Parent Information Network. The topic was breast feeding. The "heat" did not center around whether or not to breast feed; subscribers to PARENTING-L seem to agree that this is the best method of feeding an infant. The issue, however, is where to breast feed. The discussion prompted this article for Parent News, which will examine many different aspects of breast feeding. Readers interested in reviewing the PARENTING-L discussion may do so by visiting the PARENTING-L archives at gopher://ericir.syr.edu:70/11/Listservs/Parenting-L.

Advantages and Disadvantages of Breast Feeding

"Because of its nutritional composition, human milk is the ideal food for human infants" (Shevlov, 1994, p. 68).

"Breast milk has so many advantages-it's perfect for a human baby" (Brazelton, 1992, p. 9).

These statements reflect the consensus within the medical establishment that breast feeding is the best feeding method. Most family practitioners and pediatricians encourage mothers to breast feed their infants. Nutritional benefits come about because babies are not allergic to breast milk and because the milk provides the correct ratio of protein, sugar, minerals, vitamins, and enzymes, along with antibodies that provide the baby with immunity to certain illnesses. As a result, breast-fed babies are typically healthier and have fewer infections than formula-fed babies.

In addition to nutritional advantages, breast feeding requires skin-to-skin contact that promotes attachment. Mothers report that breast feeding encourages their self-confidence as they nurture and care for their infants. Finally, breast milk has economic advantages because it is less expensive than formula. Although a breast-feeding woman must increase her caloric intake in order for her body to prepare the milk, the increased food cost is still only about one-third the cost of formula (Shelov, 1994).

Societal Pressure: Is the "Perfect Mother" a "Breast Feeding Mother?"

"Since the mid 1980's, the social and medical pressure on women to breast-feed has increased..." (Maher, 1992, p. 2).

As Maher (1992) points out, there is tremendous pressure on mothers to breast feed their infants. For the most part, this pressure is based on the nutritional benefits of breast milk and the medical establishment's advocacy of breast feeding. However, Maher (1992) makes a strong case that breast feeding is not done in isolation. The decision to breast feed must take into account the culture, society, and environment in which the mother lives. Van Esterik (1989) sees the infant-feeding decision as a complex system that includes urban environments, empowerment of women, medicalization of infant feeding, and commoditization of food.

If a nursing mother returns to work, is the workplace environment conducive to her need to express and store milk during the day? In a two-year study of the potential costs to employers, it was found that 93 percent of formula-fed infants fell ill, while only 59 percent of breast-fed infants became ill during the same time. As a result of fewer illnesses in the infants, there was a lower absenteeism rate for breast-feeding mothers, at a significant savings to employers. It would seem beneficial for employers to support employees who wish to breast feed by providing a room for privacy and perhaps a refrigerator for storing expressed milk. These conditions rarely occur, and as a result, 55 percent of working mothers try breast feeding, but only 24 percent of part-time and 12.5 percent of full-time working mothers actually continue breast feeding for 5 to 6 months (Breast-feeding Promotion Committee of Healthy Mothers, Healthy Babies, n.d.).

Many women return to work and plan a feeding regime for their infant that includes both breast milk and infant formula. Unfortunately, many women who opt to supplement breast milk with infant formula are made to feel guilty by individuals who pressure the mother to breast feed exclusively. In contrast, a generation ago, mothers were told by the medical establishment that infant formula was superior to breast milk. The result was that few women breast fed. Some of these women now advise their daughters (with newborn children) that infant formula is just as good as breast milk and thus fail to support a woman's decision to breast feed.

Breast Feeding--Can It Be Deemed "Indecent Exposure?"

The answer seems to be a resounding "absolutely not." However, many breast-feeding women have had the unpleasant experience of being asked by law enforcement and security personnel to stop breast feeding their child in their chosen location. Women have had this experience when nursing in public spaces like shopping malls and in more private spaces like their own vehicles.

Recognizing the benefits of breast feeding, 12 states have enacted legislation that clearly states that breast feeding is not indecent exposure and is not a criminal behavior. The laws on breast feeding in New York state provide women with legal recourse if they are prevented from breast feeding. Further, some states (e.g., Iowa and Idaho) have amended their jury duty statutes to excuse breast-feeding women. The need for such legislation is a direct response to individuals in society who believe that breast feeding in public is indecent exposure (Baldwin & Friedman, 1997). A list summarizing legislation on breast feeding can be viewed on the World Wide Web at http://www.lalecheleague.org/LawBills.html.

