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This is a wonderful article written by one our our BirthWorks Educators and Trainers, Joan-e Rapine. This article was also published in our newsletter, vol. 7 issue 3. Breasfeeding – Not So Pure & Simple Excerpts from a paper on Beyond the Breast-Bottle Controversy by Penny Van Esterik (Rutgers, 1989) By Joan-e Rapine, CCE The breast-bottle controversy goes far beyond boycotting a product or its manufacturer. In her book Beyond the Breast-Bottle Controversy, Penny Van Esterik examines the controversy from every possible angle and brings up many points to consider, such as the environment in which many women live, medicalization of infant feeding, turning infant feeding into a status symbol, and breastfeeding as a feminist issue. As to existing studies, Van Esterik says: "What is significant is what does not get researched, what questions are not asked" (16). It is easy to question people's choices when they have everything available to them and all resources at their disposal. However, when people live in poverty with limited resources, if any at all, questioning their decisions would be unfair and inappropriate. Many people, especially in developing countries, have no choices available to them. There are women who breastfeed because that's the only choice they have, while others 'choose' not to because of physical and emotional constraints. I have seen families living in the streets of Lima, Peru – a mother sitting on a dirty old tarp, selling lemons, while her children take turns at her breast. Children as old as nine or ten were nursing, probably the only 'meal' available to them that day. That mother may have had no choice but to breastfeed when her babies were born; she most likely could not afford not to. On the other hand, there are women who have to earn a living and cannot afford to stay with their babies and breastfeed (I am referring to women, in developing and developed countries, who will die of starvation if they do not earn a living). There are also women who are so malnourished, due to poverty, that they are unable to produce milk. All of these situations are not a matter of choice, but harsh realities of many women around the world. Some women live in such inhumane conditions, that they lack the spirit it takes to protect their infants and do what is best for them. As Van Esterik wrote: "The cold, damp mountain air blows through the flimsy walls of the shack, chilling Rosa's body and soul and reducing her will to struggle for her infant sons " (36). Although technically countries are separately governed, they are part of the "world system" (55-63), which Van Esterik describes as a "unified hierarchical system" (55). As long as economy and politics continue to influence all parts of the world, breastfeeding mothers will face many challenges in their decision-making. "Certainly, …women have some choices as to how they participate in the world system, but they cannot choose not to participate in it" (62). One of the world system's effects is that women living in poverty are not only influenced by their poor living conditions, but by the aid they receive. When I lived in Guatemala I helped distribute the monthly shipment of food aid, which provided the local 'poor' villagers with powdered milk and refined flour, sugar and rice. Not only are these foods traditionally not used in Guatemala, they provide no nutritional value and may contribute to weakened immunity and disease. Nursing mothers were the main target of this aid and many accepted the food articles, believing them to be healthier than their own traditional rice (unrefined) and beans. Ultimately, it was the nursing infants who suffered from their mothers' poor nutrition. Other women accepted the food, but did not use it themselves. Instead, they sold it and used the money to purchase corn, beans, molasses, and vegetables. It seemed that the more remote the village and the simpler the people lived, the healthier the choices they made. Another way the world system affects infant feeding in developing countries is by allowing companies to advertise formula as the better choice. Most new mothers want the best for their babies and are easily influenced by advertisements for 'better' ways to care for their babies. Mothers are convinced that formula is superior to breastmilk and, despite their poverty, they purchase the pricey infant food. Many mothers cannot afford to buy the formula regularly and 'stretch' it to make it last longer by diluting it, which of course deprives the infant of whatever nourishment formula actually has. In addition, most families lack the means for proper use of formula, such as clean water, refrigeration and ways to sanitize the bottles and nipples. I have helped treat many bottle-fed babies, gravely ill with cholera and a variety of parasites whose mothers used unserilized water. When those mothers were asked to their reasons for not breastfeeding, they usually replied that they wanted to be like American mothers. Whether American mothers breast or bottle-feed is not the issue, but what the formula companies are telling mothers in developing countries. In addition to being advertised as a superior infant food, artificial infant foods have also become a status symbol. Since formula can be costly, only wealthy women would be able to afford it, so when a mother is seen bottle-feeding her infant, it may be easily assumed that she is wealthy. She now has status. In addition, with the world becoming more technological, technology equals advancement. When formula is described as "scientifically designed" and "developed", or as "new and modern" (178), women wanting to be viewed as advanced would choose formula over 'primitive' breastfeeding. New mothers are also very vulnerable and have many fears about their ability, or inability, to breastfeed successfully. One of their greatest fears seems to be having an insufficient amount of milk. Formula manufacturers take advantage of this fear and provide a 'solution' in the way of supplementation with formula, which is likely to cause milk production to decrease. Once the mother's fear has manifested she becomes very thankful for the supplementation, unaware that it may have been the cause of the problem in the first place. This makes "infant formula manufacturers… both the cause and the cure" (128) for the problem. Even well educated women in western societies fall prey to this game. They fail to recognize formula as the problem, disguised as the solution. As technology advanced, doctors became an authority on almost everything, including childbirth, breastfeeding and childrearing. The medical profession has created a dependency on medicine and doctors by labeling normal conditions as diseased ones and then creating medications to correct them (112). Infant feeding, too, has fallen under the jurisdiction of doctors and has 'earned' itself a set of rules and regulations. Mothers are advised by their doctors on how long and how often they should breastfeed their babies. Since breastfeeding offers no financial advantage for anyone but the breastfeeding mother, it is not beneficial to promote it. Unfortunately, the physiological and psychological benefits do not count when it comes to politics and economy. I feel that medical doctors have no place in the world of mothers and infants (except for when true medical assistance is needed). Doctors are trained in treatment of disease, and pregnancy, childbirth and breastfeeding are normal processes that do not require treatment. Mothers need guidance and support through patience and love- things most doctors are not trained in. When a natural process is portrayed as abnormal or diseased, it is difficult to see it as anything but that. Furthermore, the medical profession has become partners with infant formula manufacturers (143). This partnership may not be officially documented, however, they depend on and promote each other. I find it very disturbing and have lost my trust in the medical profession. The decision to breastfeed depends on so many factors – some of which are in the mother's control, but many are not. It seems that world economy and politics play the biggest role, and while well intending individuals and organizations may focus their attention on the mothers, perhaps global attention is needed. Van Esterik quotes Dr. Vicente Navarro, Professor of Public Policy, Sociology and Policy Studies: "The greatest potential for improving the health of our citizens is not primarily through changes in the behaviors of individuals, but primarily though changes in the patterns of control, structure, and behaviors of our economic and political system" (150-1). While breastfeeding is individual and intimate, it is affected by worldwide factors. Our goal should be "not to have every woman breastfeed her infant, but to create conditions in individuals, households, communities, and nations so that every women could" (211). We must begin to question global environment and its effect on what we eat and breathe. We must also question world economy and the effect that greed has on our future. When evaluating the breast-bottle controversy it's easy to get lost in statistics and facts. However, breastfeeding is a very personal choice and may not always be easily explained in a scientific factual way. Women "may well find they have no words, models, or metaphors for expressing this intimate power" (107). This may render the whole issue of breastfeeding difficult to study on a scientific level because one must rely on truths that may not be supported by facts. When examining breastfeeding it is important to keep in mind that "there's a world of difference between truth and facts. Facts can obscure the truth" (Maya Angelou), and as Van Esterik has conveyed so well in her book, there are many truths to breastfeeding.