© Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jasper Cole/Getty Images © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC BreastfeedingNOT FOR SALE OR DISTRIBUTION and NOTLactation: FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALERoots OR DISTRIBUTION and WingsNOT FOR SALE OR DISTRIBUTION

Paige Hall Smith and Ellen Chetwynd © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONcontexts in which this NOTshared FOR care SALEand responsibil OR DISTRIBUTION- ▸▸ Introduction ity for ­children occurred among humans and other Humans, like all other mammals, are born biologically ­species, it also included shared lactation (Hrdy, 2009). adapted to species-specific milk as a complete source Shared lactation can be found among many mammals, of© nutrition.Jones & ButBartlett lactation Learning, is more LLCthan nutrition such as© meerkats Jones &and Bartlett wolves, Learning,but in ethnographic LLC alone;NOT itFOR is also SALE a means OR of DISTRIBUTION bonding, nurturing, and descriptionsNOT ofFOR typical SALE foraging OR DISTRIBUTIONcultures worldwide, caring. The same hormones that drive milk letdown shared lactation is described in 87% of the 64 cultures (oxytocin) and production (prolactin) enhance our that have been studied (Hewlett, 1996). For example, parenting instincts for men as well as women. Both cultures as widespread as the Ongee foragers off the males and females secrete oxytocin and prolactin in coast of India, the Trobriand Islanders in the Pacific, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC response to parenting behaviors, but it is usually only and the Efe in Africa all engage in various forms of NOT FOR SALEfemales OR who DISTRIBUTION go on to develop the biological capacityNOT FORshared SALE ­lactation OR (Hrdy,DISTRIBUTION 2009). to lactate, beginning in adolescence and continuing Our evolution suggests that human culture is far through adulthood. from prescribed; rather, we are complex and adapt- We think of the iconic early human mother as able, and this has led to an almost endless array of par- one with her nursing© Jones child by& Bartletther side or Learning, carried in LLCenting styles and cultural© norms Jones around & Bartlett infant feeding Learning, LLC her arms—the soleNOT mother, FOR the SALE sole parent OR DISTRIBUTIONcaring for and care. In our currentNOT culture, FOR the SALEright and OR ability DISTRIBUTION her young. This view really reflects our current cul- of mothers to be consistently near her child are con- tural norms. In industrialized countries in part­ icular, tentiously debated as societies argue over the value of isolated nuclear families in which resources for motherhood and parenthood, biological nurturing, ­childrearing may be provided only by the parents or, the social value of children, the rights of workers, and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC in some cases, a single parent, are common. Histor- the role of the state in supporting families. The subtext ically,NOT thisFOR is SALEa fairly ORnew DISTRIBUTIONdevelopment. Humans, as to this NOTconversation FOR SALE is the ORchanging DISTRIBUTION family. The pa- with many primates and other mammals, are more rameters of this cultural flexibility are bracketed by the traditionally raised with larger family units and with infant’s adaptation to human milk and ability to thrive broader bonds of responsibility to the child. In many on substitutes to it on one side or the equation, and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

21

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22 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesour & adaption Bartlett of Learning, breastfeeding LLC as an embodied form of © Jones & Bartlett Learning, LLC caregiving, the value we place on nurturing, and the BOX 2-1 About Human Milk NOT FOR SALE OR DISTRIBUTION NOT FORcultural SALE expectations OR DISTRIBUTION and needs of mothers and others on the other side. Human milk is the perfect nutritional substrate for Breastfeeding links nurturing to other roles and human growth. But it is much more than simply nutrients; the microbiome of mother and baby, shared responsibilities that are typically assigned to women © Jones & Bartlett Learning, LLCand communicated across their© two Jones bodies, & ever Bartlett Learning, LLC based on gender roles and expectations. As such, it changing and adapting to their environment and presents a cultural challengeNOT toFOR women SALE as they OR strug DISTRIBUTION- moving information and knowledgeNOT fromFOR mother SALE OR DISTRIBUTION gle to inhabit the embodiment of nourishing and to child in the early days of breastfeeding, lays down nurturing their own child while balancing this with and nourishes the microflora in the gastrointestinal the increased freedoms introduced by adaptations— tract and directly supplies information, in the form such as© our Jones social &capacity Bartlett to share Learning, in parenting LLC and of immune factors,© Jones from the& Bartlett mother’s immune Learning, LLC to share our food sources, including human milk and system to her child’s. The milk that a baby is fed is NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION external sources of milk. We are also reexamining our adapted to many unique conditions. For instance, assumptions, language, practices, and policies that milk for male infants has a higher fat content (Powe reinforce the idea that breastfeeding—and, extend- et al., 2010); cortisol levels are higher in mothers ing from that, caregiving and nurturing—is for some with fewer somatic resources, which could prioritize the nursling’s caution and weight gain over time © Jonesbut & notBartlett others Learning,based on their LLC gender and sexuality. © Jones & Bartlett Learning, LLC (Hinde et al., 2015); and milk fed at night has higher NOT FORSeeking SALE balance OR DISTRIBUTIONbetween the shared responsibility of NOTmelatonin FOR SALE levels (KatzerOR DISTRIBUTION et al., 2016) and lower tending to our young, the need for our young to re- cortisol and cortisone levels (Hinde et al., 2015). The ceive all the components inherent in being fed at their mother’s microbiome is directly transferred to the ­mothers’ breasts, and the challenge of caring for in- infant via breastmilk (Duranti et al., 2017), changing fants in a modern society© Jonesinforms &our Bartlett understanding Learning, LLCwith the age of the child and the© Joneshealth of &the Bartlett mother Learning, LLC of breastfeeding as it exists in the social fabric of our (Witkowska-Zimny & Kaminska-El-Hassan, 2017). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION history and current times. It has even been demonstrated that human milk In this chapter, we will explore how this complex carries pluripotent, self-renewing stem cells to the nurturing practice is shaped by looking at it from infant via breastmilk (Hassiotou et al., 2012). These multiple vantage points. First, we will turn our atten- specific forms of information from mother to child tion to© breastfeeding Jones & Bartlett as an act ofLearning, human paren­ LLCting— are disrupted© as Jones the child & moves Bartlett away fromLearning, nursing LLC directly at its mother’s breast, reflecting the reality of how it reflects our biological norms and cultural ex- NOT FOR SALE OR DISTRIBUTION two interdependentNOT FOR and physically SALE ORlinked DISTRIBUTION biological pectations. We review the spectrum of nutrition and processes that exist between and encompassing the nurture, from embodied nursing through the use of nursing parent and child. supplemental feeds, the ability of the infant to grow and survive on human milk substitutes, and the cost © Jonesof & those Bartlett substitutes Learning, to the health LLC of the infant and the © Jones & Bartlett Learning, LLC NOT FORrelational SALE aspects OR DISTRIBUTION of human milk feeding. We explore NOT FOR SALE OR DISTRIBUTION how changes in knowledge, development, women’s ▸▸ Human Evolution: Shared status, and technology have shaped infant feeding Parenting and Lactation practices and trends in breastfeeding. We report on a variety of policies at© the Jones global & level Bartlett and inLearning, the Shared LLC parenting, or the nurturing© Jones of our & Bartlettyoung by Learning, LLC United States that shapeNOT our FORpublic SALEhealth approachOR DISTRIBUTION our families and communities,NOT has always FOR beenSALE a part OR DISTRIBUTION to breastfeeding and infant feeding trends. We con- of human nature not shared by all mammals, or even clude with a discussion of breastfeeding as an embod- all primates. A less discussed and perhaps less ac- ied, gendered, caregiving and nurturing practice, and cepted aspect of shared parenting is shared lactation. we explore the “breastfeeding conundrum” that we Shared lactation has always been present, although it are experiencing© Jones today.& Bartlett And, we Learning, offer suggestions LLC for has gone in and© Jones out of &cultural Bartlett acceptance Learning, as social LLC how toNOT disrupt FOR it. SALE OR DISTRIBUTION mores have changedNOT FOR and SALEas our ORrelationship DISTRIBUTION to our Our story begins with an exploration of nursing bodies, our breasts, and nursing itself has shifted. De- and supplementation in its many forms over time, spite the changing acceptance of shared lactation in as our resources and access to scientific information the larger cultural context, within countless societies © Joneshave & Bartlettled us from Learning, nursing, toLLC cow milk, to formulas, © Jonesand throughout & Bartlett history, Learning, it might beLLC a hidden under- NOT FORand SALE back to OR breastfeeding DISTRIBUTION with the addition of breast NOTcurrent, FOR a SALE commodity, OR DISTRIBUTION or an accepted part of daily pumping and milk sharing (see BOX 2-1). life—but it has always been something that women

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Human Evolution: Shared Parenting and Lactation 23

© Jones & Bartlettwill do forLearning, each other LLC in the right situation. Sarah© Jones in &Europe Bartlett and Learning,America, peaking LLC in the 1700s. But Blaffer Hrdy, in Mothers and Others, noted that among this is not the only time wet-nursing has been used NOT FOR SALE OR DISTRIBUTION NOT FOR SALEhunter-gatherer OR DISTRIBUTION cultures in which women are respon- for infant feeding. Wet-nursing-for-hire is mentioned sible for foraging for the survival of the group, there is in some of the oldest surviving texts, which implies immense social capital spent maintaining the egalitar- that the practice was well established even in ancient ian nature within the groups. Among these cultures, times. The Babylonian Code of Hammurabi (c. 1700 it is not uncommon© Jones for women & Bartlett to co-nurse Learning, children LLCBC) forbade a wet nurse© to Jones substitute & Bartletta new infant Learning, for LLC among lactating mothersNOT FOR so that SALE milk isOR shared DISTRIBUTION among one who had died. TheNOT Old FORTestament SALE Book OR of DISTRIBUTIONExo- families, similar to other resources (Hrdy, 2009). dus (Exodus 2:7–9; c. 1250 BC) records the hiring of a As human culture evolved into higher density wet nurse for the foundling Moses (that the wet nurse population centers with greater pressure for resources, was Moses’s own mother is incidental). The epic po- hierarchical© Jones &cultures Bartlett developed. Learning, These LLC class-based ems of ©Homer, Jones written & Bartlett down around Learning, 900 BC, LLC contain societal structures concentrated the distribution of references to wet nurses. A treatise on pediatric care NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION resources in those at the top of the social structure in India, written during the second century AD, con- over those in lower social strata. Shared parenting, as tains instructions on how to qualify a wet nurse when it was adopted in these class systems, optimized the the mother could not provide milk. The Quran, set in fertility and flexibility of mothers with more resources written form about AD 500, permits parents to “give © Jones & Bartlettover those Learning, with fewer LLCresources. In lactation, this© led Jones your & Bartlettchildren out Learning, to nurse” (and LLC also forbade children NOT FOR SALEto such OR practices DISTRIBUTION as women from higher social strataNOT FORnursed SALE by the OR same DISTRIBUTION woman to marry). fostering their children with servants, slaves, or wet The history of wet-nursing has continued virtually nurses who were lactating, or hiring wet nurses into unbroken from the earliest times to the present. In the their homes. This practice allowed wealthy mothers most recent literature on breastfeeding, wet-nursing is to return to their ©previous Jones social & Bartlett roles, including Learning, hav- LLCconsidered, although cautiously,© Jones in & emergency Bartlett Learning,situa- LLC ing another child more quickly. This can be seen in tions (United States Breastfeeding Committee, 2011; NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the birth records in England in the late 17th century, World Health Organization [WHO], 2004), in situ- when women from the aristocracy were giving birth ations in which birth mothers suffer death or disease, annually while working-class women gave birth closer and in adoptions (Wilson et al., 2015). In all cases in to every 3 years (Campbell, 1989). which wet-nursing is used as a form of infant suste- © JonesHowever, & theBartlett use of replacementLearning, sourcesLLC of milk nance, there© Jones is a risk & toBartlett the infants. Learning, There is riskLLC to the isNOT not limited FOR SALEto the aristocracy. OR DISTRIBUTION As urbanization pro- nursed NOTchild, orFOR nursling, SALE if the OR wet DISTRIBUTION nurse has a transmit- gressed, necessity drove working women to seek ex- table disease (historically, syphilis, and, more recently, ternal sources of milk as well. During the industrial HIV); there is also a risk to the wet nurse’s own infant revolution, when more European families were mov- because of the loss or degradation of their food source. ing to urban centers, the cost of living was so high that Historical records of wet-nursing demonstrate © Jones & Bartlettwomen wentLearning, back to LLCwork shortly after their babies© Jones high & Bartlettinfant mortality Learning, rates in LLC both the biological child NOT FOR SALEwere ORborn, DISTRIBUTION necessitating shared parenting and NOTthe FORand SALEthe nursling. OR DISTRIBUTION In cases in which infants lived in use of alternate sources of milk among working-class the wet nurse’s home, mortality rates as high as 80% women. We see this same trend in current cultures as have been recorded for the fostered child. The histori- urbanization draws families into cities; both parents cal records are full of accounts similar to the Dowager work outside the ©home Jones because & Bartlett of financial Learning, necessity, LLCCountess of Lincoln, who© hadJones 18 children & Bartlett in the 1600sLearning, LLC requiring childrenNOT to be FOR left SALEwith others OR for DISTRIBUTION care and “reared” by wet nurses, andNOT only FOR one of SALE whom ORsurvived DISTRIBUTION feeding. to adulthood. The countess’s daughter-in-law chose to nurse her own children. Rather than chastising her for the practice, her mother-in-law wrote a treatise implor- Wet Nurses ing more mothers to suckle their own children rather Wet© Jones nurses &are Bartlett used in Learning,cultures in LLCwhich fresh or than use© theJones services & Bartlettof the wet Learning, nurse. She concluded LLC preservedNOT FOR sources SALE of ORanimal DISTRIBUTION milks are not available. with theNOT following FOR appeal: SALE “. . . OR be DISTRIBUTION not so unnatural as The quintessential wet nurse was the rural European to thrust away your own children; be not so hardy as woman employed by the wealthy or working ur- to venture a tender babe to a less tender breast; be not ban woman who did not choose, or did not have the accessory to that disorder of causing a poorer woman © Jones & Bartlettfreedom, Learning, to nurse her LLC own child in a time before ©the Jones to &banish Bartlett her own Learning, infant for theLLC entertaining of a richer NOT FOR SALEavailability OR DISTRIBUTION of fresh dairy. This form of wet-nursingNOT FORwoman’s SALE child, OR as DISTRIBUTION it were, bidding her to unlove her was common throughout the early modern period own to love yours” (Wickes, 1953b, p. 234).

