Clarifying the Issues

Stories developed from WABA's Breastfeeding, Women and Work Seminar in Manila

by Mavic Cabrera-Balleza

As a young mother in the early '70s doing field research in rural Thailand, breastfeeding came as a natural choice. For Penny Van Esterik, professor of anthropology at the York University in Toronto, Canada, founding member of World Alliance for Breastfeeding Action (WABA) and a renowned breastfeeding advocate. Breastfeeding meant convenience and savings that amounted to US$70 a month at that time. But it wasn't until 10 years later that Penny considered breastfeeding a feminist and globalisation issue.

But in Thailand in the '70s, Penny's breastfeeding drew mixed reactions. Like everywhere in the world, Thailand was bombarded with infant formulas that companies aggressively marketed. Convinced of the benefits of infant formula, Penny's university colleagues were horrified that she was breastfeeding. But the women in the rural village where Penny worked were upset to learn that Penny was thinking of weaning her daughter at 16 months. They thought Penny was pregnant again because no one among the rural women would wean their child from their breasts unless they were pregnant. And when Penny took her 15-month old child Chandra to the paediatrician when the child had diarrhoea, the paediatrician told her that breast milk caused the diarrhoea and he gave Penny free samples of the infant milk Lactogen.

Reflecting now on her experience with the paediatrician, Penny admits getting really angry towards such partiality for infant formula. However, after studying the issue, Penny now understands the processes that brought about the preference for processed cow's milk.

Breastfeeding as a Feminist Issue

Many feminists are lukewarm to breastfeeding. Some feminists say that reinforces women's traditional roles as caregivers and nurturers.

Yet, breastfeeding advocates like Penny also claim that breastfeeding is a feminist issue precisely because "it's about women's control over their bodies." She adds that breastfeeding challenges media's image of women as consumers and as sex objects with firm breasts. "I'd like women to fully understand the health benefits of breastfeeding for them and not just for their babies. I'd like them to re-value motherhood without romanticising it. I think breastfeeding requires us to rethink the relation between women's productive and reproductive roles."

Penny says women's groups have to make choices about issues on which to concentrate but underscores that breastfeeding conforms to the women's movement's long-term goals, which is to improve the position and condition of women.

In the issue of breastfeeding, Penny says women rely first and foremost on other women. "Most conventional doctors are likely to succumb to the aggressive marketing strategies of infant formula manufacturers and are therefore not good allies. Women's unity on the issue of breastfeeding demonstrates in the clearest of terms the solidarity among women," she notes. "The best indicator of success would be when there are no more breastfeeding advocacy groups because all women's groups have become supportive of the practice. What I want is for the women's movement to work on biological and cultural explanations together, and that would require the power of linking together productive and reproductive lives."

Elaborating on the basis of solidarity, Penny points out that breastfeeding intersects with the issues of sexuality, AIDS, and women's health. It intersects with globalisation, which makes it harder for parents to spend time with their children because of the changes in working conditions. It intersects with the issue of processed food that adults and babies consume. The breastfeeding movement interacts with the consumer movement. Penny says that breastfeeding helps clarify issues. "However, most books about the women's movement do not mention breastfeeding as if women don't have breasts. The women's health movement concentrates more on issues around menstruation, childbirth, and menopause. I think they skipped breastfeeding because it's a complicated issue of choice. I hope women will soon re-examine it as a model for many of the struggles we are engaged in."

Penny was in Quezon City, Philippines last 1-5 June 1998 for the World Alliance for Breastfeeding Action (WABA) international conference. The event led to the "Quezon City Declaration on Breastfeeding, Women and Work." The declaration, Penny says, is remarkable given the tremendous cultural differences amongst the participants. The event also came out with a concrete plan of action on how the participants can accomplish the goals spelled out in the declaration. Penny says the declaration then "becomes a tool for participants and it is up to them to transform the declaration into a set of guidelines that they can take to their organisations in order to accomplish their national goals."

A Question of Choice and Human Rights

Penny is aware that women's groups object to the bracketing of women and children together because this reinforces the notion that women's rights come from their role as mothers. But Penny believes that breastfeeding is where the woman's and the child's right converge. She frames the issue as "a woman's right to breastfeed" and questions the idea of separating a woman's rights from a child's right. "So you have to make a special consideration. It sounds awkward but I call it the woman-child right. You cannot separate them."

