Wednesday, August 10, 2011

"Breast is Best" Cultivates a Western Mythology

The Breast Milk Cure by Nicholas D. Kristof was published in the New York Times on June 22, 2011:

Nicholas Kristof was recently in Niger, where he wrote a piece,
published in the NY Times about the country's surprisingly low breastfeeding rates. In that piece, he also addressed the challenges he perceived might account for such low breastfeeding rates, as well as why the situation is so dire in the region.

As if taking the words straight from the pen of the esteemed Gabrielle Palmer, who wrote in The Politics of Breastfeeding, "If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers' needs, the very announcement of their find would send their shares rocketing to the top of the stock market. The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence..."

Kristof similarly writes, "What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesn’t require refrigeration? One that is free and is available even in remote towns like this one in Niger where babies routinely die of hunger-related causes? Impossible, you say? Actually, this miracle cure already exists. It’s breast milk."

He continues: "When we think of global poverty, we sometimes assume that the challenges are so vast that any solutions must be extraordinarily complex and expensive. Well, some are. But almost nothing would do as much to fight starvation around the world as the ultimate low-tech solution: exclusive breast-feeding for the first six months of life. That’s the strong recommendation of the World Health Organization."

There are some errors in his column, such as his comment that the artificial infant milk manufacturers have become more "restrained" in their marketing tactics (babymilkaction) or that artificial infant milk is "pretty safe" in America, where only 13% of babies are exclusively breastfed by 6 months breastfeeding duration in the US. In Niger, the rate is only 9%. The problem is not unique to Niger either. He writes, "Next door to Niger in Burkina Faso, fewer than 7 percent of children get breast milk exclusively for six months. In Senegal it’s 14 percent; in Mauritania, 3 percent."

Kristof writes that the "biggest problem is that many mothers believe that breast milk isn’t enough, and that, on a hot day, a child needs water as well." Usually, as there is no safe source of water, infants are given water from mud puddles or other unsafe sources.

Kristof clearly gets it---that for some reason, in a country where breastfeeding until the age of two is still quite common, exclusivity is virtually non-existent. He accurately reports that babies should be exclusively breastfeed for 6 months and that malnourished mothers can still nurse their babies. He provides some excellent statistics:

"A 2008 report in The Lancet, the British medical journal, found that a baby that is partially breast-fed is 2.8 times as likely to die as a baby that is exclusively breast-fed for at least five months. A child that is not breast-fed at all is 14.4 times as likely to die."

"Over all, The Lancet said, 1.4 million child deaths could be averted each year if babies were breast-fed properly. That’s one child dying unnecessarily every 22 seconds."

He states very clearly that "The challenges with breast-feeding in poor countries are not the kinds that Western women face, and many women in the developing world continue nursing their babies for two years. The biggest problem is giving water or animal milk to babies, especially on hot days. Another is that mothers often doubt the value of colostrum, the first milk after childbirth (which is thick and  yellowish and doesn’t look much like milk), and delay nursing for a day or two."

In spite of the fact that the article draws very clear distinctions regarding the life or death consequences of making such uneducated errors in Niger, whether they be steeped in myth, have some historical intent or other cultural implications, these distinctions seemed to be lost entirely on many of Kristof's readers. In one stunning response after another, readers who were primarily American women, ignored these facts both in the NY Times and on his Facebook page.

In response to Kristof's very legitimate concerns that the practice of withholding colostrum followed by supplementing with animal milks and often-contaminated water are causing morbidity and death among millions of babies, readers argued over and over that breastfeeding is draining, difficult, painful, hard to learn and that you have to have a lot of help, clean water and good nutrition to do it and that such stress all but makes success impossible. And, of course, according to them, women with HIV cannot breastfeed.

How did they so effortlessly miss the glaring point that these mothers do not have access to clean water, much less the money to purchase powdered artificial infant milk. That not breastfeeding is the absolute risk factor here, no matter what other factors there might be. Not breastfeeding is the risk if the mother has HIV, if the mother is poorly nourished, if she is exhausted, if she is overwhelmed. Not breastfeeding means infant illness and possibly death. Not breastfeeding means a return of menses and the subsequent monthly iron loss and more pregnancies. Not breastfeeding means greater risk of HIV infection for the baby. Not breastfeeding means more family resources spent on feeding the infant instead of the mother, who can in turn nourish the infant.

How is it that intelligent people read both the facts and Kristof's conclusion and yet posted as they did? It was this question that gave me pause, that really made me ponder the implications and that gave impetus to this post.

I was curious that the reader responses were extrapolated from their own Western experiences and then applied to the mothers in Kristof's piece, who themselves never express such concerns. Yet, as if they never read the piece, those commenting make their assumptions as to how impossible it must be for these mothers to breastfeed for the very same reasons that they themselves have found it difficult. Rather than understanding that breastfeeding is the only safe option in Niger, they wrongly imagine the situation as if their own challenges have simply been transferred to a more hostile environment. It never occurs to them that it is this very hostility that makes breastfeeding essential, not optional.

One reader wrote: "I essentially agree with the logic of the article. Yes, breastmilk is superior. Yes, it has all of those good antibodies. Yes, it's free. But, from a pragmatic standpoint, there is one element that is missing: it is hard for some women to breastfeed and, often, it doesn't work no matter how hard you try." And another: "Those of you reading this who champion breastfeeding, please continue to do so, but please remember to keep your militancy and judgmentalism bottled up. Not everyone can do it."