In her book The Anthropology of Breast-feeding: Natural Law or Social Construct, Maher (1992) devotes a portion of a chapter to the issue of where to breast feed. She writes: "Most Westerners, both men and women, feel discomfort, not to say disgust at the idea of a woman breast-feeding outside the home, or in public" (p. 21). One woman recalls being informed that a female co-worker felt uncomfortable when she breast fed her 2-month-old son in their shared office space (J. Bezdicek, personal communication, 1997). While some object to the act itself, others react strongly only if the child being breast fed is no longer an infant, but a toddler (M. Feldman, personal communication, March 1997).

Many women were not breast fed themselves as infants, and their efforts to breast feed their own children, even in the homes of their own parents and siblings, can oftentimes be met with uncomfortable silence or hasty retreats from the room. In these situations, the nursing mother will seek the privacy of a bedroom. In public places, the mother often must nurse the baby in a bathroom stall (R. Arsenault, personal communication, March 1997).

The discomfort and objection to breast feeding in public may be related to the Western view of the breast as a sexual object. Maher notes that many manuals on breast feeding point out that some women feel inhibited about breast feeding because they know men view the breast as an erotic stimulus. This awareness creates anxiety that is often strong enough to influence a woman's decision not to breast feed.

Feminists view a woman's decision to breast feed as a decision to take control of her own body. Van Esterik (1989) argues that the development of the supportive environment necessary for successful breast feeding is a feminist issue because "it encourages women's self-reliance, confirms a woman's power to control her own body, challenges models of women as consumers and sex objects, requires a new interpretation of women's work, and encourages solidarity among women" (p. 69).

Conclusion

Recent research has indicated that although the medical profession firmly believes in the benefits of breast feeding, physicians do not typically receive information in their medical training that would help them support a woman's decision to breast feed. An ongoing study at the University of North Carolina is working towards designing educational programs for physicians to increase their ability to counsel and support women about the decision to breast feed (Teaching Physicians to Support Breastfeeding Women, 1997).

Similar efforts must be taken on a public level to educate society that women have the right to breast feed in public. There are many individuals who would like to support a nursing relationship, but don't know quite how to go about it (Biever, personal communication, 1997). Public education and efforts to coax detractors from their view that the breast is primarily a sexual object are steps in the right direction.

The La Leche League has a Web site that includes "Responding to and Avoiding Criticism about Breastfeeding." It contains helpful ways to deal with criticism and phrases nursing mothers can use to counter challenges they may face.

The decision-making process parents go through when deciding how to feed their infant is not one that is made lightly. The decision deserves respect and support, not challenges and obstacles that create anxiety in the parents.

For Further Information

Breastfeeding and Maternal and Child Health (MCH) Division at the Institute for Reproductive Health (IRH). URL: http://www.irh.org/

How Companies Can Support Employees Who Are Breast-feeding. URL: http://npin.org/pnews/pnewd96/pnewd96f.html

La Leche League Web site. URL: http://www.lalecheleague.org/

Parent-L is a listserv for individuals who wish to support breast feeding, extended breast feeding, and attachment parenting issues. For more information on subscribing, visit this Web site: http://www.greatstar.com/lois/welcome.html

The World Alliance for Breastfeeding Action (WABA). URL: http://bbs.elogica.com.br/aleitamento/ingles/waba.htm#INICIO [NPIN Editor's note (5-02-02): this url has changed: http://www.waba.org.br/wwaba.htm]

Sources:

Baldwin, E., & Friedman, K. A. (1997). A current summary of breastfeeding legislation in the U.S. [WWW document]. URL http://www.lalecheleague.org/LawBills.html

Brazelton, T. B. (1992). Touchpoints: your child's emotional and behavioral development. Reading, MA: Addison Wesley.

Breast-feeding Promotion Committee of Healthy Mothers, Healthy Babies. (n.d.). What gives these companies a competitive edge?: Worksite support for breast-feeding employees. Washington, DC: Healthy Moms, Healthy Babies. Cordes, H. (1997, March). Fighting for the right to breastfeed. Parenting, 27.

Maher, V. (1992). The anthropology of breast-feeding: Natural Law or Social Construct. New York: St. Martin's Press.

Shelov, S. P. (Ed.). (1994). The American Academy of Pediatrics: Caring for your baby and young child, birth to age 5. The complete and authoritative guide. New York: Bantam Books.

Teaching physicians to support breastfeeding mothers. [WWW document]. URL: http://www.schsr.unc.edu/RESEARCH_PROJECTS/breast_feed.html [Editor's Note: this link is no longer active 4-27-2000]

Van Esterik, P. (1989). Beyond the breast-bottle controversy. New Brunswick, NJ: Rutgers University Press.