ISCHP

By Eva Neely, April 2019

Sparked by the release of yet another parenting book, I recently found myself on the social media sidelines of yet another heated breast versus bottle dispute. At the heart of the breastfeeding/bottle-feeding debate lies the desire to determine the right way to infant feed. Yet, as we know, when it comes to childrearing there is no universal ‘right’ way. These ‘milk wars’ simply distract us from addressing what actually matters.

We know that breastfeeding provides many benefits and that from an evolutionary perspective it is the norm. This ‘natural’ approach brings a range of benefits to both infant and mother, when it can be practiced. When it cannot, we also know that formula offers a nutritious alternative for babies. The issue should no longer be about the better way to provide infants with the nutrition they need. Rather, we should be attending to the elephant in the room: the mismatch between mothers and the context in which they are expected to (breast)feed.

These ‘milk wars’ simply distract us from addressing what actually matters.

Allowing public discourse on mothering to centre on which practice is superior to another neglects the contextual factors enabling and disabling feeding practices. It individualises infant feeding practices. When we promote a particular practice without recognising the context in which it occurs, we risk creating an illusion of how that practice could be carried out. We begin to prescribe universal norms and even to shame those women who cannot attain these. We try to pursue evolutionary, traditional, even ‘natural’ ways of parenting in a modern Western world and we present it as if it is easy; simply a matter of choosing what is best for a child. However, the current context in which infant feeding occurs does not match the one in which the practice evolved.

Contextual factors also include women’s history and life circumstances. Historically, women were not in the workforce, nor were they isolated, but rather embedded within communities. The context for new mothers was quite different. Modern tools such as the breast pump have enabled some women to manage work and breastfeeding, but clearly this isn’t the evolutionary norm. Equally, when women were closely connected within a community, there was knowledge and support on hand, and wet nursing when a woman could not breastfeed. These examples demonstrate that we do not provide the right context for women to ‘succeed’ in breastfeeding.

For that reason, rather than framing breastfeeding as simply a matter of individual choice, we can, and should, challenge the system. We should collectively demand that services, systems, and resources are strengthened to enable breastfeeding for those women who wish to feed in this way.  Let’s also ask ourselves how we can recreate an environment, a context, conducive to exclusive breastfeeding. Let’s set the measures of failure on the environment, rather than making mothers feel like they have failed. If we place the role of the environment at the forefront of breastfeeding success, then we can easily determine if the system, support, or environment failed a mother in her journey to breastfeed.

Rather than setting up a research agenda that aims to dilute the benefits of breastfeeding—and, yet again, find out why and how women don’t breastfeed enough—let’s change the research questions. Let’s ask:

How can we create a supportive breastfeeding environment?

How can we ensure equitable breastfeeding support for all women?

How can we allow women time to breastfeed?

Of course, I am not the first to raise these questions. There are some excellent scholars out there in pursuit of answers to similar questions, but this issue also needs to be reframed in the public domain. We need to highlight the practice-context mismatch in public discussion and in media domains to progress public discourse on this issue. Hopefully, this will enable dialogue rather than fights. A dialogue in which we say “your context matters, nobody else’s does”, and in which we do not always need to seek ‘evidence’ on the benefits of practice X versus practice Y. Simply put, a dialogue in which we can determine which practices are achievable in a particular context and support those.

Framing breastfeeding as reliant on support, systems, and environments—rather than as a matter of choice as the current debate frames it—will allow the development of an increasingly broad research and political agenda that will ask the right questions and seek solutions that build a context that is conducive to breastfeeding.

If we can challenge and change the discussion from a battle between the benefits of breastfeeding versus formula to the importance of understanding the context of breastfeeding practices (and, in fact, for any parenting practice), then we can come together and work towards sustainable and impactful change for mothers and their infants.

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Dr Eva Neely is a Lecturer in Health Promotion in the School of Health at Victoria University Wellington, New Zealand. She has a particular interest in health promotion using strengths-based and empowerment-focused approaches to health and wellbeing particularly across childhood, adolescence, and motherhood. She is passionate about context-driven, participatory and reflexive qualitative research. Her teaching and research pursue approaches that challenge the status quo and advocate for social change and equity. She has strong links to communities and NGOs to promote practice-relevant research and sits on various governance groups and editorial boards.