeding her three-month-old son was asked to leave by a security guard because she was "exposing herself" (AP wire story, 1994). The next day, more than 40 women gathered at the mall and staged a "nurse-in" to protest against the mall's attitude toward public breastfeeding. Similarly, in Texas, a woman was asked by a security guard to leave Houston's Museum of Natural Science because she was nursing her six-month-old infant. The next day, more than 150 women and children gathered across the street from the museum and staged a "nurse-in" to protest against the museum's application to nursing infants of their policy prohibiting "eating" in the exhibits. The museum's response was that nursing mothers should go to the restroom to nurse their children. The fact that more and more women are standing up for their right to breastfeed their children in public, and finding widespread support from other people, is a cause for optimism. In addition, thousands of instances of women nursing their children in public without being harassed go unreported, and therefore, unnoticed.

There are other reasons for optimism as well. Laws in most states have vague indecent exposure statutes that often define any exposure of the nipple and areola in public as "indecent exposure." Although breastfeeding in public is not against the law in any state, hypothetically, the indecent exposure laws could be used to characterize breastfeeding as indecent exposure. Beginning as long ago as the 1980s, in a quiet effort to clarify the issues, a number of states and local jurisdictions have been amending their indecent exposure statutes to explicitly exclude breastfeeding. As of 1995, New York, Florida, North Carolina, Michigan, Texas, Nevada, and Virginia were among the few states to specifically protect women who breastfeed in public. Technically, all women have a constitutional right to breastfeed, and there are no laws anywhere in the United States that prohibit breastfeeding or limit the length of time a mother can nurse her child. The New York state law passed in 1994 defines any attempt to prevent a woman from breastfeeding a child, in any location where the woman has a right to be, as a violation of her civil rights, and includes stiff penalties for violation of the law (Baldwin, pers. comm., 1994). In New Jersey, as this book went to press, legislation was being written to protect women's rights to breastfeed their children in public.

More and more official bodies are recognizing that breastfeeding is not just a "lifestyle choice" for women, but a health choice for both mothers and children. In Florida, state law requires medical professionals to go beyond providing information and education about breastfeeding and to "actively encourage" mothers to breastfeed. In Dade County, Florida, local ordinances provide incentive programs which allow hospitals to advertise themselves as "Baby Friendly" if they meet the guidelines of the "Baby Friendly Hospital Initiative" at the 80% level of compliance. Hopefully this will encourage other hospitals to take responsibility for this issue, rather than waiting for it to be mandated.

In the past several years, over two dozen large corporations have provided pumping breaks, breast pumps, private pumping rooms, and breast milk storage facilities for mothers who are breastfeeding their children. The World Alliance for Breastfeeding Action's (WABA) theme for 1993 was the promotion of a "Mother-Friendly Workplace." In the mid-1990s, the trend is for more and more companies to support the working mother, a change that has come about because society is recognizing that breastfeeding is a positive health choice for both mothers and children. Once again, Florida is leading the way with legislation pending to designate the entire state as a supporter of WABA's "Mother-Friendly Workplace" initiative. Because of these shifts in public, corporate, and legislative attitudes and policies, I am optimistic for the future of the cultural context of breastfeeding in the United States.

In the not too distant future, I can imagine a day when a young couple enters a restaurant with an infant or young child, and notes the sign on the front door: "This is a Breastfeeding Friendly Establishment." I can imagine a day when all fifty states have legislation guaranteeing a mother's right to breastfeed her child in public. I can imagine a day when all cans of infant formula carry a series of rotating warning labels from the Surgeon General that clearly state: "Use of infant formula may be hazardous to your infant's health. Infant formula is known to be a contributing factor in many cases of infant illness and death, including cancer and Sudden Infant Death Syndrome. The use of infant formula is known to reduce children's IQ as much as lead poisoning does, and hinders the development of strong affective bonds between mother and child." I can imagine a day when parents would have to sign a release when they buy infant formula, relieving the formula company of responsibility for causing higher rates of infant morbidity and mortality.12 I can imagine a day when heavy taxes are levied on the sale of every can of infant formula, both to discourage its use and to help offset the enormous medical costs incurred by those who use it. I can imagine a day when insurance companies charge higher life-long premiums for health care coverage of bottle-fed children. I can imagine a day when all pregnant women are fully informed of the costs of bottle-feeding, in terms of both their own health, and their children's health. I can imagine a day when doctors no longer worry about "making mothers feel guilty for choosing not to breastfeed," any more than they worry today about "making mothers feel guilty for choosing not to use an infant car seat." I can imagine a day when women who work outside the home can take their children to work with them; a day when every employer has on-site child care, and women can have their children with them as they work, or can go to a nearby location to breastfeed their children as often as they like. I can imagine a day when women in the United States can choose to take a year or more of maternity/nursing leave, with a guarantee that their job will be waiting for them when they return. On good days, I can even imagine that this maternity/nursing leave will be paid leave, as it is already in some European countries! I can imagine a day when children are so used to seeing women nursing their children in public, including at work, that they just assume that's the way things have always been. I can imagine a day when movies, television shows, and children's books portray mothers, including non-human animal mothers, nursing their children as a matter of course, instead of giving them bottles.13 I can imagine a day when anthropology students will learn about "the great breast implant debacle of the late 20th century" as yet another example, along with Chinese foot-binding and female genital mutilation, of cultural beliefs gone astray to the detriment of women and children. I can imagine a day when children grow up appreciating women's breasts for the wondrous, amazing, life-sustaining organs that they are. I can imagine a day when all the world's children, including those in the United States, start out breastfeeding, and are allowed to breastfeed for as long as they need.

