How society influences women's decisions
by Amy Spangler
Despite compelling evidence of the benefits
of breastfeeding, less than one-half of the nearly 4 million babies
born each year in the United States are exclusively breastfed, most
for less than 3 months. The changing role of women in society has
significantly impacted parenting practices, including breastfeeding.
Over 50 percent of women with young children work outside the home.
Coupled with the increase in the number of single-parent families,
parents today face considerable challenges as they adapt their
parenting style to individual circumstances. But adaptation should not
mean discounting or sidestepping the biological needs of our children.
Rather, it calls for modifying personal lifestyle choices so that the
basic physical and emotional needs of our children are met.
Parenting, like many life experiences, takes place within the
framework of culture. Culture is the accumulation of beliefs,
assumptions, customs, superstitions, prejudices, and attitudes.
Culture shapes the way we interact with one another, the way we parent
our children, the decision to breastfeed. Western culture is often out
of sync with babies' most basic, biological needs. Many modern-day
parenting practices discourage breastfeeding, and the emphasis placed
on having the 'perfect' figure makes many women insecure about
their ability to breastfeed their babies.
Biology vs. culture: What is best for my
baby?
Biology determines babies' needs, but
cultural expectations and personal situations influence how parents
respond to those needs. During the first few months after a baby is
born, parents are bombarded with many choices that will affect their
baby's growth and development. Should I feed on request or put my
baby on a strict schedule? Do I pick my baby up when she cries or let
her learn to calm herself? Should my baby sleep with me or in her own
room? When babies' biological needs and existing cultural norms are
at odds with each other, parents sometimes make decisions that do not
optimize growth and development, and can even be harmful.
We know from biology, for example, that a baby has a small stomach,
that human milk is quickly and easily digested, and that a baby needs
to eat every 1-3 hours or 8-12 times each day. But because
industrialized Western cultures value babies that sleep through the
night, parents devise strategies to achieve this goal, such as
introducing solid foods at an early age, feeding at predetermined
intervals, and allowing babies to cry for extended periods of time.
Similarly, because independence and autonomy are highly valued in
Western culture, babies often are left to sleep alone in their cribs
at night, and are placed in playpens or carried in strollers during
the day. Interestingly, babies in Western cultures are reported to cry
more often and experience symptoms of colic much more frequently than
babies in cultures where slings are used routinely during the day and
babies sleep with parents at night, breastfeeding whenever they
choose. Although the desire to do what is best for one's baby is
shared by parents around the globe, different cultures disagree about
what defines "best" parenting practices.
Cultural norms make women insecure
Cultural norms in the United States are so
influential that women often choose not to breastfeed for purely
social reasons, not because they believe that formula provides better
nourishment for their babies. Few will argue that breasts are intended
to feed babies. Yet formula feeding has become a sign of modernity,
freedom, sophistication, and affluence. In many cultures, including
ours, breasts are viewed as sexual objects and women worry that they
will not be able to make enough milk to meet their babies' needs.
Insufficient milk is the most common reason given by women for
stopping breastfeeding. Studies suggest that 25-50 percent of women
"believe" their milk supply is insufficient, primarily
because their babies are fussy after feedings. Yet, careful
examination shows that only 1-2 percent are truly unable to produce
adequate milk.1 Nevertheless, perceived insufficient milk
supply is a reality for many mothers and negatively impacts
breastfeeding behavior. It is interesting to note that perceived
insufficient milk and other problems related to infant feeding -
such as colic - are only reported in Western cultures.
Another myth that has plagued Western cultures is the belief that
women who breastfeed are more likely to have breasts that sag or
droop. Although many women report breast changes after breastfeeding,
evidence suggests that breast changes occur in all women regardless of
feeding choice, and are due primarily to heredity, age, and weight
gain.
Support for breastfeeding is on the horizon
The time is right to dispel popular myths
and address the interplay between a mother's needs and the needs of
her baby. For example, the beliefs that babies need to be fed only at
designated times and that co-sleeping will foster unhealthy
dependency, need to be evaluated within the context of the culture in
which they occur.
There have been significant increases in breastfeeding among
well-educated, older, and middle and upper income women in the United
States. However, breastfeeding rates among poorly educated and
economically disadvantaged populations remain well below our nation's
Healthy People 2000 goals.2 To eliminate these disparities,
professional organizations and governmental agencies have joined
together and formed the United States Breastfeeding Committee. The
formation of this collaborative partnership represents the first step
toward the development and dissemination of a strategic plan for
protecting, promoting, and supporting breastfeeding in the United
States. This plan will minimize duplication of efforts, maximize
utilization of resources, and optimize outcomes.
Cultural changes occur over time. In the face of resistance, policy or
legislation can serve to accelerate the process. In 1997, the American
Academy of Pediatrics issued a breastfeeding policy statement
recommending that all babies, with rare exceptions, be exclusively
breastfed for the first 6 months of life, and that breastfeeding
continue, in combination with complementary foods, for the second 6
months of life and beyond as mutually desired.3 Currently
25 states have laws that protect a mother's right to breastfeed in
public and many corporations have maternity leave policies, benefits,
and work options that support breastfeeding initiation and
continuation. Rooms for breast-pumping or breastfeeding, onsite child
care, and flexible work schedules that allow mothers to breastfeed or
express milk during the work day are more and more common as employers
recognize that parents of breastfed babies miss fewer work days.
The benefits of breastfeeding are still unfolding. Evidence and common
sense tell us that no variable is more important in determining a
child's future outcome than the contribution parents make to his or
her upbringing, and there is no better example of that contribution
than the choice to breastfeed. We owe it to our children. We owe it to
ourselves.
- Hill PD. The Enigma of Insufficient Milk Supply, Maternal
Child Nursing 16(2):313-316, Nov/Dec 1991.
- Healthy People 2000 National Health Promotion and
Disease Prevention Objectives. DHHS Publication No. (PHS)
91-50213.
- American Academy Pediatrics, Work Group on
Breastfeeding: Breastfeeding and the use of human milk, Pediatrics,
100:1035-1039, 1997.
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