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24 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jones &If Bartlett the infant Learning, of the wet nurse LLC was sent away so that © Jonesof commodification & Bartlett Learning, of human LLCmilk, parenting and the nurser could live in the home of her charge, the nurture are denigrated to insignificance, and nurture is NOT FOR SALE OR DISTRIBUTION NOT FORchances SALE of survivalOR DISTRIBUTION were better for the nursling but stripped to its most basic caloric potential. It is a testa- equally or even more dismal for the wet nurse’s bio- ment to human nature that even in these stark circum- logical child, who was typically sent off for fostering or stances, there are also stories of shared nursing in which sustained by other family members on alternative food slaves and mistresses, or slaves among themselves, sources. This practice© of Jones banishing & Bartlett one’s own Learning, child share LLC in nursing each other’s babies© Jones while & working Bartlett to- Learning, LLC to receive payment forNOT feeding FOR another SALE is wellOR illusDISTRIBUTION- ward a shared goal, such as cookingNOT FOR a meal SALE (West OR & DISTRIBUTION trated in a letter to a women’s magazine by Fanny B. Knight, 2017). “My mother used to be a cook, and ­Workman in 1886. When the wet nurse arrived for her when she was busy cooking, my mistress would nurse job interview with her own infant, Workman asked: both me and her baby, who was four weeks older than me. If it happened the other way around, my mother “Did© Jonesyou not &understand Bartlett Learning,that you were LLC to © Jones & Bartlett Learning, LLC would nurse both of us” (Rawick, 1979, p. 287). leaveNOT your FOR baby?” SALE The ORwoman DISTRIBUTION quickly agreed NOT FOR SALE OR DISTRIBUTION to “place out” her baby and accepted the job. Two weeks later the new wet nurse received Animal Milks a telegram informing her of her baby’s death. To share or purchase human milk requires expending Frantic with grief, she prepared to attend the © Jones & Bartlett Learning, LLC © Jonessocial capital, & Bartlett whether Learning, that is monetary LLC or part of a re- funeral. An irate Workman complained, “I NOT FOR SALE OR DISTRIBUTION NOTlationship. FOR SALE Within OR this framework,DISTRIBUTION use of animal milks decided that would never do. . . . After an hour can be seen as a form of societal freedom, requiring or two spent in argument I prevailed upon her less capital than the use of wet nurses. But the use of to not go to the funeral.” (Wolf, 2001, p. 142) animal milks presents several difficulties that must be A variety of efforts© were Jones made & to Bartlett protect the Learning, chil- overcome. LLC First, the milk must© beJones kept fresh & Bartlett and the Learning, LLC dren of wet nurses and the children being wet-nursed. quality maintained from the source to the infant. Sec- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION France regulated the practice through the institution ond, the vessel for delivering the milk to the baby must of the Bureau of Wet Nurses (1769–1876), the med- allow a baby to suckle while also being easy to keep ical community in Germany united in disapproval of clean. Third, and most difficult to overcome, is that of wet-nursing during the same time period, and many ensuring good nutrition: Animal milks can be difficult doctors© refused Jones to &assist Bartlett in the provision Learning, of wet LLC nurses. to digest and ©do Jones not provide & Bartlett all the nutr­ Learning,ients, and cer LLC- In Maryland,NOT FOR in 1916, SALE a law OR was DISTRIBUTION passed forbidding tainly not theNOT immune FOR properties, SALE ORavailable DISTRIBUTION to human the separation of mothers and infants for the first 6 infants from human milk. The history of the use of an- months of life in an effort to discourage the practice imal milks for infants, up to and including the present (Wolf, 2001). day, is full of negative outcomes to infant health in- Nowhere is the power structure inherent in wet- herent in its use. These can be seen in the­innovat ions © Jonesnursing & Bartlett as evident Learning, as it is in LLC slave cultures in which © Jones­employed & toBartlett improve Learning,the product andLLC in the commer- NOT FORslave SALE owners OR control DISTRIBUTION everything while those in bond- NOTcial FOR practices SALE meant OR to DISTRIBUTIONmaximize profits from its sale. age own nothing—not even their own fertility or But we didn’t always use animal milks as an independ- bodies. In the slave-owning southern United States, ent product—our use of animal milks ­began with the wet-nursing by female slaves was relatively common, use of animals as wet nurses, rather than the use of and the historical record© gives Jones us some & Bartlett insight into Learning, this animal LLC milk taken from the animal­© Jones and &given Bartlett to the Learning, LLC particularly exploitative NOTform ofFOR wet-nursing SALE practicedOR DISTRIBUTION baby via a vessel. NOT FOR SALE OR DISTRIBUTION in many locations around the world. During the 1800s, The earliest use of animals as wet nurses is difficult although the use of animal milks was becoming more to determine; however, references to its use are pres- popular in urban areas, for rural slave-owning families, ent in the Quran, in which the practice is discouraged, it was easier to assign a slave to nurse the owner’s chil- and in the Talmud, which permits the use of animals dren than© Jones to bottle-feed. & Bartlett During Learning, slavery, the LLC survival as wet nurses© when Jones the welfare& Bartlett of the Learning,child is at stake. LLC of the slave’sNOT infantFOR had SALE monetary OR DISTRIBUTION value, so the master’s Greek mythologyNOT is FORalso full SALE of stories OR of DISTRIBUTION humans being child was often added to the slave’s child at the breast, nursed by a variety of animals, the best known being rather than risking the health of the enslaved infant by the mythical founders of Rome, Romulus and Remus, taking him from the breast early. In other cases, ba- who were fed by a wolf. Agricultural societies brought © Jonesbies & ofBartlett slaves were Learning, taken away LLC from some mothers who © Joneswith them & theBartlett close proximity Learning, of farm LLC animals; as re- NOT FORwere SALE sent back OR to DISTRIBUTION the fields and given to already nurs- NOTcently FOR as the SALE 19th century,OR DISTRIBUTION using such animals as goats ing mothers to maximize the labor pool and fertility or donkeys as wet nurses was culturally accepted, and among the slave population. In this extreme example even institutionalized. In hospitals and homes for

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Human Evolution: Shared Parenting and Lactation 25

© Jones & Bartlett Learning, LLC © Jonesancestors & Bartlett to our Learning, most progressive LLC alternative defin- itions of family. The knowledge that a mother’s own NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION milk is best for her baby has been present as far back as there has been choice about what to feed an infant. But there has also been a persistent drive to feed infants other substances from early in their lives by mothers © Jones & Bartlett Learning, LLCand others. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Examples of prelactealNOT feeds FOR are soSALE pervasive OR asDISTRIBUTION to be difficult to define as atypical, but the way the rit- ual is performed can be different. Of 120 traditional societies (and, by inference, many ancient preliterate © Jones & Bartlett Learning, LLC societies)© whoseJones neonatal & Bartlett feeding Learning, practices have LLC been FIGURE 2-1 Infants in a Foundling Hospital Being Fed with described, 50 delay the initial breastfeeding more than AnimalNOT WetFOR Nurses. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2 days, and some 50 others delay it 1 to 2 days. In India, Courtesy of SH Sadler. as many as 88% of women give prelacteal feeds mostly because they believe colostrum is harmful or of poor foundlings, the animals were kept in close proxim- nutritional value (Raina et al., 2012). Early medical © Jones & Bartlettity, and infantsLearning, were broughtLLC to the animals’ stalls© to Jones writers & Bartlett in the easternLearning, Mediterranean LLC region (Greece, FIGURE 2-1 NOT FOR SALEsuckle OR directly DISTRIBUTION at their teats ( ). This practiceNOT FORRome, SALE Asia ORMinor, DISTRIBUTION and Arabia) and later in Europe— may have been more sanitary than the alternatives from Soranus through the authors of the 1600s—also during a time when there was no refrigeration, water discouraged the use of colostrum for feeding. These for washing was not easily accessible, and the snouted writers recommended avoiding breastfeeding for per- vessels used to feed infants were difficult to keep clean © Jones & Bartlett Learning, LLCiods as short as 1 day (Avicenna,© Jones &c. BartlettAD 1000) Learning,to as LLC (Valenze, 2011). A variety of animals were used for this long as 3 weeks (Soranus, c. AD 100). Commonly, to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION purpose, but goats and donkeys were thought to be the promote the passage of meconium, the newborn was closest to human milk because the size of the curd pro- first given a “cleansing” food, such as honey, sweet oils duced was smaller (Weinberg, 1993). (e.g., almond), or sweetened water or wine. In comparison to using an animal as a wet nurse, A modern version of this practice can be seen in the© Jonesuse of an & animal Bartlett as a source Learning, of milk LLC did not require the prelacteal© Jones bottle & feeds Bartlett commonly Learning, given in LLC ­Western theNOT infant FOR to remainSALE inOR proximity DISTRIBUTION to the animals. The (or Western-style)NOT FOR SALEhospital OR nurseries DISTRIBUTION and neonatal use of purchased animal milk or hand feeding infants intensive care units (NICUs). Ostensibly these prac- nonmilk substances required access only to the prod- tices allow staff to check for esophageal patency and uct. Given the complexity and cost of obtaining wet to protect against hypoglycemia. Despite the lack of nurses, be they human or animal, it is not surprising evidence to support these practices, they were com- © Jones & Bartlettthat dairy Learning, was also used LLC as a substitute for human milk,© Jones mon & Bartlettuntil very Learning,recently and areLLC still being practiced in NOT FOR SALEparticularly OR DISTRIBUTION as families moved to urban centers. DuringNOT FORsome SALE hospitals OR today. DISTRIBUTION The reasons for prelacteal feeds industrialization, whether historical or current, fami- vary and are rarely evidence based; however, the prac- lies are drawn away from farms and into cities, where tice may actually serve other purposes, such as provid- women need to work outside the home to contribute ing an opportunity to expand the circle of care that a to the family’s financial stability. This requires shared child will receive by giving others access to the mother parenting or child© care, Jones and alternative& Bartlett sources Learning, of nu- LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONand child while they areNOT still experiencing FOR SALE high OR levels DISTRIBUTION trition, such as milk or other supplemental foods, for of important bonding hormones (oxytocin, prolactin, infants at an early age. Shared parenting is well within beta-endorphins). When early prelacteal feeds are the realm of common human behavior. In fact, prelac- viewed through the lens of shared parenting, it is not teal feeds—or the supplementation of colostrum in the surprising that many cultures have prioritized others very© Jones early days & Bartlett after birth, Learning, which is inherent LLC in many feeding© the Jones baby during & Bartlett this time, Learning, nor is it surprising LLC culturesNOT FOR around SALE the world—areOR DISTRIBUTION uniquely adapted to that formulaNOT companiesFOR SALE have OR prioritized DISTRIBUTION marketing to maximize this human potential. mothers during this early bonding period. However, there is a balance between the social Prelacteal Feeds benefit of shared parenting and the cost to the infant © Jones & BartlettBiologically, Learning, we produce LLC oxytocin when we eat, caus© Jones- of &receiving Bartlett alternative Learning, sources LLC of nutrition. Each NOT FOR SALEing us OR to formDISTRIBUTION social ties with those with whomNOT we FORday’s SALE delay inOR initiation DISTRIBUTION of breastfeeding steadily in- share a meal. The definition of family has always -in creases the likelihood of neonatal death from infec- corporated meal sharing, from our earliest human tion (­Edmond et al., 2007), and any food introduced

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26 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesinto & Bartlettthe infant’s Learning, immature gastrointestinalLLC tract can © Jonesease. The & Bartlettrise in infant Learning, mortality LLC and morbidity has alter the delicate integrity of the microflora that would caused state, professional, and civic organizations to NOT FOR SALE OR DISTRIBUTION NOT FORotherwise SALE be OR a system DISTRIBUTION protected by exposure to only intervene with public health messaging, funding for the mother’s milk. For the mother, reduced breast interventions, and scientific inquiry in order to pro- stimulation can decrease her capacity to produce suf- mote improved ways to feed infants and young chil- ficient milk later on and undermine her confidence in dren. We can see this pattern, historically and globally, her ability to provide for© her Jones child. & Bartlett Learning,with LLC all breastfeeding substitutes—from© Jones wet-nursing,& Bartlett Learning, LLC Prelacteal feeds areNOT not FORthe only SALE form OR of supDISTRIBUTION- to dairy, to formula—as countriesNOT rise FOR out SALEof poverty OR DISTRIBUTION plemental nutrition given to babies. All babies in the presence of normalized alternatives to nursing: transition to adult sources of food; it is the timing First they are adapted by the wealthy and then they that has been a source of debate. Our current view become normalized among working women, causing comes ©from Jones the scientific & Bartlett evidence Learning, suggesting LLC that infant mortality© Jonesrates to rise.& Bartlett Learning, LLC 6 months of exclusive breastfeeding reduces the risk Historically, formula use is inextricably linked NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of infant morbidity and mortality (WHO, 2004), with the rapid pace of change in technology, com- but we have not always had the same measure of munication, and the medical system in the late 19th certainty. Early or “hand-fed” foods have been, and and early 20th centuries, when it was first developed. continue to be, used much earlier than 6 months These changes included the increased reach of media; © Jonesand & canBartlett include Learning, tea infusions, LLC mashed fruits, and a © Jonesthe rise of& Western, Bartlett hospital-based, Learning, LLC allopathic medical NOT FORvariety SALE of starchy OR DISTRIBUTION gruels or pastes. Early ­Europeans NOTsystems; FOR the SALE scientific OR DISTRIBUTIONexploration of human nutrition; used paps or peplums consisting of stale bread and the technology used to produce, transport, and mixed with broth, milk, or even beer and stronger feed infants. During this time, patents were awarded alcohols (Wickes, 1953a). However, it was not until for the invention of refrigerated boxcars, and then the rise of the dairy industry© Jones and & the Bartlett development Learning, home LLC refrigerators, which facilitated© Jones transport & Bartlett and Learning, LLC and aggressive marketing of formula that breast- storage of dairy and other perishable goods; an up- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION feeding reached record-low levels in countries right bottle with a rubber nipple, which made feeding all over the world—particularly where there was liquids to babies much easier and safer because they industrialization. were easier to keep clean than the snouted pots used previously; breast pumps that were originally com- © Jones & Bartlett Learning, LLC plicated modifications© Jones &of Bartlettpumps for Learning, cows but that, LLC The RiseNOT of FOR Formula SALE OR DISTRIBUTION over the years,NOT became FOR gentler SALE on OR women’s DISTRIBUTION breasts The rise in the use of formula started with an increased and easier to use; and condensed and powdered milk dependence on unaltered dairy for infant feeding and products. Dairy products were originally used by followed a trajectory similar to wet-nursing. Specif- themselves or as part of recipes given to mothers to ically, the use of alternatives to nursing started with make infant food; eventually, they were modified to © Joneswealthy & Bartlett women Learning, who insisted LLC on being free from the © Jonesproduce &formulas, Bartlett making Learning, dairy-based LLC foods easier NOT FORburdens SALE of ORparenting. DISTRIBUTION The use of supplemental milk NOTfor FORthe infant SALE to ORtolerate DISTRIBUTION (FIGURE 2-2). The printing became associated with wealth, and families with press was developed much earlier, but it was during lower incomes seeking upward mobility or outward this same period that mechanization allowed for mass symbols of prosperity took on the practice. As coun- marketing of cheap periodicals with advertising and tries prospered, they were© Jonesmore able & to Bartlett support urbanLearning, books LLC on child-rearing. © Jones & Bartlett Learning, LLC centers, and as families movedNOT FOR to urban SALE centers, OR wom DISTRIBUTION- Perhaps the most influentialNOT change FOR in ourSALE progres OR- DISTRIBUTION en’s social latitude expanded. Often women needed or sion from breastfeeding to formula feeding involved desired to work outside the home while their children the acceptance of medical management for childbirth were still young. This expansion in the choices or ex- and child-rearing. During the 19th and 20th centuries, pectations of women’s roles as workers pushes against in developed countries, there was a move away from embodied© Jones nurturing, & Bartlett such that Learning, breastfeeding LLC may female healers,© Jonesmidwives, & andBartlett home-centered Learning, health LLC be deprioritizedNOT FOR or SALEabandoned OR out DISTRIBUTION of need or desire. care to male NOTphysicians FOR and SALE hospital-based OR DISTRIBUTION practices When poor feeding strategies are compensated for by for birth and the immediate postpartum period (Starr, high-resource parenting, the negative results might 1982). This trend can be seen in the United States be- be less obvious; however, the widespread move away ginning in 1900, when all births occurred in the home. © Jonesfrom & Bartlett human milk Learning, has caused LLC spikes in infant mor- © JonesBy 1950, & 88% Bartlett were hospital Learning, births, LLC and by 1960, al- NOT FORbidity SALE and mortalityOR DISTRIBUTION in the population statistics as a NOTmost FOR no one SALE was givingOR DISTRIBUTION birth at home (Devitt, 1979). whole, particularly when the use of formula is nor- This same movement can be seen as countries develop malized and shortcuts are taken out of necessity or and urbanize around the world.