What can we do to make these imaginations become reality? Among the first steps might be the following:

We can speak out against the prevailing cultural view that breasts are "naturally" sex objects, and that 'breast-mouth' contact is, by definition, sexually charged. It is inappropriate to take the very Western cultural idea that breasts are sexual organs and turn it into a "Law of Nature," applicable to all people, at all times. It is inappropriate to let the very Western cultural idea that breasts are for men overshadow their primary biological function for feeding children, just as it was inappropriate for people in Chinese society to let the cultural idea that deformed feet were sexually stimulating overshadow their primary biological function for walking. Women and children are harmed by Western beliefs about breasts, both directly and indirectly, both physically and emotionally.

I am not suggesting that it is wrong or immoral or perverted to experience sexual pleasure from manual or oral manipulation of the breasts as part of sexual behavior. I am insisting, however, that we recognize this as learned behavior, learned in a particular cultural context. I am not suggesting that men and women in any culture should give up this aspect of their sexuality; I am suggesting that they should recognize this role of the breasts as a very distant, secondary lagniappe. Can't we "have our cake and eat it, too?" one may ask. Perhaps, I would respond, but with caution. Perhaps, but only to the extent that using our breasts for these purposes doesn't lead to the excesses represented by female mammary mutilation, widespread dissatisfaction among women with the way their bodies look, men who judge a woman's value on the size of her breasts, and widespread misunderstanding of the primary function of women's breasts, which leads to breastfeeding being defined as sexual behavior. The costs of these cultural beliefs, in terms of women's physical health and self-esteem, and children's health, are, it seems to me, too high a price to pay.

Women deserve to have their bodies accepted as they are, and not feel compelled to submit to the knife in pursuit of the perfect body. The size of a woman's breasts is not related to her ability to produce breast milk. We can teach our daughters that whatever the size of their breasts, they will be able to sustain and nurture their children through their breastmilk. If we can teach our children that breasts are for feeding children, then the phenomenon of female mammary mutilation and the issue of breast implant safety will simply fade away, as the desire and demand for artificially inflated breasts disappears.

We can educate ourselves, and others, about all the different roles that breastfeeding plays in normal, healthy child development. Breastfeeding is more than just the transfer of nutrients from mother to child. Not only nutritionally, but immunologically, physically, cognitively, and emotionally, breastmilk is vastly superior to artificial infant feeding products, and breastfeeding is much more than just a way to feed a child, much more than just a "lifestyle choice." Women need to know about the advantages of breast milk and breastfeeding; they need to know that breast milk protects children against a variety of illnesses and parasites as long as they are ingesting it, and that an early diet of breast milk sets the stage for life-long health advantages through a strengthened immune system. Women also need to know about the very real "risks" of bottle-feeding, including higher morbidity and mortality during childhood, higher rates of cancer and diabetes in adulthood, and poorer cognitive development. Women need to know that infant formula is not "almost as good" as breast milk. They need to have realistic expectations about how often and for how long human children need to nurse, so that they will nurse often enough to produce enough milk, of sufficiently high fat content, to satisfy their child's needs. They need to know that breastmilk continues to be an important source of clean, cheap and convenient nutrition for their children as long as they are producing milk, and that breast milk can be a critical source of nutrients for a sick child. They need to know that breastfeeding releases a flood of hormones that promote maternal behavior and that will help them cope with the many demands of child rearing. Women need to know that breastfeeding quiets a noisy or fussy child, relaxes an anxious child, comforts a sick, injured, or frightened child, and conveys unequivocally that the child is safe and loved. They need to know that a child who has the "safe haven" of her mother's arms is a secure, independent child, one who has the self-confidence to reach out and explore the world. Finally, women need to know that meeting their children's needs through breastfeeding, as long as children express those needs, is both normal and appropriate.

