When done well, breast-feeding advocacy works to expand women’s choices by way of support and education for new moms. When done poorly—as a good amount of it is—this advocacy barrages women with overstated claims about the benefits of breast-feeding and commands them to do whatever it takes to breast-feed their children, no matter the toll. There’s little acknowledgment that women should have a choice in the matter, nor is there an understanding that a lot of women simply don’t have the freedom to choose.
This blind spot is, thankfully, absent from a recent op-ed by Jennifer Grayson, author of the new book Unlatched: The Evolution of Breastfeeding and the Making of a Controversy. Writing in the Los Angeles Times, Grayson explains just how much harder it is for poor women to breast-feed their babies. She compares the experience of an affluent Hollywood actress who breast-feeds her 1-year-old to that of a Guatemalan immigrant who feeds her 2-month-old formula. The former has a live-in nurse and access to quality health care and lactation consultants. The latter, like many Americans, lacks paid leave.
“I know both women want the best for their babies: healthy childhoods and, later, adult lives filled with promise. Yet these two mothers—and those who fall between the extremes they represent—live in a nation where the fundamental ability to nourish their young with free, life-sustaining mother's milk has been turned into a luxury for the elite, or a hard-fought prize for the intrepid,” Grayson writes.
Now, breast-feeding is not free; it requires time and energy, physical and emotional, which some women can’t spare. While Grayson doesn’t state this explicitly (in fact, she states the opposite), the rest of her essay makes the point very effectively. She looks at data from the federal Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, and finds that many low-income women initially opt for packages designed for breast-feeders but then switch over to formula-feeding ones. Reasons for this switch include an inability to find the time to take advantage of WIC’s free lactation support, that many of their employers don’t provide them with the legally mandated nursing breaks and a clean, private space to pump, and the fact that many of them lack paid leave and can’t afford to stay home with their infants following childbirth. Grayson also points out that many women don’t have access to baby-friendly hospitals, or hospitals where babies aren't sent to sleep in a nursery (and sleep near their mom instead) or given formula unless medically necessary. However, a recent study suggests that these programs may not be effective in increasing breast-feeding rates after all. (They are effective in increasing some moms’ unhappiness though.)
Other research confirms the relationship between access to paid leave and baby feeding decisions. A 2011 study published in Pediatrics found that women who go back to work shortly after having a baby are less likely to breast-feed their children than those who don’t, and a 2013 survey from Childbirth Connection found that half of new moms say their employment status will affect how they feed their baby. Recent data from the Centers for Disease Control and Prevention reveals a disparity between the breast-feeding rates of wealthy women and those of low-income women and minorities—again, the women who are least likely to have paid leave.
Advocating for motherhood-related issues is a delicate act. In order to improve things like maternity care and support for new mothers, including breast-feeding, advocates need to explain why mothers are so important. Unfortunately, this importance often gets exaggerated, and women are made to feel as though their own efforts as mothers are inadequate or as if their biology is destiny. The trick then is to show that motherhood matters—but not too much. If breast-feeding advocates would dedicate more of their energy to advocating for paid leave, as opposed to warning women about the evils of formula or extolling the magic of breast milk, they would do just this. There would be more opportunity for women who want to breast-feed and less judgement for those who don’t.