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Human Evolution: Shared Parenting and Lactation 27

© Jones & Bartlett Learning, LLC © Jonesoccurs, & Bartlett to varying Learning, degrees, in LLC developed and develop- 1845 1845 ing countries around the world as scientific medicine NOT FOR SALE OR DISTRIBUTION NOT FOR SALERubber OR nippleDISTRIBUTIONAmerican Medical Association gains precedence over local healers. 1854 1856 In the United States, this process was evidenced by Electric breast pump Evaporated milk the rise of pediatrics and obstetrics. Midwifery was ac- tively discouraged; licensing laws were used that made © Jones1867 & Bartlett Learning, LLCit difficult for midwives© Jonesto practice & Bartlett(Starr, 1982), Learning, and LLC Refrigerated boxcar NOT FOR SALE OR DISTRIBUTIONmedia campaigns aggressivelyNOT FOR slandered SALE midwifery OR DISTRIBUTION care (Devitt, 1979). As midwifery declined in favor of modern, scientifically driven medical care, so did breastfeeding. The practices of the day were fueled by © Jones & Bartlett Learning, LLC the belief© thatJones science & Bartlett could provide Learning, answers LLCand that “the combined efforts of the cow and the ingenuity NOT FOR1899 SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Formula using of man” could construct a food that was equal to hu- evaporated milk 1905 man milk (Gerrard, 1974). This confidence in science Hospital expansion 1910 over nature drove breastfeeding rates down as doctors Flexnor Report 1913 Powdered formula normalized the use of formula as a medical interven- © Jones & Bartlett Learning, LLC © Jonestion. & BartlettFor example, Learning, physician LLCThomas Rotch developed NOT FOR SALE OR DISTRIBUTION NOT FORa complex SALE systemOR DISTRIBUTION for modifying cow milk so that it 1930 “more closely resembled human milk.” He observed American Academy of Pediatrics that the composition of human milk varies, as do di- gestive capacities in infants. He devised mathematical © Jones & Bartlett Learning, LLCformulas to denote the ©proportions Jones & of Bartlett fat, sugar, Learning, and LLC FIGURE 2-2 Historical Timeline Illustrating Some of the protein he believed infants required at different ages NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Important Patents and Medical Events That May Have (Rotch, 1907). The result was an exceedingly complex Contributed to the Progression to Formula Feeding. system of feeding that required constant intervention by the physician, who often changed the “formula” weekly. Supervising infant feeding was thus a prin- © JonesOne way & toBartlett understand Learning, this shift LLC in healthcare cipal focus© Jones of the &newly Bartlett emerging Learning, specialty LLC of pedi- practiceNOT FOR is through SALE the OR concept DISTRIBUTION of authoritative know- atrics, inextricablyNOT FOR linkingSALE itOR to theDISTRIBUTION scientification of ledge (Jordan, 2014). This theoretical framework milk, scheduled and controlled feeding regimens, and suggests that “within any particular domain several the increasing use of formula. knowledge systems exist, some of which, by consen- During the 20th century in the United States and sus, come to carry more weight than others, either other Western countries where hospital birth was © Jones & Bartlettbecause Learning,they explain LLCthe state of the world better© Jones becoming & Bartlett the norm,Learning, bottle-feeding LLC by nursery staff NOT FOR SALEfor the OR purposes DISTRIBUTION at hand (‘efficacy’) or becauseNOT they FORbecame SALE common. OR DISTRIBUTION Postpartum hospital stays in the are associated with a stronger power base (‘struc- United States lengthened during the 1930s and 1940s tural superiority’), and usually both” (Jordan, 1997, to as long as 2 weeks in order to support women as p. 56). When there is ascendance of one kind of know- they recuperated from highly medicated childbirth ledge, the result ©is aJones devaluing & Bartlett or dismissiveness Learning, of LLCexperiences. Mothers were© Jones separated & Bartlett from their Learning, in- LLC other forms of knowledge.NOT FOR This SALE social ORprocess DISTRIBUTION evolves fants and their familiesNOT and friends FOR SALE(in part OR because DISTRIBUTION around societal power relationships and community of the fear of infection) and attended, in their place, practices. Our current Western medical system so- by hospital staff. This separation of mother, infant, lidified its power base with the Flexner Report, a re- and family effectively eliminated the possibility of view and elimination of many of the existing medical parallel ideology by completely controlling access to schools© Jones in the & UnitedBartlett States Learning, by the American LLC Medical the birthing© Jones suite, &excluding Bartlett everyone Learning, except LLC those in AssociationNOT FOR and SALE the Carnegie OR DISTRIBUTION Foundation in 1910. Au- the medicalNOT system.FOR SALE During OR the DISTRIBUTION early hours of high thoritative knowledge of the time included a scientific oxytocin and bonding after birth, the mother had approach to scheduled, infrequent feedings; the use of the hospital staff, rather than her baby and her com- dairy-based products, such as milk and ­formula; and munity, at her side. This meant that women were re- © Jones & Bartletta move Learning,toward hospital-based, LLC medicalized births.© Jones turning & Bartlett home withLearning, an impaired LLC milk supply, a baby NOT FOR SALEAlthough OR DISTRIBUTIONthis process from traditional breastfeedingNOT FORwho SALE was accustomed OR DISTRIBUTION to feeding from bottle nipples, to scientific formula feeding was particularly acute and a mother disconnected from her community and in the early 20th century in the United States, it also bonded with the hospital and the medical system as a

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28 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonessource & Bartlett of support, Learning, making it LLC far too late to effectively © Jonesbreastfeeding & Bartlett “failed,” Learning, and dairy products,LLC then for- initiate breastfeeding. As long ago as the mid-1940s, mula, were used by women to compensate for their NOT FOR SALE OR DISTRIBUTION NOT FORBain SALE noted thatOR babiesDISTRIBUTION who were older than 8 days at insufficiency. discharge were less apt to be breastfed than babies who were younger at discharge (Bain, 1948). The Problem with Dairy © Jones & Bartlett Learning,The LLC formulas of today, despite© Jones their & long-Bartlett and Learning, LLC Scheduled FeedingNOT FOR SALE OR DISTRIBUTIONshort-term health consequences,NOT are FOR far more SALE palat OR- DISTRIBUTION It was no wonder that women giving birth in hospi- able than the dairy products that were first introduced tal settings had low breastfeeding self-efficacy and to infants. One of the difficulties with any dairy prod- insufficient production. But even before the advent of uct, today or earlier in our history, is that when milk hospital© births, Jones women’s & Bartlett belief inLearning, their ability LLC to pro- is removed from© Jones the animal, & Bartlett it becomes Learning, a commodity. LLC duce enough milk for their babies was deteriorating as Like any other commodity, it needs to be produced, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION wealthy women, then urban women, turned to med- shipped to market, and sold to a customer before it ical advice and the latest scientific discoveries to guide reaches the infant. Although this process creates a their infant care. It was not that the push to timed and product that is easily accessible to families, particu- proportioned feedings was a new idea; early med- larly in urban centers, it also exposes the milk to many © Jonesical & writers,Bartlett even Learning, those who LLC strongly recommended © Jonessets of hands.& Bartlett Although Learning, some infants LLC survived the NOT FORbreastfeeding, SALE OR also DISTRIBUTION recommended regulated times for NOTingestion FOR SALEof unaltered OR DISTRIBUTIONdairy, particularly children of feedings. This type of thinking may have originated as wealthy women who could pay for extra precautions, early as the 1500s in Europe. At this time, overfeeding the distance from source to infant allowed for care- was thought to be a primary cause for gastrointestinal lessness, ignorance, and the market economy to nega- discomfort, diarrhea, and© Jones death, &leading Bartlett to recom Learning,- tively LLC impact the quality of milk© purchasedJones & for Bartlett infants. Learning, LLC mendations to regulate or reduce infant feedings. This This resulted in extremely high infant mortality rates NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION one, from the mid-1600s, states, “Nothing is more during the mid- to late 1800s, when the rate of dairy apt to disorder the child than suckling it too often, milk replacement of breastfeeding was rapidly increas- since large quantities of milk stagnating in the stom- ing. For instance, in Chicago in 1897, 5 years after high ach, must need corrupt . . . especially if fresh milk be rates of infant mortality were attributed to the city’s pour’d ©in beforeJones the & preceding Bartlett be Learning, digested” (Ettmuller, LLC unsanitary cow© Jonesmilk, 18% & Bartlettof infants Learning,in the city were LLC 1703, citedNOT in FOR Wickes, SALE 1953c, OR p. 332).DISTRIBUTION Ettmuller’s firm dying before NOTtheir first FOR birthday. SALE OROf these, DISTRIBUTION 54% of the endorsement of breastfeeding and largely sound ad- deaths were caused by diarrhea (Wolf, 2001). vice prompted many privileged English women to Milk quality was vulnerable to degradation at breastfeed, yet he too advocated only four feeds a day every level of production. Cows were often fed on the at equal intervals, and no night feeds. by-product of breweries, introducing alcohol into the © Jones & WhileBartlett medical Learning, men wereLLC encouraging infre- © Jonesmilk produced. & Bartlett This Learning,milk, called “swill LLC milk,” could be NOT FORquent SALE feeds, OR until DISTRIBUTION the late 1800s and early 1900s, this NOTpurchased FOR SALE at much OR lower DISTRIBUTION prices than “country milk,” advice was given in the presence of parallel models which was milk from cows fed a standard grain diet of care. This is seen in this lament by Rotch, who in (Wolf, 2001). When milk was shipped, dairymen were 1907 deplored that when it came to infant feeding, notorious for diluting it with water, then adding chalk “mothers and nurses . . .© Jonesdominated & Bartlettthe physicians” Learning, to LLC make it appear creamier. This© Jones was so & prevalent Bartlett in Learning, LLC (Rotch, 1907, p. 55). ButNOT as the FOR medical SALE model OR of DISTRIBUTIONcare London that when farmers soldNOT donkey FOR milk, SALE which OR DISTRIBUTION became the authoritative knowledge of the day, moth- was much more expensive than cow milk, the animal ers were pressured to implement scheduled feedings, itself was brought to the home and milked at the door- and schedules were prioritized over feeding a baby ac- step to verify that it wasn’t being altered (Weinberg, cording to hunger cues. Wolf (2001) proposed that it 1993). Refrigerated boxcars, first patented in 1867, was the© scheduling Jones & ofBartlett feedings Learning, that caused LLClow milk made the transport© Jones of milk & Bartlett from the Learning, dairy to urban LLC production,NOT or FOR the perception SALE OR of lowDISTRIBUTION milk production, centers safer.NOT Before FOR that, SALE however, OR milk DISTRIBUTION was often as women moved away from reading infant cues and transported in open train cars; as a result, the milk ar- toward watching the clock. The biological reality of rived at its destination full of bacteria and other con- human milk production, which in hunter-gatherer taminants, particularly in the summer months. Public © Jonessocieties & Bartlett constitutes Learning, feeding LLC multiple times in an © Joneshealth campaigns & Bartlett called Learning, Milk Public LLC Health Crusades NOT FORhour SALE (Konner, OR 2005), DISTRIBUTION was just not up to the level of NOTwere FOR aimed SALE at cleaning OR DISTRIBUTIONup and regulating the dairy in- scheduling implemented by women as they tried to dustry. These campaigns were the topic of newspaper satisfy both the baby and the physician. As a result, stories and fliers through much of the early 1900s in

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Human Evolution: Shared Parenting and Lactation 29

© Jones & Bartlettthe United Learning, States. The LLC language of the crusades© was Jones support & Bartlett breastfeeding Learning, women LLC faded from the curricu- incendiary, such as this rhyme on a Chicago Depart- lums of medical and nursing schools and was replaced NOT FOR SALE OR DISTRIBUTION NOT FOR SALEment ORof Health DISTRIBUTION poster: with the visible, controllable calculations used to man- age formula feeding. “Bye Baby Bunting Healthman’s gone a hunting Formula Marketing To get the dirty© Jonesmilkman’s & skinBartlett Learning, LLC © Jones & Bartlett Learning, LLC The developments in the previous section were cou- And save the NOTBaby’s FOR life for SALE him. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION pled with aggressive marketing practices by formula Is your milkman a friend or an enemy of companies directly targeting physicians (Greer & your baby? Apple, 1991). These practices included sales repre- If you don’t know ask the Health Department.” sentatives posing as medical experts on feeding and © Jones(Bulletin & Chicago Bartlett School Learning, of Sanitary LLC Instruc- ingratiating© Jones themselves & Bartlett with physicians, Learning, giving LLC lavish NOTtion, FOR 25 April SALE 1914, OR figure DISTRIBUTION 5, p. 55 as cited in gifts inNOT exchange FOR for SALE time andOR attention DISTRIBUTION to their sales Wolf, 2001) pitches (Wolf, 2001). Infant feeding curricula in med- ical schools was even taught by formula companies, Yet despite the voracity of these media efforts who would potentially spend as much as $10,000 on equating poor sanitation in the dairy industry to the each medical student during the student’s education © Jones & Bartlettdeath of infants,Learning, it still LLC took decades for farmers to ©test Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR(Walker, SALE 2007). OR DISTRIBUTION cattle for tuberculosis and to seal, bottle, pasteurize, Although the gifts might be smaller, these and keep milk cold during shipping (Wolf, 2001). ­practices are still in use by formula companies today (­Fortin, 2007; Tanovic, 2014). In the United States, The Rise of Formula in Medicine the symbiotic relationship between formula compan- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Unfortunately, once safety in the dairy industry im- ies and physicians is demonstrated by the practice of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION proved, the use of dairy and formula grew. Infants removing instructions for use from formula cans in were surviving on formula, which led to a generalized the 1930s, replacing them with a message to consult a complacency and even acceptance and recommenda- physician for use. This necessitated a pediatric visit in tion of formulas over breastmilk. Use of formula as order to feed the baby, which worked well to promote a© medical Jones intervention & Bartlett was Learning, normalized, LLC and it came the growing© Jones medical & Bartlettspecialty ofLearning, pediatrics. LLCIn addi- toNOT be seen FOR as SALE the nutritional OR DISTRIBUTION equal of human milk. tion, advertisementsNOT FOR SALE such as ORthe following DISTRIBUTION were placed Strong medical recommendations for formula lasted by formula manufacturers in medical journals: until the 1970s; however, even today, dependence When mothers in America feed their babies by on formula is still a part of our cultural and medical lay advice, the control of your pediatric cases rhetoric. Breastfeeding statistics during this period passes out of your hands, Doctor. Our interest © Jones & Bartlettillustrate Learning,how rapidly LLCthis transition occurred. In ©the Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALEin this importantOR DISTRIBUTION phase of medical econom- United States in 1917, 82% to 92% of women were ex- ics springs, not from any motives of altruism, clusively breastfeeding their babies at 1 month. The philanthropy, or paternalism, but rather from rate dropped to 38% at hospital discharge in 1948 and a spirit of enlightened self-interest and coop- to 21% in 1957 ­(Apple, 1987). Multiple forces were eration because (our) infant diet materials are at work in equating© Jones formula & to Bartlett human milk. Learning, Within LLC advertised only to ©you, Jones never &to Bartlettthe public. Learning, LLC the medical field,NOT it was FOR no longerSALE commonOR DISTRIBUTION for ba- (Mead Johnson, 1930)NOT FOR SALE OR DISTRIBUTION bies to die because their mothers were feeding them formula, so young doctors grew into the field without As Western markets became saturated, formula the same drive to support breastfeeding that some of companies aggressively targeted developing coun- their older colleagues had. The studies of the day were tries to maintain market growth, which had a devas- designed© Jones to &demonstrate Bartlett Learning, an equality betweenLLC modes tating effect© Jones on the & livesBartlett of infants Learning, in areas thatLLC could ofNOT feeding, FOR and SALE prestigious OR DISTRIBUTIONmedical journals published not sustainNOT safe FOR use SALE of dehydrated OR DISTRIBUTION formula products. research indicating that it was physician supervision In developed countries, the derailing of breastfeeding or social status that positively affected the health of in- in hospital settings meant that women bought more fants rather than what they were fed (Garland & Rich, formula. In developing countries, women went home, © Jones & Bartlett1930; Glazier, Learning, 1930). AsLLC a “safe” alternative to breast© Jones- having & Bartlett lost their Learning, breastfeeding LLC relationship, to a set- NOT FOR SALEfeeding, OR formula DISTRIBUTION was simpler to assess and control NOTand FORting SALE in which OR their DISTRIBUTION family might not be able to afford could be used any time a problem with breastfeeding to purchase more formula, or where water was not occurred. Knowledge about human milk and how to safe for reconstituting formula. The result was a steep