Everyone, from doctors and lactation consultants down to the youngest school children, needs to know that breastfeeding is not only for newborn infants. All of the evidence from our closest living relatives in the animal kingdom, the non-human primates, suggests a natural weaning age between two and seven years of age. Cross-cultural evidence from around the world suggests that two to four years of breastfeeding is typical of modern humans. The question "Is that child still nursing?" needs to be stricken from our conversations. Parents and health professionals need to recognize that the benefits of breastfeeding (nutritional, immunological, cognitive, emotional) continue as long as breastfeeding itself does, and that there never comes a point when you can replace breast milk with infant formula or cows' milk, or breastfeeding with a pacifier or teddy bear, without some costs to the child.

We can work to counter the artificial separation of private and public domains, the cultural perception that our private lives have no relevance for our professional lives, and that our roles as "mothers" render us "unprofessional." Women can make a statement by breastfeeding their children wherever they happen to be, whatever they happen to be doing, to show others that breastfeeding is important and can be accomplished by normal women living in the real world. Women can continue to lobby for realistic maternity/nursing leave, and employment opportunities that allow them to care for their children at the same time. All women, whether breastfeeding or not, whether mothers or not, as well as all men, need to understand the importance, for all members of society, of nurturant child rearing practices.

This isn't a male versus female issue; most of the outspoken critics of breastfeeding in public, and breastfeeding older children, are women, just as women are the ones clamoring for their right to have their breast size increased through surgery. Likewise, some researchers have suggested that breastfeeding advocacy represents a call for women to return to their "traditional," circumscribed roles as housewives and mothers. In this chapter, I explicitly reject this interpretation. Women should not have to choose between nurturing their children in the best possible way and pursuing other interests outside the home. Just as an earlier generation of women thought that they had to choose between having a family and having a career, today's generation of working mothers often think they must choose between breastfeeding their children and having a career, but it doesn't have to be that way. It is up to us to change the cultural context of breastfeeding, and of work, in the United States, so that breastfeeding is compatible with the modern workplace. Rather than concluding that an advocacy of breastfeeding means a return to the days of "a woman's place is in the home," one can argue that an advocacy of breastfeeding means a change in a culture's valuation of child rearing as an activity, and a change in the valuation of the important contributions that only women can make to the social reproduction of a society.

We can teach fathers other ways to nurture and care for their children besides giving them a bottle. We can show them that their cultural beliefs about the sexual nature of women's breasts are cultural beliefs, not biological givens. Men need to know that, however much sexual pleasure they may derive from women's breasts, breasts were designed, first and foremost, to feed children. Every father can be taught that the long-term health of his spouse and children should overshadow his culturally-taught sexual desires for access to his wife's breasts.

We can teach our sons that they should not judge a woman's character or sexual attractiveness on the basis of her breast size. We can teach our daughters to value their bodies, to have confidence in their bodies, and to not be ashamed of using their bodies as they were designed. We can make sure that children have many opportunities to see women breastfeeding, in many different contexts. We can answer our children's questions about breasts and breastfeeding in a forthright, practical, straightforward manner. Finally, we can continue to combat the "culture of misinformation" that surrounds breastfeeding among medical professionals and the lay public. Medical students and other health professionals need general nutrition education, as well as specific classroom and clinic education in breastfeeding (Freed, 1993; Stanfield, 1984). If doctors don't know how to effectively treat a particular problem, they can refer their patients to the experts--La Leche League International, lactation consultants, or other local women who have experience breastfeeding--rather than just recommending weaning. Women need to have their problems with breastfeeding met with serious concern and treatment, from knowledgeable, experienced people. Women's and new parents' magazines can make available objective, accurate information about breastfeeding, not bow to the power of the infant formula industry.

I realize that what I am calling for constitutes nothing less than a cultural revolution. Just as women have held rallies and marches to "Take Back the Night," we can "Take Back Our Breasts." We can restore our breasts to their rightful place as the most important point of contact between mother and child after birth. We can do as much as possible to facilitate breastfeeding for all women, and to make sure that women have all the information they need to make informed choices about infant feeding. No child should have to settle for bottle-feeding because his mother thought it was "just as good." No child should have to settle for bottle-feeding because his mother thought she "didn't have enough milk." No child should have to settle for bottle-feeding because his mother thought breastfeeding would be painful, or could only be done in private. No child should have to settle for bottle-feeding because his mother wasn't allowed enough maternity leave, and/or couldn't find child care near her workplace. No child should have to settle for bottle-feeding because her father wants her mother's breasts all to himself.

The path to a "Breastfeeding Friendly" society is open before us. We have only to take the first steps.

Prepared  August 3, 1995.

Last updated March 11, 2004, by kad. Contents copyright 1999-2004 Sue Ann Kendall and Kathy Dettwyler.   Thanks to Prairienet, the Free-Net of east-central Illinois, for hosting this site from 1999 through 2004.  

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