I have no idea what those commenting imagine mothers, immersed in poverty, with very limited access to clean water, should feed their babies instead of their own milk. What seemed clear to me is that Western biases make it difficult for us to view anyone else from beyond our own paradigm where infant feeding is concerned. Perhaps American women, who assume that the challenges they themselves may face are universally inherent to breastfeeding, rather than bound in cultural bias, are at a loss as to why they experience breastfeeding the way they do.

Another comment follows: "Kristof is right to underscore the value of breastfeeding for all newborns, and particularly for those in developing nations where safe formula is unavailable, in short supply, or prohibitively expensive. ....Successful breastfeeding takes considerable work, time, patience, and loads of assistance from fellow family members and even, perhaps, outside sources."

Many mothers come to assume that breastfeeding is universally a struggle few can overcome. If we perceive the challenges familiar to American women as sufficient to warrant most of us abandoning exclusive breastfeeding, and we recognize how much more intense challenges might be in developing nations, then there is certainly a linear logic in expecting even fewer women in Niger, Burkina Faso, Mauritania or Senegal to succeed.

A common myth, frequently repeated in the comments was the belief in the need for extra food to make breastmilk:

"Breast milk is great, but it is not free. The mother needs extra calories, extra nutrition, extra fluids." 

Several writers tried to correct this myth, explaining that the body is more efficient after birth and while extra calories are used, extra food is not necessary. But, Americans, so quick to judge the cultural myths of others--such as feeding babies water that the Koran has been dipped into, held fast to their own, even in the face of new information:

"Several commenters claimed that milk-producing women require no more water or nutrients than non-milk-producing women. If this idea is true, then the water and nutrients in the milk are coming out of nowhere. The idea is as absurd as a perpetual motion machine."

Another myth they held fast to and repeatedly argued was how difficult it is for mothers to make enough milk.

"Of course breast is best, and it is especially important to encourage breastfeeding in countries where sanitation is poor, but Mr. Kristof seriously underestimates how difficult breastfeeding can be, even when the mother is highly motivated to do it. I gave birth recently, and always intended to breastfeed exclusively for at least 6 months. It didn't work out that way. I simply did not produce enough milk."

"I just want to throw out there the fact that women pay a price for constant and exclusive breastfeeding."

Interestingly, the readers tended to ignore the fact that most mothers in Niger continue breastfeeding for two years.  These mothers are not throwing in the towel. They do not, however, seem to understand that some of their choices--religious or cultural--are terribly dangerous to their babies. In the same way, American women do not seem to understand that their own feeding choices are just as likely to be culturally mis-driven, albeit more commonly by Big Pharma and the marketplace.

"I feel the author does not have a real sense of the obstacles many mothers face in producing enough milk to keep a baby satisfied and the mother in good health. I know from my own experience, as a pampered non-starving North American, that when I would so much as skip a meal, my milk supply would dwindle in a very marked way." Physiologically speaking, mothers will not be risking their milk supplies by skipping a meal. When we view breastfeeding as so fragile, we can easily find cause to expect failure.

In  general, breastfeeding was viewed in the highly touted, artificial-feeding mindset that has been the prevailing marketing strategy of artificial infant milk manufactures for the past twenty years--"Breast is best, but when you can't..."

"So my humble, non scientific opinion as to why women aren't thrilled to nurse is that it makes them feel physically terrible, and it impairs their ability to function. Like a good workout, it can be emotionally satisfying, but it's not without a steep physical toll." 

Most interesting to me is that few of the responses to Kristof's article focused on problem-solving, as they were so immersed in their own experiences and the belief that "breast is best...but when you can't" (however one might decide that), you simply don't.  If we can possibly believe that breastfeeding is just icing on the cake, nice if you can do it, but no big deal if you cannot in developing nations with no other options, it is no surprise that we think it's readily expendable in the West. 

So long as we continue to believe that milk production is a fragile process, that we need to never skip a meal, have plenty to drink, never be uncomfortable, that breastfeeding depletes us, that artificial feeding is a "safe" alternative, that we are immune to marketing and cultural biases, that breastfeeding advocates must be wary of inducing "guilt", then we will continue to view breastfeeding as optional, rather than the fact of life it is meant to be.  

Given the prevalence of reader comments imposing a Western perspective on Niger, external of the Western realities responsible for that perspective, such as medicalized birth, artificial feeding as the cultural norm, paltry parental leave policies and a pounding marketing and misinformation campaign that has lasted for 50 years, it is no surprise that the rates of exclusive breastfeeding are so poor in the West. That there can be such a significant disregard for the facts in favor of Western mythology is powerfully instructive. Consider the implication when readers draw the almost absurd conclusion that women who have no safe choice other than their own milk just cannot manage to exclusively breastfeed. If we think they cannot, even when it is a matter of life and death, it is easy to see why we have such such widespread acceptance that few American women can indeed succeed with breastfeeding, let alone exclusive breastfeeding.

Yes, we need to address the underlying issues: birth practices, misinformation, marketing, cultural biases and the lack of parental leave that all work hard against breastfeeding success. But, until mothers are given all the facts--including just how vital breastfeeding is--and how risky the alternative is--then it's a wonder that anyone would wade through the enormous challenges to find success.

And, if we continue to believe that our own experiences are universally inherent to breastfeeding, rather than culturally designed, then we are less inclined to be terribly vigilant in recognizing and avoiding the misinformation that subtly guides our decision-making. Marketing strategies, myths, lies, misinformation and other practices that cause us to struggle so much in our own efforts to breastfeed probably bring little cognitive awareness to our beliefs. The fish cannot see the water in which he swims. I suspect that this may well be the overwhelming success of the marketing strategies designed by the artificial infant milk manufacturers.

No comments:

Post a Comment