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30 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesrise & inBartlett infant mortality Learning, rates LLC in these resource-poor © JonesInfant Nutrition & Bartlett and BreastfeedingLearning, LLC (World Health As- countries. sembly, 1974). The resolution, which reaffirmed that NOT FOR SALE OR DISTRIBUTION NOT FOR SALEIn 1974, OR a publication DISTRIBUTION called The Baby Killer, by “breastfeeding has proved to be the most appropri- Mike Muller and the British organization War on ate and successful nutritional solution,” noted “the Want, reported on the harm done to infant health general decline in breastfeeding related to sociocul- and survival that was due to the way infant formula tural and environmental factors, including the mis- was marketed and distributed© Jones in developing & Bartlett countries Learning, taken LLC idea caused by misleading© Jones sales promotion & Bartlett that Learning, LLC (Muller, 1974). AlthoughNOT this FOR was notSALE the firstOR DISTRIBUTIONtime breastfeeding is inferior to feedingNOT with FOR manufactured SALE OR DISTRIBUTION this form of “commerciogenic malnutrition” (Jelliffe, breast milk substitutes”; observed “that this decline is 1971) was identified, The Baby Killer drew global at- one of the factors contributing to infant mortality and tention to the reality that: malnutrition, particularly in the developing world”; © Jones & Bartlett Learning, LLC called the attention© Jones “of countries& Bartlett to theLearning, necessity LLCof Third World babies are dying because their taking adequate social measures for mothers working NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mothers bottle feed them with Western style away from their homes during the lactation period”; infant milk. Many that do not die are drawn urged countries to “review sales promotion activities into a vicious cycle of malnutrition and dis- on baby foods”; and urged the Director-General of ease that will leave them physically and intel- the United Nations to “intensify activities relevant © Jones & lectuallyBartlett stunted Learning, for life. LLC The frightening fact © Jonesto the promotion& Bartlett of Learning, breastfeeding, LLC to bring those NOT FOR SALEis that thisOR sufferingDISTRIBUTION is avoidable. The rem- NOTmatters FOR to SALE the notice OR ofDISTRIBUTION the medical profession and edy is available to all but the small minority health administrators and to emphasize the need for of mothers who cannot breast feed. Because health personnel, mothers and the general public to mothers’ milk is accepted by all to be the best be educated.” food for any baby under six months old. Al- © Jones & Bartlett Learning, LLCGrowing awareness of the© harm Jones of infant & Bartlett formula Learning, LLC though even the baby food industry agrees led to a consumer boycott against the Nestlé corpor- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION that this is correct, more and more Third ation for the way it marketed and distributed infant World mothers are turning to artificial foods formula in developing countries. The boycott, which during the first few months of their babies’ started in 1977, garnered global support; as the boycott lives. In the squalor and poverty of the new spread, concern over the harm being done to children cities© Jonesof Africa, & Asia,Bartlett and LatinLearning, America LLC the around the world© Jones by the displacement& Bartlett Learning,of breastfeeding LLC decisionNOT isFOR often SALE fatal. ORThe DISTRIBUTIONbaby food industry with infant formulaNOT FOR extended SALE beyond OR theDISTRIBUTION breastfeed- stands accused of promoting their products ing community and into the lives of the everyday con- in communities which cannot use them prop- sumer. In 1978, Dr. Michael Latham, then professor of erly; of using advertising, sales girls dressed nutrition at Cornell University, spoke to the Govern- up in nurses uniforms, give away samples and ing Board of the National Council of Churches, en- © Jones & freeBartlett gift gimmicks Learning, that LLC persuade mothers to © Jonescouraging & themBartlett to support Learning, the Nestle LLC boycott. In his NOT FOR SALEgive up ORbreast DISTRIBUTION feeding. (Muller, 1974, p. 1) NOTtalk, FOR he said, SALE OR DISTRIBUTION A Public Health Approach to I may sound emotional about this issue and I do not seek to hide my emotions. I have Breastfeeding: A Framework for Action strong feelings because I have frequently seen © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC It was within this milieu that the most recent public babies die unnecessarily because they were health efforts began toNOT take shapeFOR in SALE the early OR 1970s. DISTRIBUTION bottle fed, babies that wouldNOT haveFOR lived SALE to OR DISTRIBUTION The complete recent history of a public health ap- become useful world citizens had they been proach to breastfeeding protection, promotion, and breastfed. I have shared the grief of sorrow of support would be impossible to recount in this chap- their mothers and have felt great frustration at ter, but© we Jones want to & highlight Bartlett key Learning, actions taken LLC globally not being© able Jones to do &more Bartlett to prevent Learning, needless LLC and in NOTthe United FOR States SALE to ORrespond DISTRIBUTION to concerns over sickness andNOT death. FOR (Latham, SALE 2003,OR DISTRIBUTIONp. 51) the rise of infant formula and the decline of breast- feeding around the world. The National Council of Churches voted in ­November 1978 to support the boycott. As reported in Policy in the Global Arena the Washington Post at the time, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORIn 1974, SALE national OR DISTRIBUTIONrepresentatives from the 194-member NOT FORChurch SALE leaders OR have DISTRIBUTION maintained that promo- states of the World Health Assembly, the decision- tional practices of formula manufacturers seek making body of the WHO, approved a resolution on to convince mothers in the Third World that

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Human Evolution: Shared Parenting and Lactation 31

© Jones & Bartletttheir Learning,babies will fare LLC better if they substitute © Jones & Bartlett Learning, LLC the formula for breast feeding. A Nestle vice BOX 2-2 WHO Code of Marketing of Breast-Milk NOT FOR SALE OR DISTRIBUTION NOT FOR SALEpresident OR DISTRIBUTION told the NCC governing board that Substitutes “Nestle is not involved in aggressive promo- tion of infant formula anywhere in the world.” ■■ No advertising of these products to the public. Church groups argue that the following items ■■ No free samples to mothers. militate against© Jonespromotion & ofBartlett formula Learning, sales in LLC ■■ No promotion of products© Jones in healthcare & Bartlett facilities. Learning, LLC ■ Third WorldNOT countries: FOR PrimitiveSALE OR conditions DISTRIBUTION ■ No company mothercraftNOT nurses FOR to SALE advise OR DISTRIBUTION mothers. of sanitation and storage. Inability of mothers ■■ No gifts or personal samples to health workers. to read and follow directions for preparation ■■ No words or pictures idealizing artificial feeding, of formula. The cost to low-income families including pictures of infants, on the products. © Jonesof a nutrient & Bartlett generally Learning, considered LLC inferior to ■■ Information© Jones to &health Bartlett workers Learning, should be scientific LLC breast milk. (Hyer, 1978) NOT FOR SALE OR DISTRIBUTION andNOT factual. FOR SALE OR DISTRIBUTION ■■ All information on artificial feeding, including the On the heels of the boycott, the World Health labels, should explain the benefits of breastfeeding, Assembly hosted an international meeting on infant and the costs and hazards associated with artificial and young child feeding that was attended by close feeding. © Jones & Bartlettto 150 leadersLearning, from LLCgovernment, the private and© Jones ■&■ BartlettUnsuitable Learning,products, such LLC as condensed milk, NOT FOR SALEpublic OR sectors, DISTRIBUTION and scientists. At this 1979 meeting,NOT FOR SALEshould notOR be DISTRIBUTION promoted for babies. ■ discussions focused on “the encouragement and sup- ■ All products should be of a high quality and take into account the climatic and storage conditions of port of breast-feeding; the promotion and support the country where they are used. of appropriate and timely complementary feeding (weaning) practices© Jones with the & Bartlettuse of local Learning, food re- LLC Reproduced, with permission of the publisher,© Jones from World Health & Organization.Bartlett Learning, LLC sources; the strengthening of education, training and International code of marketing of breast-milk substitutes. 1981. Available at: http://www NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION information on infant and young child feeding; the .who.int/nutrition/publications/infantfeeding/9241541601/en/. Accessed March 1, 2018. promotion of the health and social status of women in relation to infant and young child health and feed- services (see BOX 2-3), (3) the implementation of the ing; and the appropriate marketing and distribution WHO International Code of Marketing of Breast- of© breast-milkJones & Bartlett substitutes” Learning, (WHO, 1981,LLC pp. 4–5). milk Substitutes,© Jones and& Bartlett (4) enactment Learning, of enforceable LLC ANOT key outcomeFOR SALE from ORthis DISTRIBUTIONmeeting was the adoption laws forNOT protecting FOR SALEthe breastfeeding OR DISTRIBUTION rights of em- of the International Code of Marketing of Breast ployed women (UNICEF, 1990). This declaration Milk Substitutes by the World Health Assembly in was signed by 30 countries, including the United 1981 (see BOX 2-2). The Code aims to “contribute States. In 1991, the WHO and UNICEF launched the to the provision of safe and adequate nutrition for ­Baby-Friendly Hospital Initiative (BFHI) to encour- © Jones & Bartlettinfants, byLearning, the protection LLC and promotion of breast-© Jones age & specific Bartlett birth-center Learning, practices LLC in all countries that NOT FOR SALEfeeding, OR and DISTRIBUTION by ensuring the proper use of breast-NOT FORpromote SALE exclusive OR DISTRIBUTION breastfeeding. To be designated milk substitutes, when these are necessary, on the “Baby-Friendly,” a hospital must demonstrate to an basis of adequate information and through appropri- external review board that it practices each of the ate marketing and distribution” (WHO, 1981, p. 8). 10 steps to successful breastfeeding outlined in the In- The Code, passed© Jonesby a vote & of Bartlett 118 to 1 Learning,(the United LLCnocenti Declaration. © Jones & Bartlett Learning, LLC States cast the soleNOT dissenting FOR SALE vote), OR permits DISTRIBUTION the In the next decade,NOT the FOR WHO SALE and UNICEFOR DISTRIBUTION availability of manufactured baby milk products but jointly developed the Global Strategy for Infant and forbids advertisement or free distribution directly to Young Child Feeding to “revitalize world attention to consumers. the impact that feeding practices have on the nutri- In 1990, the WHO and the United Nations Inter- tional status, growth and development, health, and national© Jones Children’s & Bartlett Emergency Learning, Fund (UNICEF)LLC were thus the© veryJones survival & Bartlett of infants Learning, and young LLCchildren­ ” instrumentalNOT FOR SALEin the ORdevelopment DISTRIBUTION of the Innocenti (WHO,NOT 2003, FOR p. v). TheSALE strategy, OR DISTRIBUTION the result of a 2-year Declaration on the Protection, Promotion and Sup- ­participatory process, reaffirmed a global commit- port of Breastfeeding, which restated the importance ment to the International Code of Marketing of Breast- of breastfeeding for maternal and child health. It set milk Substitutes, the Innocenti Declaration, and the © Jones & Bartlettforth four Learning, goals to be LLCmet by 1995: (1) the establish© Jones- ­Baby-Friendly & Bartlett ­HospiLearning,tal Initiative. LLC The global strategy NOT FOR SALEment ORof nationalDISTRIBUTION breastfeeding coordinators andNOT a FORsought SALE to ­provide OR DISTRIBUTION a framework “for linking synergis- national breastfeeding committee, (2) the practice of tically the contributions of multiple programme areas, Ten Steps to Successful Breastfeeding by maternity including nutrition, child health and development,

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32 Chapter 2 Breastfeeding and Lactation: Roots and Wings

■■ © Jones & Bartlett Learning, LLC © JonesHealth & Bartlettworkers should Learning, be empowered LLC to provide BOX 2-3 Ten Steps to Successful Breastfeeding effective feeding counseling and to have their ser- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION vices be extended in the community by trained lay Critical management procedures or peer counselors. 1a. Comply fully with the International Code of ■■ Governments should review progress in national Marketing of Breast-milk Substitutes and relevant implementation of the International Code of Mar- World Health Assembly© Jones resolutions. & Bartlett Learning, LLCketing of Breast-milk Substitutes© Jones and & Bartlett consider Learning, LLC 1b. Have a written infantNOT feeding FOR policy SALE that isOR DISTRIBUTIONnew legislation or additionalNOT measures FOR SALE as needed OR DISTRIBUTION routinely communicated to staff and parents. to protect families from adverse commercial 1c. Establish ongoing monitoring and data- influences. management systems. ■■ Governments should enact imaginative legis- 2. Ensure that staff have sufficient knowledge, lation protecting the breastfeeding rights of competence,© Jones & and Bartlett skills to support Learning, breastfeeding. LLC © Jones & Bartlett Learning, LLC working women and establishing means for its NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Key clinical practices enforcement in accordance with international la- bor standards. 3. Discuss the importance and management of breastfeeding with pregnant women and their Today, new energy is coming from the growing rec- families. ognition of the important ways that breastfeeding con- © Jones &4. BartlettFacilitate Learning,immediate and LLC uninterrupted skin- © Jonestributes to& theBartlett global effort Learning, to tackle LLC poverty, inequality, NOT FOR SALEto-skin OR contact DISTRIBUTION and support mothers to initiate NOTand FOR climate SALE change, OR as DISTRIBUTION reflected by the ­Millennium breastfeeding as soon as possible after birth. Development Goals (MDG) (United Nations, 2015a) 5. Support mothers to initiate and maintain and the Sustainable Development Goals (SDG) breastfeeding and manage common difficulties. (United Nations, 2015b). TheMillenni ­ um Develop- 6. Do not provide breastfed© Jones newborns & Bartlett any food Learning, ment LLC Goals, set forth by the United© Jones Nations & as Bartlett goals for Learning, LLC or fluids other than breast milk unless medically 2015, were to (1) eradicate extreme poverty and hun- indicated. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 7. Enable mothers and their infants to remain ger; (2) achieve universal primary education; (3) pro- together and to practice rooming-in 24 hours a day. mote gender equality and empower women; (4) reduce 8. Support mothers to recognize and respond to child mortality; (5) improve maternal health; (6) com- bat HIV/AIDS, malaria, and other diseases; (7) ensure ©their Jones infants’ &cues Bartlett for feeding. Learning, LLC © Jones & Bartlett Learning, LLC 9. Counsel mothers on the use and risks of feeding environmental sustainability; and (8) develop a global NOTbottles, FOR teats, andSALE pacifiers. OR DISTRIBUTION partnership forNOT development. FOR SALE ­Follo ORwing DISTRIBUTION this, in 2012, 10. Coordinate discharge so that parents and their UNICEF and the governments of Ethiopia, India, and infants have timely access to ongoing support the United States came together to plot a strategic and care. pathway to achieve goals 4 and 5. In response, nearly © Jones & Bartlett Learning, LLC © Jones“180 governments & Bartlett and Learning, hundreds ofLLC civil society and Reprinted from World Health Organization. Baby-Friendly Hospital Initiative: ten steps to faith-based organizations rallied around this ambi- NOT FORsuccessful SALE breastfeeding OR revised.DISTRIBUTION 2018. Available at: http://www.who.int/nutrition/bfhi/ NOT FOR SALE OR DISTRIBUTION ten-steps/en/. Accessed October 1, 2018. tious new goal for child survival, pledging to accelerate efforts to stop mothers and children from dying of pre- ventable causes.” This commitment was outlined in the and maternal and reproductive health” (WHO, 2003 document Ending Preventable Maternal, Newborn and p. 25). Notably, the global© strategyJones called& Bartlett for actions Learning, to Child LLC Deaths: A Promise Renewed.© Jones Promise & Bartlett Renewed Learning, LLC address HIV and the needsNOT of childrenFOR SALE and families OR DISTRIBUTION in recognized breastfeeding as oneNOT “intervention” FOR SALE during OR DISTRIBUTION emergency situations. Key actions called for included the postnatal period that could help reduce neonatal the following: morbidity and mortality. The document noted that ■■ All governments should develop and implement a scientific evidence is building that early breastfeeding comprehensive© Jones & policy Bartlett on infant Learning, and young LLC child initiation is valuable© Jones in &reducing Bartlett infant Learning, mortality. LLC It feedingNOT in FOR the context SALE of OR national DISTRIBUTION policies for nu- does so by preventingNOT FOR hypothermia SALE OR and DISTRIBUTION strengthen- trition, child and reproductive health, and poverty ing the baby’s immune system through colostr­ um (the reduction. mother’s milk during the first days after birth). It also ■■ All mothers should have access to skilled support helps establish the bond between mother and child. to initiate and sustain exclusive breastfeeding for 6 Much more must be done to promote this ­practice. © Jones & monthsBartlett and Learning, ensure the timelyLLC introduction of ad- © JonesIn most ®ions Bartlett of the Learning, world, fewer LLC than half of all NOT FOR SALEequate andOR safeDISTRIBUTION complementary foods with con- NOT­newborns FOR SALEare put ORto the DISTRIBUTION breast within 1 hour of birth tinued breastfeeding up to 2 years or beyond. (UNICEF, 2012, p. 20).