On the question of whether it is a woman's choice to breastfeed or not, Penny expounds: "I think it's better to think of it as a woman's choice to have children or not. If she chooses to have children she must have all the possible information about the options, and that's not enough. She has to have all the support from the community and family. In my opinion, if she has support and knowledge, she would probably breastfeed. But I don't like it when women tell other women about politically correct breastfeeding: that women have to do it this way, for this number of months. Women do the best they can under difficult circumstances." But what if despite all the information and support, a woman still chooses not to breastfeed? Penny remarks, "I would feel sadness for her missing a very important experience of being female and would think that she may be living in a community where she didn't get a lot of support. I would hope though that she's not made to feel guilty and less of a mother."

Penny dislikes coercion and believes that the promotion of breastfeeding may result in the insensitivity of some health workers who force women to breastfeed. "I think that's absolutely terrible," she adds. Penny cites programs in Scandinavian countries where breastfeeding support groups welcome bottlefeeding mothers in the hope that they will learn and be encouraged by breastfeeding mothers in the centres.

Male Support

Lately, some sections of the women's movement are talking of male support and male involvement in women's causes and Penny sees how this is also significant in breastfeeding. "Some women's groups I know prefer renegotiating the sexual division of labour. One common arrangement is for women to take on the feeding responsibility during the breastfeeding period. When the time for complementary feeding comes, the male partner takes charge. Male support also concerns the attempt to change the attitude of other men around and educating their sons that women are not sex objects made up of breasts. Particularly for women survivors of domestic violence, it is absolutely critical to have a strong partner support."

Gains and Backlash

The worldwide breastfeeding movement has made many gains. Foremost among these are international instruments including human rights instruments supporting breastfeeding. Examples are the Innocenti Declaration and the Declaration on the Rights of the Child. But perhaps the most important has been the Code for the Marketing of Breast Milk Substitutes. Sponsored by the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF), the code, which took effect in 1981, instructs infant formula companies not to promote their products as substitutes for breast milk. This led to the inclusion in infant formula labels of the advice that "breast milk is best for babies up to two years."

Yet, Penny quickly adds that this did not result in major losses for milk companies. "Multinational milk companies are in an endless search for new markets. New kinds of milk such as milk for toddlers, milk for growing kids, even milk for pregnant women and breastfeeding mothers are in the market. Strictly speaking," Penny clarifies, "there is nothing wrong with huge consumption of a food item but the question is whether it is the right food. Is the amount of money spent on buying this processed food item worth its nutritive value? We need to make a very careful analysis and, ideally, a feminist analysis of food marketing," says Penny.

But all is not smooth sailing as breastfeeding experiences a backlash "from people who don't understand the issue very thoroughly and from people who have a vested interest in talking about women's right to choose between breastfeeding or bottlefeeding." Penny reiterates that this is where the danger in politically correct breastfeeding comes in, when bottlefeeding mothers don't get as much support in other aspects of child rearing. "You have to support women where they are and I don't like the idea of coercion or making a woman feel guilty." Penny also notes that women should be vigilant all the time especially since fence sitters are wont to say, "oh, the boycott was so successful. Now Nestle and all these companies have changed their practices so why don't you just let up. It's all over." It's far from over, Penny declares. "Milk companies have only become more sophisticated in their marketing strategies. There are also trade agreements amongst countries that in fact gives corporations so much power that they wouldn't even have to listen to governments," Penny stresses.

Breastfeeding and Food Security

Food security may be a complex issue but Penny is convinced that food security and breastfeeding are tightly linked. "For the 140 million babies born every year, breastfeeding is food security for them for the first six months. And it is probably the most important item of their first two years and beyond. Breastfeeding is a very simple, straightforward situation where the total nutritional needs of 140 million human beings are met. We should note that at households, particularly of poor families, money that infant formula would otherwise drain from the budget can go to other food items for the family."

Penny adds that the myth that milk is necessary in a healthy diet should be debunked. Humans, she says, need milk until our fourth or fifth year. Beyond that age, milk is not really necessary because there are other sources of its nutrients. "When I did my field work in Thailand, fresh milk was hardly available. There was only instant formula and this awful milk powder. Soon there was a huge marketing push for the dairy products from Europe, Australia, and New Zealand. And now Thai children get milk at school even though a large portion of the population is lactose intolerant," says Penny.

"Concern for food security should begin from the moment of conception. It starts with ensuring pregnant women with an adequate diet and continues to proper feeding of infants, children, and certainly adults. We breastfeeding advocates want to see breastfeeding considered part of a national food security plan. We want to explore the idea of including breast milk in the calculation of a country's food supply and the food balance sheet. We expect a lot of resistance but at least we're beginning to discuss the issue."