Breast is not always best for mothers

Women shouldn’t be pressurised into breastfeeding — it’s sexist and illiberal to claim that anyone who bottle-feeds is a bad mother

Features
Milk it: Formula was once a preferred method of feeding (Wellcome Library, London, CC BY 4.0)

Having a baby is hard. From sleepless nights to dirty nappies, bringing up a child is tough — but full of joy. And while social changes over the last 40 years have encouraged fathers to take a more active role in parenting, it is still the case that mothers are centre-stage when it comes to rearing children.

Sure, you might see dads with their babies in papooses walking through the park, or TV commercials with fathers waking up in the night to settle a grizzly toddler. But despite these welcome changes in gender equality, motherhood has become one of the most scrutinised parts of a woman’s life. A growing trend around “natural parenting” has refashioned old prejudices and pressures around a woman’s role in childrearing. Breastfeeding — and “nurturing” your child the natural way — has heightened the pressure on mums.

The slogan “breast is best” is well known — the claim that breast milk is superior to formula powder. And while medical evidence shows that breast milk contains antibodies and other benefits for newborns, there has also been a lot of quack science around the fetishisation of breastfeeding. Three months after I was born, in February 1992, a study was published in the Lancet which claimed that there was a “beneficial effect of human milk on neurodevelopment” — simply put, breast milk made kids smarter. Despite the fact that this was based on a study of 300 babies, and even the study itself claimed that IQ “could be explained by differences between groups in parenting skills or genetic potential”, the theory stuck. The link between IQ and breast milk remained relatively unchallenged for more than 20 years until a study of over 11,000 children conducted by researchers at Goldsmiths University in 2015 proved that there was “no reliable association” between breast milk and IQ.

As it happens, the year I was born also marked the initiation of the Baby Friendly Initiative — set up by Unicef and the World Health Organisation. Brought into force in the UK in 1995, the BFI’s main intention was to focus on breastfeeding as a preferred option to bottles. In 1999, the then Labour minister for public health Tessa Jowell launched a national campaign, spending more than £1 million to combat Britain’s low level of breastfeeding. “A mother’s breast milk is the ultimate designer food for babies. If each mother’s breast milk came in a bottle it would have a designer label,” Jowell said. This was a strange slogan to use — given the fact that the government’s main concern was that breastfeeding levels were lowest among “Britain’s poor”. It’s a rather insulting view of the working class to imagine that the government telling mothers in Slough that their breast milk was “designer” had much of an effect.

The panic over breastfeeding was in part sparked by the Nestlé scandal of the 1970s, in which the use of formula milk with unclean water caused deaths of babies in developing countries. Partly in response to the scandal, the World Health Assembly instituted the “International Code of Marketing of Breast-milk Substitutes” in 1981 which banned all “promotion of breast milk substitutes, bottles and teats to the general public” as well as preventing health professionals from promoting formula milk to new mothers. Similar legislation followed — including a 33-page commission directive from the European Union on formula milk which prohibited its promotion to mothers. The pro-breastfeeding group La Leche League has even said it fears Brexit might mean mothers will no longer be safeguarded from the evils of formula milk promotion by EU law.

But formula milk didn’t always get such a bad rap: it was once the preferred method of feeding for more well-off women. Brid Hehir, a retired midwife, told me what life was like for new mothers in the 1970s. “I’ve seen it go from a complete emphasis on bottle-feeding to one on breastfeeding,” she said. “In Dublin, where I trained and worked as a midwife in the early 1970s, most women were expected to bottle-feed. It was only poor women who couldn’t afford formula who breast fed.” For Hehir, the invention of better-quality, cheaper, pre-made formula was a boon for women. She and her colleagues were teaching new mothers how to prepare formula milk for their children until the late 1980s. Having worked as a midwife for decades, Hehir says she has always believed that formula milk is “perfectly adequate as an alternative to breast milk”. The important thing is that women make their own decisions on what type of feeding process they want to pursue.

I asked my mother what it was like to have two children (my brother and me) in the early 1990s when the push for breastfeeding was gathering momentum in the UK. “I tried for the first three months, but what no one prepares you for is how hard breastfeeding is,” she said. “Unlike bottle-feeding, you have to be on call for your baby all the time because you’re the one with the breasts. After a few months of struggling with late-night feeds, I realised that you would be happier if I was happier. Bottle-feeding gave me the freedom to be your mother and my own person.” Did she feel guilty for going against the wisdom of the time? “Yes, especially when I had my second child, because by that point formula milk was considered to be the wrong option. If you were a good mother, you were expected to drop everything for your kids — dedicating yourself to feeding them the natural way. There was a class element to it too: you’ll usually find that the women who can sacrifice the time and effort it takes to breastfeed are those who don’t have to work or take care of other responsibilities.”