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United States Policy 33

© Jones & BartlettIn 2015, Learning, building on LLC the momentum of the MDGs,© Jones public & Bartlett health agenciesLearning, of breastfeeding LLC as standard the United Nations set forth Transforming Our World: practice. However, the key elements identified by the NOT FOR SALE OR DISTRIBUTION NOT FOR SALEThe OR2030 DISTRIBUTIONAgenda for Sustainable Development.This workshop were more tightly focused on improving the ambitious agenda is a continuum of care in healthcare settings, inclusive of primary care, prenatal care, hospital care, and post- plan of action for people, planet and pros- partum ambulatory care. perity. . . . All© countries Jones &and Bartlett all stakeholders, Learning, LLC Given that the United© JonesStates was & theBartlett one country Learning, LLC acting in collaborativeNOT FOR partnership, SALE OR will DISTRIBUTION im- that did not sign the Code,NOT itFOR is not SALE surprising OR DISTRIBUTIONthat plement this plan. We are resolved to free the the recommendations from this workshop did not human race from the tyranny of poverty and include any reference to monitoring or addressing want and to heal and secure our planet. We the marketing of infant formula. Surgeon ­General are determined to take the bold and trans- © Jones & Bartlett Learning, LLC Koop established© Jones two& Bartlett task forces Learning, in November LLC 1981 formative steps which are urgently needed to in response to the controversy over the Interna- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION shift the world onto a sustainable and resilient tional Code of Marketing of Breast-milk Substitutes. path. (United Nations, 2015a) A ­Public Health Service Task Force on the assessment Although the SDGs do not highlight breastfeeding of ­scientific evidence related to problems of infant per se, the WHO and UNICEF issued a joint ­message feeding in both domestic and international contexts © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC for World Breastfeeding Week (WBW) in 2016, iden- was chaired by Dr. William Foege, then director of NOT FOR SALEtifying OR how DISTRIBUTION breastfeeding links to each SDG (WorldNOT FORthe SALECenters ORfor DiseaseDISTRIBUTION Control and Prevention. The Breastfeeding Week, 2016). Beginning with the 2016 findings of the task force were published as a sup- WBW, the World Alliance for Breastfeeding Action plement to Pediatrics in October 1984 (American launched a long-term campaign to focus each sub- Academy of Pediatrics, 1984). Dr. Koop chaired the sequent WBW on© aJones different & Bartlett SDG (World Learning, Alliance LLCother task force on domestic© Jones activities, & Bartlett and the Learning,find- LLC ings were reported to the World Health Assembly in for BreastfeedingNOT Action, FOR 2016; SALE World OR Breastfeeding DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Week, 2016). In some cases, breastfeeding can help Geneva. The articles in Pediatrics suggested that the advance a goal (e.g., improving health, reducing cli- evidence that breastfeeding had a large, positive effect mate change). For example, breastfeeding contrib- on infant health in the United States was inconclu- utes to a healthy planet because its lower ecological sive (USDHHS, 1984); that not much is known about footprint,© Jones compared & Bartlett with Learning, infant formula, LLC reduces the the many© Jonesfactors related& Bartlett to how Learning, long and exclusively LLC useNOT of water,FOR energy,SALE paper,OR DISTRIBUTION and metal. In other cases, womenNOT breastfeed FOR (Simopoulos SALE OR &DISTRIBUTION Grave, 1984); that the advancement of the SDG may make it easier for lower income women are less likely to breastfeed women to breastfeed by, for example, reducing gen- (Hendershot, 1984); and that human milk is deficient der inequality, income inequality, and poverty (World in vitamin K, vitamin D, and iron. Specifically, re- garding vitamin K, authors concluded, © Jones & BartlettBreastfeeding Learning, Week, LLC2016). These potential syner© Jones- & Bartlett Learning, LLC NOT FOR SALEgies presentOR DISTRIBUTION the breastfeeding community with NOTex- FOR SALEBecause OR human DISTRIBUTION milk provides less vitamin K citing opportunities for policy, practice, and research than fortified formulas do, and because breast- collaborations. fed infants consume relatively small amounts of milk during the first few days of life, vitamin K deficiency in the newborn period is more © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ▸▸ United States Policy common in breast-fed than in ­formula-fed NOT FOR SALE OR DISTRIBUTION infants. Thus, parenteralNOT FOR administration SALE OR of DISTRIBUTION In 1984, 3 years after the adoption of the International a water-soluble vitamin K preparation to Code of Marketing, the first U.S. Surgeon General’s the newborn soon after birth is particularly Workshop on Breastfeeding and Human Lactation ­desirable for breast-fed infants. (Miller & was© Jones held. As & summarizedBartlett Learning, by C. Everett LLC Koop, then Chopra,© Jones 1984, &p. Bartlett639) Learning, LLC surgeonNOT FOR general, SALE this OR workshop DISTRIBUTION identified a frame- NOT FOR SALE OR DISTRIBUTION work for public health action for the “promotion of The next year, a follow-up report to the 1985 Sur- breastfeeding in the continuum of maternal and in- geon General’s Workshop (USDHHS, 1985) docu- fant care” (USDHHS, 1984) This framework included mented efforts that emerged from the workshop and establishing breastfeeding as the norm; promoting described useful public health-initiated approaches © Jones & Bartlettuniversal Learning, education (for LLC professionals and the public);© Jones to &breastfeeding Bartlett Learning, promotion LLC that were being imple- NOT FOR SALEaddressing OR DISTRIBUTION problems in the workplace; and developNOT- FORmented SALE around OR theDISTRIBUTION country. This report summarized ing a continuum of postpartum care and adoption by recommendations in five key areas of the public health

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34 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesaction & Bartlett that were Learning, consistent LLCwith the framework laid © JonesThe & 20 Bartlett action steps Learning, outlined LLCin the 2011 Call to out the previous year, including professional and pub- Action also followed the 1984 framework, with two NOT FOR SALE OR DISTRIBUTION NOT FORlic education; SALE OR strengthening DISTRIBUTION support in the healthcare additions: (1) one action (#6) addressed the market- sector; developing a broad range of support services ing of infant formula; and (2) one action (#20) focused in the community; initiating a breastfeeding pro- on advancing public health infrastructure (USDHHS, motion effort directed toward working women; and 2011). More so than the other documents, the 2011 expanding research on© human Jones lactation & Bartlett and breast Learning,- Call LLC to Action outlined several© Jonesspecific & actions Bartlett that Learning, LLC feeding (USDHHS, 1985).NOT These FOR activitiesSALE OR were DISTRIBUTION fol- communities could take to addressNOT breastfeeding, FOR SALE and OR DISTRIBUTION lowed, albeit much later, by further actions from the it further identified specific populations and organiz- U.S. surgeon general. In 2000, under the leadership of ations that could be targeted by interventions. As the Dr. David Satcher, the U.S. Office of Women’s Health 2000 Blueprint did, the 2011 Call to Action identified and other© Jones federal &agencies Bartlett and Learning, healthcare organizaLLC - that breastfeeding© Jones had health & Bartlett benefits Learning, for the infant LLC tions came together to develop the HHS Blueprint for and the mother and economic benefits for the family. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Action on Breastfeeding (Satcher, 2001), and in 2011, New to the 2011 Call to Action were references to the Surgeon General Regina Benjamin issued The Sur- psychosocial benefits of breastfeeding for the mother geon General’s Call to Action to Support Breastfeeding­ (e.g., lower postpartum depression) and the benefits (USDHHS, 2011). for the global environment—for example, “Although © Jones & OverBartlett the last Learning, 35 years, the LLC public health approach © Jonesbreastfeeding & Bartlett requires Learning, mothers to LLC consume a small NOT FORto breastfeeding,SALE OR DISTRIBUTION as outlined by these reports, has NOTamount FOR of SALE additional OR calories, DISTRIBUTION it generally requires no built on the framework outlined in 1984. The 2000 containers, no paper, no fuel to prepare, no transpor- Blueprint drew attention to two additional issues. tation to deliver, and it reduces the carbon footprint First, it noted the importance of addressing the racial by saving precious global resources and energy” (US- and ethnic disparities in© breastfeeding. Jones & Bartlett The document Learning, DHHS, LLC 2011, p. 4). © Jones & Bartlett Learning, LLC noted, “Significant steps must be taken to increase The 2010 Patient Acceptability and Affordable NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION breastfeeding rates in the United States and to close Care Act (ACA) ushered in an important policy the wide racial and ethnic gaps in breastfeeding. This change for breastfeeding promotion and support. The goal can only be achieved by supporting breastfeed- ACA requires workplaces to provide a time and space ing in the family, community, workplace, health care for hourly workers to pump, and it includes a provi- sector, ©and Jones society” & (USDHHS,Bartlett Learning, 1984, p. 9). However,LLC sion that requires© Jones coverage & Bartlett of preventive Learning, health ser LLC- other thanNOT acknowledging FOR SALE that OR “this DISTRIBUTION Blueprint for Ac- vices for women,NOT includingFOR SALE “breastfeeding OR DISTRIBUTION support, tion is directed toward all women and cuts across all supplies, and counseling,” further defined as “compre- racial and ethnic populations, socio-economic classes, hensive lactation support and counseling, by a trained educational groups and employment arrangements” provider during pregnancy and/or in the postpartum (p. 191), there were no focused actions to address period, and costs for renting breastfeeding equip- © Jonesthese & Bartlett disparities. Learning, Some of theLLC recommendations for © Jonesment” (U.S. & Bartlett Department Learning, of Health LLC and Human Ser- NOT FORresearch SALE priorities OR DISTRIBUTION noted the importance of capturing NOTvices, FOR 2018). SALE OR DISTRIBUTION more data on breastfeeding practices among African American and other minority and ethnic groups. Strengths of Our Global and U.S. Second, it offered a brief statement noting that the marketing of infant formula© Jones negatively & Bartlett affects Learning,breast- Approaches LLC © Jones & Bartlett Learning, LLC feeding; however, as wasNOT the case FOR with SALE prior ORU.S. DISTRIBUTIONrec- Over the decades, the global NOTand U.S. FOR approaches SALE ORto DISTRIBUTION ommendations, none of the action items addressed breastfeeding protection, promotion, and support the marketing of infant formula. It is clear, however, have become broader and deeper. We can see a tran- in the Blueprint that the views about the contributions sition from the view that breastfeeding, as the feed- of breastfeeding to infant health had changed from ing norm, needed protecting from the growing threat those outlined© Jones in the& Bartlett 1984 articles Learning, in Pediatrics LLC (Hen- posed by the ©global Jones spread & Bartlettof infant formulaLearning, through LLC dershot,NOT 1984): FOR “Extensive SALE researchOR DISTRIBUTION on the biology of unethical marketingNOT FOR practices, SALE to OR an DISTRIBUTIONapproach that human milk and on the health outcomes associated saw formula feeding as a norm, resulting in the need with breastfeeding has established that breastfeeding to actively promote the benefits of breastfeeding and is more beneficial than formula feeding” (Satcher, to support it by eliminating barriers within the health- © Jones2001 & Bartlett p. 72). The Learning, Blueprint also LLC acknowledged the re- © Jonescare system, & Bartlett workplace, Learning, and community. LLC Today, the NOT FORsearch SALE demonstrating OR DISTRIBUTION that breastfeeding benefits the NOTmost FOR recent SALE documents OR DISTRIBUTION and trends globally and in the mother and provides economic and social benefits to United States indicate that the public health approach the family. reflects a social ecological approach to breastfeeding.

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The Rise of Breastfeeding 35

© Jones & BartlettThis approach Learning, recognizes LLC that because many of© the Jones report & Bartlett by the International Learning, FoodLLC Policy Research In- forces that affect infant feeding are outside the control stitute, which investigated the importance of wom- NOT FOR SALE OR DISTRIBUTION NOT FOR SALEof nursing OR DISTRIBUTIONparents and their families, we need inter- en’s status for child nutrition in developing countries, ventions that improve conditions at multiple levels of makes this point very clearly: influence, including the individual (intrapersonal), relationship (interpersonal), community, organiza- The empirical results leave no doubt that tional, sociocultural,© Jones and policy & Bartlett levels. WeLearning, are also LLC higher women’s status© Jones has a significant, & Bartlett pos Learning,- LLC seeing a growingNOT effort FOR to broadly SALE communicate OR DISTRIBUTION that itive effect on children’sNOT FORnutritional SALE status OR in DISTRIBUTION the benefits of breastfeeding extend beyond the infant all three regions. Further, they confirm that to include the health and well-being of the mother, the women’s status impacts child nutrition be- community, and the global environment. It is signifi- cause women with higher status have better nutritional status themselves, are better cared cant© Jones that by linking& Bartlett breastfeeding Learning, to each LLC of the SDGs, © Jones & Bartlett Learning, LLC we are challenged to envision ways we can extend for, and provide higher quality care to their NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION breastfeeding promotion and support activities far be- children. . . . Women with low status tend yond the usual domains (health care, workplaces) and to have weaker control over household re- link our efforts with those seeking to bring peace and sources, tighter time constraints, less access to prosperity to the world. information and health services, poorer men- © Jones & Bartlett Learning, LLC © Jones &tal Bartlett health, Learning,and lower self-esteem. LLC These fac- NOT FOR SALE OR DISTRIBUTION NOT FOR SALEtors are ORthought DISTRIBUTION to be closely tied to women’s own nutritional status and the quality of care ▸▸ The Rise of Breastfeeding they receive, and, in turn, to children’s birth Breastfeeding rates across the world have increased as weights and the quality of care they receive. (Smith et al., 2003, p. xi) a result of these efforts© Jones and &other Bartlett trends. Learning, One signif- LLC © Jones & Bartlett Learning, LLC icant factor influencing the resurgence of breastfeed- NOT FOR SALE OR DISTRIBUTION The International NOTFood PolicyFOR SALEResearch OR Institute DISTRIBUTION ing in the United States was the natural childbirth also cautioned that improvements in women’s status movement of the 1960s and 1970s (Wright & Schan- could result in reductions in breastfeeding, which ler, 2001). This movement, although not exclusively could result in poorer child nutrition. Although there focused on breastfeeding, did result in changes to the were inconsistencies in their data, they concluded that: birthing© Jones practices & Bartlett of the Learning,early and mid-20th LLC century © Jones & Bartlett Learning, LLC thatNOT had FOR interfered SALE with OR breastfeeding DISTRIBUTION initiation. This Women’sNOT FORrelative SALE decision-making OR DISTRIBUTION power has social change, a companion to the women’s movement, a statistically significant and negative effect questioned the medicalization of women’s bodies and on the duration of breastfeeding in all three experiences, including childbirth. The view of birth regions. . . . Gender equality at the commu- as natural, not medical, ushered in unmedicated de- nity level has an added negative effect in Latin © Jones & Bartlettliveries, childbirthLearning, classes, LLC more family involvement,© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALEAmerica OR and DISTRIBUTION the Caribbean. It seems clear rooming-in, and encouragement of early breastfeed- that increases in women’s status lead them to ing. These practices foreshadowed those later encour- breastfeed less. (Smith et al., 2003, p. 83) aged by the Baby-Friendly breastfeeding movement (Wright & Schanler, 2001). Women are reacting to the increased evidence, The patterns ©of Joneswho is and& Bartlettwho is not Learning, breastfeed- LLCsocial messaging, and policy© Jones support & Bartlett for breastfeed Learning,- LLC ing and for how longNOT have FOR changed SALE significantly OR DISTRIBUTION since ing. However, the reestablishmentNOT FOR of SALE breastfeeding OR DISTRIBUTION is the 1970s. As we noted earlier, the use of breastfeed- following the same patterns of privilege that the move ing substitutes, including wet-nursing and the use of away from breastfeeding followed historically. Women formula, started with the wealthier populations be- with higher social status are more able to insist on the fore becoming widespread. There was much concern accommodations necessary to make breastfeeding during© Jones this &time Bartlett that education Learning, and LLCliberation were successful.© Jones Thus, &we Bartlett now see aLearning, reversal of theLLC earlier leadingNOT FOR women SALE to stop OR breastfeeding. DISTRIBUTION Of some im- pattern:NOT Women FOR with SALE higher OR economic DISTRIBUTION and social portance is that these same demographic changes, ­status—those who are married, are more educated, particularly increasing urbanization and female ed- have more income, and are from majority populations ucation, led to improvements in other public health in developed countries—are more likely to breastfeed. © Jones & Bartlettgoals during Learning, this same LLC time period. In particular,© in Jones- Women & Bartlett from Learning,more disadvantaged LLC populations are NOT FOR SALEcreases OR in women’sDISTRIBUTION status have been strongly linkedNOT to FORless SALElikely to OR initiate DISTRIBUTION breastfeeding and more likely to reductions in fertility, increases in birth spacing, and introduce formula sooner. This pattern also has raised improvements in maternal and child health. A 2003 concerns because it is happening at a global level.

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36 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jones &A Bartlett study conducted Learning, in LLC2003 by Rafael Pérez- © Joneslower rates & Bartlettof breastfeeding Learning, were associated LLC with a va- Escamilla examined 23 developing countries using riety of anti-choice legislation, including mandatory NOT FOR SALE OR DISTRIBUTION NOT FORdata SALE from the OR Demographic DISTRIBUTION and Health Surveys be- counseling and delay laws, and laws restricting low-­ tween the mid-1980s and mid-1990s. Pérez-Escamilla income and young women’s access to abortion services sought to understand a seeming paradox in the epi- (Smith, 2015). demiology of breastfeeding. He observed that breast- A variety of factors contribute to the positive feeding data collected a© decade Jones earlier & Bartlett suggested Learning, that association LLC between high social© Jones status & andBartlett high Learning, LLC further urbanization andNOT improvements FOR SALE in ORwomen’s DISTRIBUTION breastfeeding rates. The naturalNOT FORchildbirth SALE move OR- DISTRIBUTION education would decrease breastfeeding rates; how- ment, for example, “typically involved middle class, ever, the data suggested that just the opposite was hap- well-educated Caucasian women, the same group of pening. Breastfeeding was decreasing among women women among whom the earliest increases in breast- without© formal Jones education, & Bartlett whereas Learning, it was increasing LLC feeding rates© occurred” Jones & (Wright Bartlett & Schanler,Learning, 2001, LLC among women with at least secondary education. The p. 422S). Pérez-Escamilla (2003) wrote that rising rates NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION authors reported that they found increases in breast- of breastfeeding among women with higher education feeding duration when they would have predicted a and income are likely to be related to well-execu­ ted decline: breastfeeding promotional efforts that change beliefs and attitudes, thereby encouraging mothers and oth- © Jones & LatinBartlett America Learning, has been LLC deeply immersed in © Jonesers to want & Bartlettto breastfeed. Learning, It is noteworthy LLC that breast- NOT FOR SALEthe epidemiological OR DISTRIBUTION and demographic transi- NOTfeeding FOR initiation SALE ORoccurred DISTRIBUTION when new mothers were tion characterized by increased levels of ur- returning to work in greater numbers than ever be- banization, maternal education, and maternal fore. Returning to work full time continues to lead employment outside the home, all of which women to stop breastfeeding earlier than they desire; have been inversely© associatedJones & withBartlett breast Learning,- part-time LLC employment has less© Jonesof a negative & Bartlett effect Learning, LLC feeding outcomes in developing countries. . . . (Mirkovic et al., 2014). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The case of Brazil and other countries exam- Although breastfeeding may be the preferred ined raises the concern that breastfeeding method of infant feeding and may increase overall duration may be declining among the most rates of in-hospital breastfeeding and duration among disadvantaged groups (e.g., women with lit- higher status women, the lack of support for nursers in tle ©schooling) Jones &that Bartlett stand to Learning, lose the most LLC in public spaces,© in Jones the workplace, & Bartlett and in Learning, the community LLC termsNOT of FORmaternal SALE and OR child DISTRIBUTION health when makes extendedNOT or exclusiveFOR SALE breastfeeding OR DISTRIBUTION difficult for this form of infant feeding is abandoned. many to sustain. The confluence of good promotion (Pérez-Escamilla, 2003, pp. S124–S125) and weak support means that those who have more control over their workspaces and schedules, per- It is worth noting that in the Pérez-Escamilla sonal circumstances, and resources (i.e., those with © Jonesstudy, & Bartlett there was Learning, an overall LLCincrease in breastfeeding © Joneshigher status) & Bartlett are able Learning, to breastfeed LLC longer and are NOT FORduring SALE this ORtransition; DISTRIBUTION therefore, the relative shift in NOTmore FOR able SALE to breastfeed OR DISTRIBUTION exclusively than their coun- breastfeeding by maternal education was a result not terparts who have less control and fewer resources. only of a decline in women with lower education but However, there have been some improvements in also of an increase in women with more education. A breastfeeding rates among African American women recent study in the United© JonesStates investigated & Bartlett the Learning, rela- in LLC the United States. A 2013 Morbidity© Jones and & BartlettMortality Learning, LLC tionship between the statusNOT of FORwomen SALE and breastfeed OR DISTRIBUTION- Weekly Report by the Centers forNOT Disease FOR Control SALE and OR DISTRIBUTION ing rates and found that higher rates of breastfeeding Prevention reported that between 2000 and 2008, the at the state level were associated with higher eco- gap between black and white breastfeeding initiation nomic status (including median annual earnings and and 6-month duration rates narrowed significantly percent of women in the labor force), higher levels (Centers for Disea­ se Control and Prevention, 2013). of social© Jonesand economic & Bartlett autonomy Learning, (including LLC per- Nonetheless, ©the Jones world we & largelyBartlett inhabit Learning, today is oneLLC cent ofNOT women FOR with SALE a college OR degree DISTRIBUTION and percent of that has greatNOT disparities FOR in SALE breastfeeding OR DISTRIBUTION by maternal women living above poverty), and a more supportive age, race, ­ethnicity, income, education, marital status, climate for reproductive rights (Smith, 2015). For ex- and obesity. Overall, the patterns in the data suggest ample, higher rates of breastfeeding were associated that even as breastfeeding is becoming more desir- © Joneswith & Bartlettmore pro-choice Learning, positions LLC held by the governor, © Jonesable and & preferred, Bartlett it Learning,is inaccessible LLC to many parents. NOT FORthe SALEstate senate, OR DISTRIBUTIONand the state house; the percent of NOTGlobally, FOR fewerSALE than OR half DISTRIBUTION of infants under 6 months counties with abortion providers; and laws granting of age (40%) are exclu­ sively breastfed (WHO & women access to emergency contraception. Similarly, UNICEF, 2017).

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The Rise of Breastfeeding 37

© Jones & BartlettHowever, Learning, when we LLC compare breastfeeding in ©the Jones to &pump Bartlett at work, Learning, normalizing LLC breast pumping and ex- industrial era of the 19th and 20th centuries with our ponentially increasing the use of breast pumps both in NOT FOR SALE OR DISTRIBUTION NOT FOR SALEcurrent OR culture DISTRIBUTION of urbanization and industrialization, and outside the work setting (United States Congress, there are important differences in the way women 2010). enter the workforce. First, many countries have insti- The prevalence of milk sharing is even more dif- tuted family leave so that gestational and sometimes ficult to ascertain. Three modes of milk sharing have nongestational parents© Jones have &more Bartlett time to Learning, spend with LLCbeen documented: (1) ©donating Jones milk & Bartlett to milk banks,Learning, LLC their very young NOTinfants. FOR For SALEinstance, OR India DISTRIBUTION just in- where it is tested, pooled,NOT and FOR pasteurized SALE ORand DISTRIBUTIONdis- creased its maternity leave policy from 12 weeks to tributed predominantly to ill or premature infants 26 weeks, and Canada provides 35 additional weeks in NICUs; (2) casual sharing among known friends of parental leave beyond 15 weeks of maternity leave or family members or among unknown parties; and that© Jones can be &split Bartlett between Learning, both parents. LLC Second, we (3) selling© Jonesmilk to companies & Bartlett or individuals. Learning, Milk LLC bank- have much more evidence about the risks of formula ing is practiced in many countries worldwide, some NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION feeding, driving parents to prioritize the breastfeed- with well-developed and centrally organized systems ing relationship. And finally, the portable breast pump of education, collection, and distribution, such as Bra- gives parents a way to maintain breastfeeding, even zil. Not all countries have or even allow milk-banking, exclusive human milk feeding, while also returning to however (Ghaly, 2018). For example, Muslim tradition © Jones & Bartlettwork. Although Learning, all these LLC are important developments© Jones does & Bartlettnot allow marriageLearning, between LLC individuals who have NOT FOR SALEin the OR landscape DISTRIBUTION of breastfeeding initiation and conNOT- FORshared SALE milk ORfrom DISTRIBUTION the same mother, making milk bank- tinuation over the last few decades, the breast pump ing impractical because of the pooling of milk from deserves particular attention. multiple mothers that occurs. Casual milk sharing is Like shared infant feeding techniques of the on the rise, with Internet-based free milk-sharing sites past, including shared© Jones lactation, & Bartlett wet-nursing, Learning, animal LLCactive in at least 50 countries© Jones (Akre et al.,& Bartlett 2011), as Learning, well LLC milks, and formula feeding, pumping can again pro- as coordination of milk-sharing partnerships by some NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION vide a tool that allows for equality through shared members of the healthcare team (O’Sullivan et al., resourcing. By using an electric pump, women can 2016) and extensive local networks in which friends, disentangle the biological from the social; doing so families, and acquaintances share human milk re- not only has the potential to increase breastfeeding sources through pumped milk and cross-nursing prac- duration© Jones by &providing Bartlett greater Learning, flexibility LLC but also has tices (Reyes-Foster© Jones & et Bartlett al., 2015). Learning, Unlike milk LLC banks, openedNOT FOR the door, SALE once OR again, DISTRIBUTION to milk sharing by cre- casual sharingNOT FOR is uncontrolled, SALE OR meaning DISTRIBUTION that there are ating stores of disembodied milk, which can devalue no formal screening tests for the donating mother, nor the physical connection between breastfeeding parent a way to verify that the milk is unadulterated, leaving and child. The prevalence of milk pumping practices donors and recipients to develop their own screening is difficult to ascertain using typical breastfeeding tools and systems to establish trust in the transaction © Jones & Bartlettsurvey questions, Learning, which LLC elicit information about ©the Jones (Palmquist & Bartlett & ­Doeh Learning,ler, 2016). LLC NOT FOR SALEfeeding OR product, DISTRIBUTION human milk or formula, rather thanNOT FOR SALEHuman ORmilk DISTRIBUTION sold for profit from nonregulated the source of milk or mode of delivery. In the United sources poses significant concern because a level of States, there is one national survey, the Infant Feed- risk exists that is not present when obtaining milk ing Practices Study II, collected between 2005 and from milk banks or from known donors. As with 2007, that explored© Joneswomen’s & experiences Bartlett Learning,with breast LLCdairy, when human milk© is Jonescommodified, & Bartlett sellers Learning,could LLC pumping. Labiner-WolfeNOT FOR and colleaguesSALE OR (2008) DISTRIBUTION found be enticed to reduce the NOTquality FOR by diluting SALE or OR modify DISTRIBUTION- that most women had expressed breast milk at some ing it to increase profits, or women could be exploited point, but approximately one-quarter of women ex- by “manufacturing” the product using less expen- pressed breastmilk on a regular basis, and this num- sive or disadvantaged labor pools. Like wet-nursing, ber decreased as infants aged. It is easy to assume that the risk of commodifying human milk is that the re- pumping© Jones would & Bartlett increase breastfeedingLearning, LLC duration in the sources© are Jones pooled & at Bartlett the top of Learning, the social strata, LLC and workplace,NOT FOR but SALE in fact, OR the DISTRIBUTIONonly study to examine this those withNOT fewer FOR options SALE end OR up DISTRIBUTION producing milk for shows that pumping had a null effect on breastfeed- sale or obtaining milk in unhealthy situations. How- ing duration among working women (Yourkavitch ever, in the same way that disembodied human milk et al., 2018). This study, however, used data from the opens the door to commodification, it also expands © Jones & BartlettInfant Feeding Learning, Practices LLC Survey, which was collected© Jones options & Bartlett for sustaining Learning, human LLC milk feeding while re- NOT FOR SALEbefore OR the DISTRIBUTIONACA of 2010. The ACA mandated thatNOT in- FORturning SALE to workOR DISTRIBUTIONor reestablishing independent social surance companies provide pumps to all women and activities. As stated by Kate Boyer, “If we start with that employers provide women with a place and time the assertion that the transmittal of breast milk is a

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38 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesfoundational & Bartlett act Learning, of care, what LLC can this story tell us © Jonesprograms & inBartlett the community” Learning, (Rollins LLC et al., 2016, about the new geographies of care enabled by breast p. 491). Similarly, a recent narrative review of the lit- NOT FOR SALE OR DISTRIBUTION NOT FORpumps SALE and mobileOR DISTRIBUTION breast milk? First, it illustrates just erature identified themes related to factors that create how far, both geographically and socially, what is com- an enabling environment for breastfeeding and re- monly understood as a high-touch interaction can be vealed the continued need to develop interventions stretched” (Boyer, 2010, p. 12). Cultural flexibility is across the social ecology beyond the individual level again taking root within© Jonesa framework & Bartlett that includes Learning, (Brown, 2017). LLC © Jones & Bartlett Learning, LLC professional childcare settings,NOT FOR dual-income SALE OR ­families, DISTRIBUTION An examination of the livesNOT and FOR experiences SALE ORof DISTRIBUTION and ­non­gestational parents opting to be primary breastfeeding women reveals two important yet con- caretakers. This, in conjunction with our increasing tradictory realities that helped to shape this pattern knowledge about the risks of formula feeding and of breastfeeding rates, showing disparities by race, the normalization© Jones & of Bartlett sharing Learning,personal information LLC income, and ©education. Jones First,& Bartlett for breastfeeding Learning, to LLCbe through social media, has driven us back to practices successful, mothers and babies must be together, and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION similar to hunter-­gatherer societies, in which small second, being with babies often reinforces gender groups of trusting individuals are reaching out across ­inequities in ways that could undermine women’s eco- traditional social barriers and public health concerns nomic security and political and social status (Smith and forming milk-sharing partnerships. et al., 2012). Despite the progress that has been made © Jones & Bartlett Learning, LLC © Jonesboth in the& Bartlett United States Learning, and around LLC the world, one NOT FOR SALE OR DISTRIBUTION NOTimportant FOR SALE persistent OR concern DISTRIBUTION stands out: It is diffi- ▸▸ Challenges Going Forward: cult for our social solutions to reconcile the biological imperative of lactation with the realities of the lives The Breastfeeding of breastfeeding parents who participate in the labor Conundrum © Jones & Bartlett Learning,force LLC and are active in public© spaces. Jones Navigating & Bartlett the Learning, LLC challenges between these two realities is more difficult NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION In an effort to promote and support breastfeeding, we for women and families with fewer economic and so- have at times failed to support nursers. Indeed, many cial resources. have argued that our efforts have focused more on This irony of general societal acceptance of the promoting the infant health benefits of breastfeed- benefits of breastfeeding and the general lack of soci- ing, leading© Jones mothers & Bartlettand others Learning, to want to nurse, LLC but etal support for© Jonesbreastfeeding & Bartlett parents Learning,in working and LLC less onNOT providing FOR real, SALE practical OR supportDISTRIBUTION that can help public spacesNOT has created FOR SALEa breastfeeding OR DISTRIBUTION conundrum. nursers overcome the many constraints they face in ex- The conundrum erupts when most people know and tending exclusive breastfeeding beyond the early days believe that breastfeeding is the healthier choice and and months. For instance, the penalties for not provid- want to try it, but they find that feeding at the breast, ing workplace accommodations for women who are or embodied feeding, is so challenging that they wean © Jonespumping & Bartlett are limited, Learning, meaning LLC that workplaces with © Jonesfrom the & breast/chest Bartlett Learning,or supplement LLC prematurely with NOT FORdisempowered SALE OR workers DISTRIBUTION are less likely to implement NOTexpressed FOR SALEmilk and/or OR DISTRIBUTIONformula. Indeed, pumping has breastfeeding-friendly policies. This type of disparity become one solution to this breastfeeding conun- could explain why we see significant and unacceptable drum. Research by British scholar Johnson and col- differences in breastfeeding rates by race, ethnicity, leagues (2010) suggests that women pump because income, and other indicators© Jones of status. & Bartlett An edited Learning, vol- it LLChelps them navigate the dilemmas© Jones that & come Bartlett from Learning, LLC ume of papers on women’sNOT lives FOR and SALEexperiences OR withDISTRIBUTION the varying cultural pressuresNOT and FOR contradictions SALE OR DISTRIBUTION breastfeeding concluded that the ­difficulties many they experience when trying to be good breastfeed- women experience stem from the challenges of trying ing mothers, workers, and partners. They concluded to integrate employment with motherhood combined that for “many women feeding their baby is a matter with gender role inequities that continue to place most of balancing different demands, finding solutions, and of the burden© Jones for ensuring& Bartlett the family’sLearning, health LLC and care struggling with© Jones choices & in Bartlett difficult Learning, circumstances” LLC on womenNOT (Smith FOR et al., SALE 2012, OR p. DISTRIBUTION1). (Johnson et al.,NOT 2010, FOR p. 187). SALE Pumping, OR DISTRIBUTION like the use of A 2016 study reported in The Lancet similarly human milk supplements throughout history, makes noted that women should not be shouldering full re- it easier for mothers and others who nurse to be sepa- sponsibility for the success or failure of breastfeeding rate from their child; it also expands the circle of those © Jonessince & Bartlett “her ability Learning, to breastfeed LLC is very much shaped © Joneswho feed & the Bartlett baby and Learning, facilitates shared LLC parenting. As NOT FORby theSALE support OR DISTRIBUTIONand the environment in which she NOTwas FOR the case SALE with OR wet-nursing DISTRIBUTION in the past, pumping lives. There is a broader responsibility of governments may be viewed as optimizing the resources of mothers and society to support women though policies and and family by allowing the mother to work and to take

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Challenges Going Forward: The Breastfeeding Conundrum 39