What is the experience of women today? I spoke to a retired health visitor who is now volunteering at a Baby Café in London — a group linked to Unicef’s Baby Friendly Initiative. Sarah (not her real name) was adamant that there was no judgment on women who didn’t breastfeed. “I don’t think that they are pressurised into breastfeeding: a lot of women come to the Baby Café for support.” When I asked Sarah about the benefits of breastfeeding, she said: “Part of it is the bonding, part is the nutrition within the milk, part is the immunity it gives children in the reduction of allergies.” Do the volunteers tell women at the Baby Café that breastfeeding is better than bottle-feeding? Sarah said that support is given whatever a woman chooses to do, but admitted that the Cafés were there to promote breastfeeding, rather than as an unbiased source of information for new mothers. She told me that campaigners and “breastfeeding advisers” no longer use the term “breast is best”, preferring now to tell women that “breast is normal”. But if “best” sounded hectoring when it comes to getting women to breastfeed, the not-so-subtle suggestion that bottle-feeding is “abnormal” doesn’t seem like an empowering message for women.

It’s this desire to influence women’s personal decisions about how they raise their children that seems so intrusive. Dr Jan Macvarish, a sociologist and visiting research fellow at the Centre for Parenting Culture Studies in the University of Kent, tells me: “The breast is best message poses probably the defining dilemma for pregnant women and new mothers: what to do when ‘breast’ does not, in fact, seem to be ‘best’ at all.” Macvarish says the subtext of the pro-breastfeeding message is that mothers who don’t choose to do it are doing something wrong. “On top of recovering from labour, dealing with sleepless nights and adjusting to a new role, struggling to breastfeed can rob new motherhood of its pleasures,” she says. “There is increasing evidence that this pressure can make early motherhood intolerable, especially when a woman’s desire to breastfeed founders on the reality of her own body’s or her baby’s reluctance to comply.” Despite breastfeeding enthusiasts claiming to be sympathetic to women who can’t breastfeed, it’s a different story when women simply choose not to. If you haven’t laboured over getting your baby to latch on, you haven’t really tried hard enough to do what’s best for your child. If you simply choose to bottle-feed, perhaps because you just don’t like the idea of breastfeeding, you’re a bad mother.

This was the experience of Dr Ashley Frawley, senior lecturer in public health, policy and social sciences at the University of Swansea, and a mother of of two. “It was absolutely horrible when I had my first child,” she told me. “I got so much ‘advice’ in the hospital that it felt like information overload. Ironically, because they made it seem like it was far beyond my capabilities to breastfeed, because they made such a fuss of it, I felt it almost impossible to do. I remember being in the shower and asking someone to give my baby a formula feed just so I could have the time to have a shower and get a bit of sleep. I was told my baby was hungry — as if I didn’t already know that.” Frawley told me about a conference she organised on breastfeeding at Swansea, at which a midwife informed a mother that giving a child formula milk was like “sticking a cigarette in its mouth”.

But it isn’t just government departments, EU campaigners and fussy health professionals pushing women to breastfeed, it’s often feminists who demand that breast is best. Take the #freethenipple campaign. After several high-profile incidents, including a breastfeeding mother being asked to leave the restaurant at Claridge’s hotel in London, the campaign claimed that women were being stigmatised for breastfeeding in public. The poet Hollie McNish’s poem “Embarrassed”, a hit in 2016,  argued that women were being forced to hide their breastfeeding from the scrutinising eyes of society’s prudes. Behind it all, McNish argued, was the “cocaine generation white powder”, the idea that the “milk-makers” thrived off the embarrassment around breastfeeding because it pushed women towards using formula milk. Rather than fight for women’s freedom to choose what they feed their children — formula or breast — feminists are arguing that women are being hoodwinked into allowing their babies to get hooked on formula. Either way you look at it, the message is clear: women can’t be trusted to decide for themselves.

I imagine I’ll probably  give breastfeeding a go when I have a baby, even if it’s just because I’ve heard it helps you lose the baby weight quicker. But the idea that I would be doing something wrong, abnormal or uninformed if I chose to bottle-feed is sexist. It’s the same trope that was used to keep women in their place in the past: that women, not men, are the natural caregivers for children. That seems to me like a pretty convenient way to let men off the hook when it comes to sharing the load of raising a child.

Most women will do what they think is best for their children, and most mothers will put their children’s needs before their own. But when it comes to weighing up what’s best for mother and child, we should always champion the importance of women’s rights and women’s freedom first and foremost. I suspect that what is beneath the more militant lactivists’ concern for babies is really an expression of a middle-class suspicion of the capabilities of working-class mothers to raise their kids properly. In that sense, the tyranny of breast-is-best has nothing to do with the wellbeing of children, but rather a desire to control the actions of poorer mothers. Speaking as a bottle-fed child, I can assure the Islington mums worrying about my wellbeing that formula milk didn’t hamper my ability to smell a moral panic. If we want women to be happy, healthy mums, we should make sure they have all the information. But, in the end, if women feel they don’t have the freedom to choose what kind of parent they want to be, all the breast milk in the world won’t help them.