© Jones & Bartlettadvantage Learning, of various opportunities. LLC A study analyzing© Jones & Bartlett Learning, LLC data from the U.S. Infant Feeding Practices Survey II BOX 2-4 Fragmenting the Whole—All Babies Need NOT FOR SALE OR DISTRIBUTION NOT FOR SALEfound OR that DISTRIBUTIONthe most commonly cited reason for pump- Not Just Food, But Nurturing ing was the ability to have someone else feed the baby (work as a reason was not an option in the survey); re- ■■ Step 1: Reduce that larger truth (nurturing) to lated to this was the second most common reason: to what is easier to study and, seemingly, most have an emergency© supplyJones (Yourkavitch & Bartlett et al., Learning, 2018). LLC essential—feeding. © Jones & Bartlett Learning, LLC ■ Hrdy (2000)NOT reminds FOR us SALEthat for OR most DISTRIBUTION of hu- ■ Step 2: Reduce feeding,NOT an actFOR simultaneously SALE OR DISTRIBUTION social and physical, to its physical fraction—food. man existence, human and nonhuman mothers have ■■ Step 3: Reduce this food to generic milk, forgetting worked to combine their productive and reproductive that the substance varies woman to woman and responsibilities and that combining changes adaptively over the course of feeding. ■ © Joneswork with & Bartlettmotherhood Learning, has always LLC entailed ■ Step© 4:Jones Reduce &generic Bartlett milk to Learning, its nutrients as LLC if it were not a veritable soup of living antimicrobial, NOTtradeoffs. FOR SALE Mothers OR either DISTRIBUTION sustain energetic NOT FOR SALE OR DISTRIBUTION anti-inflammatory, and immunoregulatory agents. costs and lost efficiency by toting babies every- where . . . or else located an alloparent to take Reproduced from Van Esterik P, O’Connor RA. The dance of nurture: negotiating infant on the task. What is new for modern mothers, feeding. New York, NY: Berghahn Books; 2017. though, is the compartmentalization of their © Jones & Bartlett Learning, LLC © Jonespractices & Bartlett and experiences Learning, of LLC mothers and others who NOT FOR SALEproductive OR DISTRIBUTION and reproductive lives. The fac-NOT FOR SALE OR DISTRIBUTION tories, laboratories, and offices where ­mothers nurture infants and young children. in postindustrial societies go to “forage” are Mann (2017) reminded us that caring for others even less compatible with childcare than is valuable for its own sake, not just because it leads to ­jaguar-infested­ forests and distant groves of better health outcomes: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC mongongo nuts reached by trekking across embodied care is an ethic that understands in- deserts. (p. 109)NOT FOR SALE OR DISTRIBUTION dividual and social NOTmorality FOR as deeplySALE bound OR DISTRIBUTION Despite public health efforts to promote, protect, up with the caring relationships and com- and support breastfeeding, the real difficulties that come munities in which human beings are embed- from trying to integrate nursing and being a parent with ded. Care is also a set of practices whereby paid© Jones employment & Bartlett and breastfeeding Learning, in LLCpublic continue individuals© Jones take & upBartlett the work Learning, of caring for LLC the toNOT result FOR in decreasing SALE breastfeeding OR DISTRIBUTION rates, particularly for ­bodiesNOT of FORothers . . .SALE with andOR through DISTRIBUTION their own women who have lower income jobs. Next-­generation ­bodies . . . Finally, care . . . is a virtue that is choice breastfeeding protection, promotion, and support ­efforts worthy because it is a context within which must address this breastfeeding conundrum. we become most fully human. (pp. 19–20) © Jones & Bartlett Learning, LLC © Jones &She Bartlett further Learning, posited that breastfeeding,LLC like friend- NOT FOR SALECaregiving OR DISTRIBUTION and Paid Labor: Fixing NOT FORship, SALE provides OR us DISTRIBUTION the Conundrum with the necessary context to learn how to Too much focus on the nutrient content of human milk do well by others. Caregiving relationships, can detract our attention from breastfeeding as a nur- in particular those that arise within the con- turing practice. Van© EsterikJones and & O’ConnorBartlett (2017)Learning, wrote LLC texts of child-rearing© andJones maternity, & Bartlett are most Learning, LLC that our tendenciesNOT toward FOR dualistic SALE thinking OR DISTRIBUTION led us to valuable because theyNOT form FOR an SALE important OR DISTRIBUTION frequently separate biology from culture. We create structure in which we learn other-regarding separatism both academically and practically, and we thought and action, and they also become the fragment wholes into bits. They described a four-step re- enabling conditions for our own acting and ductionist process that turns “nurturing (a flexiblesocia­ l doing well in life. (Mann, 2017, p. 20) relationship)© Jones & [into] Bartlett nutrients Learning, (fixed physical LLC facts)” (Van © Jones & Bartlett Learning, LLC EsterikNOT FOR& O’Connor, SALE 2017, OR p.DISTRIBUTION 28). (See BOX 2-4.) This re- ThisNOT benefit FOR to SALE the breastfeeding OR DISTRIBUTION parent is gener- ductionist process focuses our gaze on human milk as ally not discussed in the breastfeeding promotion lit- the best nutrition for the baby and less on how breast- erature or activities. feeding as a nurturing practice actually gets done. Ironically, caregiving—this life-affirmingactiv ­ ity— © Jones & BartlettNursing Learning, as an aspect LLC of nurture has certain© Jones is socially& Bartlett gendered. Learning, That is toLLC say, both historically and NOT FOR SALE­characteristics—it OR DISTRIBUTION is part of an embodied form of care,NOT FORcurrently, SALE women—mothers, OR DISTRIBUTION daughters, ­sisters—are as- it is gendered, it is real labor, and it is unpaid. These signed responsibility for most caregiving activities, even characteristics interact with one another to shape the if it is not biologically required. This social gendering

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40 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesof &caregiving Bartlett hasLearning, several LLCimportant consequences: © JonesIt is, & however, Bartlett labor Learning, that often LLC remains invisible (1) ­because it is generally unpaid and assigned to women, in terms of its contribution to the well-being of our NOT FOR SALE OR DISTRIBUTION NOT FORcaregiving SALE receives OR DISTRIBUTION fewer social resources and has lower society. Unpaid caregiving is big business around social status than forms of work that are paid; (2) this the world. As of 2015 in the United States, 40% of all imbalance in status and resources may obscure the value mothers with infants under age 1 were not in the labor of caregiving for individuals, families, and societies; force. In addition, according to the Family Caregiver (3) fulfilling this unpaid© roleJones can &become Bartlett an impedi Learning,- Alliance, LLC over 40 million people© Jones each year& Bartlett provide Learning, LLC ment to women’s securityNOT if, or when,FOR itSALE leads or OR requires DISTRIBUTION care to an adult or child (assistedNOT with FOR tasks SALE of daily OR DISTRIBUTION them to trade off career/employment opportunities; and living or medical care), and about two-thirds of all (4) gendering has the potential to obscure the caregiving caregivers are women. As the primary caregivers, fe- and infant feeding preferences and practices for lesbian, male caregivers spend more time providing care than gay, bisexual,© Jones transgender, & Bartlett queer, andLearning, intersex (LGBTQI) LLC male caregivers© Jones(21.5 vs. &17.4 Bartlett hours/week). Learning, This issue LLC parents, particularly those who are male or transgender, is global in scope. The Organization for Economic NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and for men more generally. (See BOX 2-5.) Co-operation and Development (OECD) argued that Mulford (2012) in fact argued that breastfeeding, or the gender imbalance in the provision of unpaid care “extreme caregiving,” is real labor that can be physic- work is reflected in the gender imbalance in paid ally and emotionally demanding. Similar to what Mann ­labor and its benefits. © Jones(2017) & Bartlett writes, Mulford Learning, notes LLC that breastfeeding is care © Jones & Bartlett Learning, LLC Time is a limited resource, which is divided NOT FORwork SALE because, OR in DISTRIBUTIONpart, of the intimacy created by the use NOT FOR SALE OR DISTRIBUTION between labour and leisure, productive and of the caregiver’s body to provide protection and food: reproductive activities, paid and unpaid The physical mouth-to-breast contact be- work. Every minute that a woman spends tween care receiver and caregiver is highly on unpaid care work represents one minute personal, as is the ©temporal Jones interlocking& Bartlett ofLearning, LLCless that she could be potentially© Jones spending& Bartlett Learning, LLC mothers’ and child’sNOT rhythms FOR of SALE activity, OR re -DISTRIBUTIONon market-related activitiesNOT or FORinvesting SALE in OR DISTRIBUTION laxation, provisioning, and sleep. The physio- her educational or vocational skills. (Ferrant logical function of lactation draws on the et al., 2014, p. 1) caregiver’s nutritional reserves, changes her Gender inequality in care work is greater in lower hormone© Jones profile & Bartlett and her Learning,body shape, affectsLLC wealth countries,© Jones such that& Bartlett women Learning,in low-income, LLC herNOT fertility FOR and SALE her state OR of DISTRIBUTION mind, and has lower-middle-income,NOT FOR and SALE upper-middle-income OR DISTRIBUTION an impact, predominantly positive, on her countries spend more time in care work relative to short-term and long-term health. (Mulford, men as compared with women in higher-income 2012, pp. 128–129) countries. This is largely due to men’s increasing role in care work in higher income countries. The more © Jones & Bartlett Learning, LLC © Joneshours women & Bartlett spend Learning, in unpaid LLCcaregiving activi- NOT FOR SALE OR DISTRIBUTION NOTties, FOR the less SALE likely OR they DISTRIBUTION are to be employed; if they BOX 2-5 About Transgender Breastfeeding are employed, they are more likely to be employed in part-time, low-income, and/or insecure positions. A 2018 case report in Transgender Health (Reisman & Ultimately, unpaid care work leads to lower income Goldstein, 2018) described the process whereby a both over the course of a career and in retirement. 30-year-old transgender ©woman Jones was &able Bartlett to “breastfeed Learning, LLC © Jones & Bartlett Learning, LLC exclusively for 6 weeks. DuringNOT thatFOR time SALE the child’s OR DISTRIBUTIONThe OECD report argued thatNOT outsourcing FOR SALE this careOR DISTRIBUTION pediatrician reported that the child’s growth, feeding, work is unaffordable for most women and that both and bowel habits were developmentally appropriate. discriminatory policies and social norms contribute At 6 weeks the patient began supplementing to gender inequalities in unpaid care work (Ferrant breastfeedings with 4–8 oz of [formula] daily due to et al., 2014). concerns© Jones about insufficient & Bartlett milk Learning, volume. At the LLC time of The economic© Jones value & ofBartlett caregiving Learning, and of breast LLC- this articleNOT submission, FOR SALE the babyOR isDISTRIBUTION approaching feeding remainNOT largely FOR unmeasuredSALE OR DISTRIBUTIONand invisible. 6 months old. The patient continues to breastfeed as a The Family Caregiver Alliance estimates that the supplement to formula feeding, and she continues to monetary value of caregiving in the United States adhere to [her] medication regimen” (p. 25). This story is $470 billion. A study by Price Waterhouse assess- upends our traditional notions of who can biologically ing the value of unpaid caregiving for the Australian © Jones breastfeed,& Bartlett who Learning, wants to breastfeed, LLC and how families © Jones & Bartlett Learning, LLC economy concluded that unpaid childcare has a true NOT FORorganize SALE caregiving OR DISTRIBUTION roles and responsibilities. NOT FOR SALE OR DISTRIBUTION economic value of $345 billion, making it Australia’s Data from Reisman T, Goldstein Z. Case report: induced lactation in a transgender woman. Transgender Health. 2018;3(1):24–26. largest industry. The authors argue that “counting” the

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Challenges Going Forward: The Breastfeeding Conundrum 41

© Jones & Bartlettvalue of caregivingLearning, is importantLLC for several reasons:© ItJones or & more Bartlett employees Learning, to provide LLC nursing mothers with highlights the importance of this work to society; it time and space, the United States has not passed any NOT FOR SALE OR DISTRIBUTION NOT FOR SALEcontributes OR DISTRIBUTION to a better picture of the value of women’s major federal initiative to help workers accommodate labor and the division of labor in society; and it pro- their family and work demands since the Clinton ad- vides data for policy and social investment decisions. ministration passed the Family and Medical Leave Act They concluded that “the issue becomes how we can in 1993. Additionally, only women who are “nonex- ensure that the requirements© Jones & of Bartlett the unpaid Learning, economy, LLCempt employees covered© byJones the Fair & LaborBartlett Standards Learning, LLC and the value it generatesNOT FOR to society,SALE ORis given DISTRIBUTION appro- Act (FLSA),” meaning NOTthose FORwho workSALE 40 OR hours DISTRIBUTION a priate weight in policy and investment decisions” week and are eligible for overtime, are covered by the (Thorpe et al., 2017, p. 5). ACA. Women who are not be covered by FLSA may Several studies in both the developed and the de- be covered by state laws. The lack of such policies and veloping© Jones world & Bartlett have produced Learning, estimates LLC for the eco- practices© makesJones it &more Bartlett difficult Learning, for many LLC parents to nomic value of human milk production. Julie Smith, navigate the competing demands and responsibilities NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION an economic researcher in Australia, argued that it is of the workplace and family and dampens individual important to estimate this value in order to “a) em- and family economic security. phasize the extent of breastfeeding and its value, b) ac- A full accounting of the value of human milk knowledge women’s unique contributions to society, production could shift policy discussions about gov- © Jones & Bartlettc) highlight Learning, its importance LLC to economic welfare, ©and Jones ernment & Bartlett funding Learning, for food, LLCformula, and caregiving. NOT FOR SALEd) contribute OR DISTRIBUTION to more accurate public policy analysisNOT FORFor SALEexample, OR Smith DISTRIBUTION (2013) noted that the United and more soundly based economic and health poli- States expends significant public resources on pro- cies” (Smith, 2013, p. 538). Her analysis of the value of grams that reduce the cost of infant formula for human milk produced in Australia, Norway, and the low-income ­families, and these dollars are visible. United States, which© Jones based the & marketBartlett price Learning, of human LLCBut the value and cost ©of Joneshuman milk& Bartlett is not visible. Learning, LLC milk on the price of milk sold by North American Smith writes, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION milk banks, estimated the value of human milk pro- If breast milk were more visible in economic duction to be US$1 billion in Norway, US$45 billion statistics such as GDP, greater funding pri- in the United States, and US$3.6 billion in Aust­ ralia. ority might be given to potentially more This value is well below the biological potential be- cost-effective programs that expand human cause© Jones it is based & Bartlett on breastfeeding Learning, prevalence; LLC Smith © Jones & Bartlett Learning, LLC milk production by increasing breastfeeding. estimated that about 60% of the potential human milk NOT FOR SALE OR DISTRIBUTION SuchNOT programs FOR SALEmight include,OR DISTRIBUTION for example, production is lost in the United States and Australia, implementing the Baby-Friendly Hospital and 40% is lost in Norway. Initiative including restraining unethical mar- The economic and social value of caregiving for keting through hospitals, financing access to society makes clear how important it is for caregivers peer counselor or health professional lacta- © Jones & Bartlettto continue Learning, doing this LLC work, even when they also par© Jones- & Bartlett Learning, LLC tion support, or introducing paid maternity NOT FOR SALEticipate OR in DISTRIBUTIONthe paid labor force. However, most sociNOT- FOR SALE OR DISTRIBUTION leave and requiring breastfeeding accommo- eties and communities throw up roadblocks that make dation in workplaces. (p. 544) it difficult to do both. For example, in the United States, most employees return to work soon after birth Policies, practices, and norms supporting work- and do not have ©access Jones to paid, & Bartlett or even unpaid,Learning, par- LLCing parents and nursers© Jonesare key &to Bartlett fixing the Learning, co- LLC ental leave or childcareNOT atFOR the workplace. SALE OR Mothers DISTRIBUTION and nundrum because work—notNOT FOR marriage—is SALE OR vital DISTRIBUTION to others must navigate caregiving, nursing, and paid women’s economic security. A study examining the work in the context of both a conceptual and a spatial changes in the causes of women’s poverty over the separation of the public world of work and the private 30-year period from 1960 to 1990 in the United States world of family and caregiving. The persistence of this revealed significant and important shifts in the causes separation© Jones certainly& Bartlett complicates Learning, the livesLLC of mothers of women’s© Jones poverty & Bartlett(Lieb & Thistle, Learning, 2006). LLC Histori- andNOT others FOR because SALE it isOR not DISTRIBUTION altogether easy to keep the cally inNOT the United FOR States,SALE marriage OR DISTRIBUTION was women’s way public and private each sequestered in its own place. of avoiding poverty; today, it is paid employment. During the time nursing parents are at work, lacta- The authors concluded that the data clearly indicate tion does not stop and children are not invisible. It is that “marriage as a solution for women’s poverty is © Jones & Bartlettdifficult Learning, to live in the LLC boxes society prescribes for© Jonesus; an & outdated Bartlett approach, Learning, a story LLC for the 1950s rather NOT FOR SALEthings OR just DISTRIBUTION have a way of seeping out. NOT FORthan SALE today. ORSecondly DISTRIBUTION it is an approach that is not Aside from the provision in the ACA (United race neutral, since statistically, it is less likely to be States Congress, 2010) requiring employers with 50 advantageous to women of color . . . however, work in

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42 Chapter 2 Breastfeeding and Lactation: Roots and Wings

© Jonesand & ofBartlett itself does Learning, not end poverty. LLC Rather such work © JonesSummary & Bartlett Learning, LLC must provide decent wages and benefits. . . .Women NOTThis FOR short SALE history OR of infantDISTRIBUTION feeding practices reveals NOT FORraising SALE children OR face DISTRIBUTION the highest poverty, in part due to seven important themes about how the feeding and the difficulties of combining work at home and for pay care of infants is accomplished by real people in [emphasis added]” (Lieb & Thistle, 2006, p. 17). This the context of their culture, time, and place. These new reality calls for policies that support the better integration of our reproductive© Jones and & productive Bartlett Learning,roles, themes LLC reveal that human culture© Jones is indeed & Bartlett far from Learning, LLC of our ability to care forNOT children FOR and SALE to be successful OR DISTRIBUTION proscribed. We are biologicallyNOT complex FOR and SALE socially OR DISTRIBUTION economically. More than good policy, such strategies adaptable, and we have created an almost endless ar- are “essential to human life, . . . [and] a more efficient ray of parenting styles and cultural norms around in- way to spend public funds to reduce poverty” (Lieb & fant feeding and care. The forms of feeding that are culturally accepted change over time; today, most of ­Thistle,© 2006,Jones p. 18).& Bartlett Learning, LLC © Jones & Bartlett Learning, LLC This shift in the circumstances surrounding us would shudder at the idea of feeding our infants NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION wealth and poverty for women has implications not directly from the udders of cows. Instead, today we only for the United States but also, possibly, for many accept feeding our infants from bottles that contain other countries. Leib and Thistle’s (2006) analysis sug- milk sucked from women’s breasts by a machine. To- gests that the shift toward work and away from mar- day, Internet-supported informal milk sharing is gain- © Jonesriage & Bartlett comes from Learning, women’s improved LLC opportunities for © Jonesing in acceptance & Bartlett in Learning,some communities LLC but is still NOT FORemployment, SALE OR including DISTRIBUTION decent wages and benefits and NOTnot FORrecommended SALE OR by manyDISTRIBUTION public health authorities. reduced employment discrimination. These circum- However, as we have explored in this chapter, human stances are not unique to the United States and are milk sharing has been part of our feeding practices for conditions that are worthy of support worldwide. The thousands of years. Today, formula, human milk sharing, and pump- choice to breastfeed at ©the Jones expense & of Bartlett real economic Learning, LLC © Jones & Bartlett Learning, LLC security is a “Sophie’s choice,” or a choice between two ing are all feeding practices that allow for people other NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION unbearable options. than the nursing parent to feed the baby. This allows This is a troubling conundrum because both care- mothers and others to separate from the baby while giving and paid work are critical for a healthy society: expanding the circle of those who can participate in We need people to care about children and who can feeding; this is reminiscent of the cultural value of help raise© Jones a smart, & healthy, Bartlett moral Learning, next generation; LLC we prelacteal foods© Jones used historically & Bartlett in someLearning, places and LLC need peopleNOT whoFOR can SALE care forOR the DISTRIBUTION sick or vulnerable; still widely practicedNOT FOR around SALE the world.OR DISTRIBUTION Although we and we need people to engage in paid work that sus- continue to discuss the harm to infants from these tains them and the society. To relieve this conundrum, other sources of food, mothers and others must bal- we must work toward a social agreement that breast- ance the risk of alternative feeding strategies against feeding is a socially valued activity, that breastfeed- the social benefit of expanding the child’s circle of care © Jonesing & is Bartlett a worthy Learning,choice for its LLC own sake and for human © Jonesand of being & Bartlett able to leave Learning, the child toLLC go to work. From NOT FORhealth, SALE that OR it is DISTRIBUTIONvaluable to have parents participate NOTthis FOR point SALEof view, OR formula DISTRIBUTION has both health risk and in the labor economy, and that society shares in the social value, whereas breastfeeding has both health responsibility for raising children. The labor and benefits and social risk. Looked at from the view point pleasure of breastfeeding, along with its economic of the value of care, however, breastfeeding has real and social value, call for© Jonesan approach & Bartlett to policy Learning, and social LLC value. The risk–benefit© Jonescalculus &is Bartlett more com- Learning, LLC investment that acknowledgeNOT FORand support SALE this OR value DISTRIBUTION plex with the more variables weNOT add FORto the equation.SALE OR DISTRIBUTION and those who do it. Oakley and O’Connor (2015) We frequently reduce the value of human milk to argued for an ethic of care approach to social policy, the level of its nutrients. This lens guides much of our which acknowledges that all humans need to be cared health promotion of breastfeeding as best and the most for at some point—at the beginning of life, at the end nutritious food. Commodification of human milk has of it, and© Jonesat points & in Bartlett between—that Learning, caregiving LLC is so- both positive© and Jones negative & Bartlett consequences. Learning, The posiLLC- cially valuable,NOT FOR and SALEthat society OR DISTRIBUTIONshares responsibility tive side is thatNOT we FORare able SALE to increase OR DISTRIBUTION the perceived with individuals for care work. Social policy should value of human milk for human health and the desire be geared toward ensuring that care occurs and that of mothers and others to breast/chestfeed. This desire caregivers are rewarded. Policies and practices that leads to both pumping and human milk sharing and © Jonesreward & Bartlett caring, Learning,however, also LLC must take into consid- © Jonesmay increase & Bartlett the proportion Learning, of infants LLC who receive hu- NOT FOReration SALE that OR breastfeeding DISTRIBUTION is an embodied from of NOTman FOR milk. SALE On the OR negative DISTRIBUTION side, viewing human milk nurture that may demand more time from one parent primarily as nutritious food could contribute to our than another. taking a narrow health-focused approach to assessing

9781284189971_CH02_021_046.indd 42 30/08/19 5:44 PM © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION.

References 43

© Jones & Bartlettthe risks Learning,(of formula) LLCand benefits (of breastfeeding)© Jones their & Bartlettbabies. However, Learning, we also LLC see that breastfeeding is while ignoring the aforementioned social risk–benefit a survivor: Although rates have waxed and waned, it NOT FOR SALE OR DISTRIBUTION NOT FOR SALEcalculus. OR Commodification DISTRIBUTION of milk may also slip into continues to be a valued, if not the most valued, way of the commodification of those who provide the milk— feeding and nurturing children. Of particular interest as happened historically with slaves, paid wet-nursing, at this point is the question of why. What enables this and now when companies pay women for their milk. embodied form of nurture to survive? Is it the nutrient Finally, this practice© Jones also neuters & Bartlett breastfeeding; Learning, it ob- LLCvalue of breastmilk? Is ©it becauseJones breastfeeding& Bartlett Learning,saves LLC scures the realityNOT of breastfeeding FOR SALE as ORembodied DISTRIBUTION care lives and improves humanNOT health? FOR IsSALE it because OR nurDISTRIBUTION- work, with its concomitant challenges, constraints, ture and care are part of our humanity? Is it because and consequences for women who remain the main of the pleasure nursing offers to mothers and others? providers of unpaid, socially undervalued caregiving. Is there some biological yearning? Is it the policies we © JonesIgnoring & the Bartlett gendered Learning, nature and LLC social risks of put in place© Jones to protect, & Bartlett promote, Learning, and support LLC breast- breastfeeding as embodied caregiving has two particu- feeding? Also, what should we seek to optimize? The NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION larly troubling consequences. First, many of those who quality of the experience of those who nurse? Exclu- want to breastfeed—in particular, mothers and others sivity or duration? The milk supply? How we choose who seek to combine nursing with employ­ ment— to answer these questions and advance our policies, still do not have the structural and normative supports programs, and advocacy will have important influ- © Jones & Bartlettthey need Learning, to successfully LLC do this. Our history teaches© Jones ences & Bartlett on the patterns Learning, of breast/chestfeeding LLC that we NOT FOR SALEus that OR mothers DISTRIBUTION have always worked, and the supportsNOT FORsee goingSALE forward. OR DISTRIBUTION and resources available to them, including breastfeed- ing substitutes, shape how they feed and care for their Key Concepts infants. Today, we see pumping, mixed feeding, and ■■ The forms of infant feeding that are culturally ac- early weaning. In earlier times, we saw wet-nursing © Jones & Bartlett Learning, LLC cepted change over ©time. Jones & Bartlett Learning, LLC and various forms of dairy feeding. The need to work NOT FOR SALE OR DISTRIBUTION■■ Parents engage in practicesNOT FOR that expandSALE theOR circle DISTRIBUTION takes us back to the need that many parents have to of those who love, care for, and feed children. expand their infants’ circle of care and to secure feed- ■■ We engage in practices that commodify human ing strategies that support this. milk, valuing it primarily for its caloric and nutri- Particularly troubling is the persistent theme that ent potential, that run the risk of overemphasizing class-based© Jones societal& Bartlett structures, Learning, which LLCconcentrate re- © Jones & Bartlett Learning, LLC the health benefits at the expense of other nurtur- sourcesNOT FOR at the SALE top of theOR social DISTRIBUTION strata, operate in ways NOT FOR SALE OR DISTRIBUTION ing potentials. that also make it more feasible for women/families at ■■ Lactation and breastfeeding are linked to gender, the top to feed their infants in a manner that is seen and this linking has consequences for who we ex- as the most desirable at the time; meanwhile, those pect to nurse and for the impact that nurturing at the lower end of the strata find it more difficult to others has on the caregiver. © Jones & Bartlettfeed their Learning, babies in the LLC socially determined “best” way.© Jones & Bartlett Learning, LLC ■■ Women have always worked to help sustain the NOT FOR SALEWe see OR this DISTRIBUTION play out when wealthy women employedNOT FOR SALE OR DISTRIBUTION family economically, and the need for their con- wet nurses, whose own babies sometimes died for lack tributions shapes how families feed and care for of their mother’s breastmilk; this occurred when the their children. status of wealthy women began to rise in society, and ■■ Class-based societal structures, which concentrate breastfeeding became something that “poor women” © Jones & Bartlett Learning, LLC resources at the top ©of Jonesthe social & strata, Bartlett operate Learning, in LLC did. Today, we see rising breastfeeding rates among NOT FOR SALE OR DISTRIBUTION ways that also makeNOT it more FOR possible SALE for ORwomen/ DISTRIBUTION women with higher status. These women have the ben- families at the top to feed their infants in the way efit of being able to afford electric pumps, of working seen as most desirable (at the time); meanwhile, in a private office that makes pumping easier, of having those at the lower end of the strata find it more one stable job, and of having access to maternity leave. difficult to feed their babies in the best way. © JonesOver time & Bartlettand place, Learning, it has become LLC clear that al- © Jones & Bartlett Learning, LLC thoughNOT FOR babies SALE have to OR be fed,DISTRIBUTION they do not have to be NOT FOR SALE OR DISTRIBUTION breastfed. There have always been, and will continue References to be, human milk substitutes that are used by a wide Akre JE, Gribble KD, Minchin M. Milk sharing: from private prac- swath of the population. Breastfeeding is not really an tice to public pursuit. Int Breastfeed J. 2011;6(1):8–10. “unmovable object” standing in the way of “unstop- American Academy of Pediatrics. Report of the task force on the sci- © Jones & Bartlett Learning, LLC © Jones &entific Bartlett evidence Learning, relating to infant-feeding LLC practices and infant NOT FOR SALEpable ORforces”; DISTRIBUTION the forces of economic, social, demoNOT- FOR health:SALE executive OR DISTRIBUTION summary. Pediatrics. 1984;74(4):579–583. graphic, and political change have powerful effects Apple RD. Mothers and medicine: a social history of infant feeding, on how individuals, families, and communities feed 1890–1950. Madison: University of Wisconsin Press; 1987.

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44 Chapter 2 Breastfeeding and Lactation: Roots and Wings

Bain K. The incidence of breast feeding in hospitals in the United Johnson S, Leeming D, Lyttle S, et al. Empowerment or regula- © Jones &States. Bartlett Pediatrics. Learning, 1948;2(3):313–320. LLC © Jonestion? &Exploring Bartlett the Learning,implications of LLCwomen’s perspectives NOT FORBoyer SALE K. Of care OR and DISTRIBUTIONcommodities: breast milk and the new politics NOT onFOR pumping SALE and ORexpressing DISTRIBUTION breast milk. In: 5th Breastfeed- of mobile biosubstances. Prog Hum Geogr. 2010;34(1):5–20. ing and Feminism Symposium: Informing Public Health Ap- Brown A. Breastfeeding as a public health responsibility: a review proaches. Greensboro, NC; 2010. Available at: http://eprints of the evidence. J Hum Nutr Diet. 2017;30(6):759–770. .hud.ac.uk/id/eprint/31363/. Accessed March 1, 2018. Campbell L. Wet-nurses in early modern England: some evidence Jordan B. Authoritative knowledge and its constuction. In: from the Townshend archive.© Jones Med Hist &. 1989;33(3):360–370. Bartlett Learning, LLC­Davis-Floyd RE, Sargent C, eds.© Childbirth Jones and & authoritativeBartlett Learning, LLC Centers for Disease Control NOTand Prevention. FOR SALE Progress ORin increas DISTRIBUTION- knowledge: cross-cultural perspectives.NOT Oakland, FOR CA: SALE University OR DISTRIBUTION ing breastfeeding and reducing racial/ethnic differences— of ­California Press; 1997. United States, 2000–2008 births. MMWR Morb Mortal Wkly Jordan B. Technology and social interaction: notes on the achieve- Rep. 2013;62(5):77–80. ment of authoritative knowledge in complex settings. Talent Devitt N. The statistical case for elimination of the midwife: Dev Excell. 2014;6(1):96–132. fact versus prejudice, 1890–1935 (part 1). Women Health. Katzer D, Pauli L, Mueller A, et al. Melatonin concentrations and 1979;4(1):81–96.© Jones & Bartlett Learning, LLC antioxidative© capacity Jones of &human Bartlett breast Learning,milk according LLC to Duranti NOTS, Lugli FOR GA, SALEMancabelli OR L, DISTRIBUTIONet al. Maternal inheri- gestational ageNOT and theFOR time SALE of day. J ORHum DISTRIBUTIONLact. 2016;32(4): tance of bifidobacterial communities and bifidophages NP105–NP110. in infants through vertical transmission. Microbiome. Konner M. Hunter-gatherer infancy and childhood: the !Kung 2017;5(1):66–79. and others. In: Hewlett BS, Lamb ME, eds. Hunter-gatherer Edmond KM, Kirkwood BR, Amenga-Etego S, et al. Effect of early ­childhoods: evolutionary, developmental, and cultural ­perspectives. © Jones &infant Bartlett feeding practicesLearning, on infection-specific LLC neonatal mortal- © JonesNew Brunswick, & Bartlett NJ: Aldine Learning, Transaction; LLC 2005:19–64. NOT FOR ity:SALE an investigation OR DISTRIBUTION of the causal links with observational data NOTLabiner-Wolfe FOR SALE J, Fein SB,OR Shealy DISTRIBUTION KR, et al. Prevalence of breast milk from rural Ghana. Am J Clin Nutr. 2007;86(4):1126–1131. expression and associated factors. Pediatrics. 2008;122(suppl Ferrant G, Pesando LM, Nowacka K. Unpaid care work: the 2):S63–S68. missing link in the analysis of gender gaps in labour out- Latham M. The case against Nestle: statement before the Gov- comes [Issues paper]. 2014. OECD Development Centre. erning Board National Council of Churches in New York on Available at: https://www.oecd.org/dev/development-gender 3 November, 1978. In: Menon L, Fazal A, Amin S, Siew S, eds. /Unpaid_care_work.pdf. ©Accessed Jones March & 1,Bartlett 2018. Learning, LLCThe breastfeeding movement: a sourcebook.© Jones Penang, & Bartlett Malaysia: Learning, LLC Fortin J. Formula for Disaster:NOT UNICEF FOR Documentary SALE. 2007.OR AvailDISTRIBUTION- World Alliance for BreastfeedingNOT Action; FOR 2003:51–54. SALE OR DISTRIBUTION able at: https://www.youtube.com/watch?v=3PBtb-UDhEc. Lieb H, Thistle S. The changing impact of marriage, mother- Accessed March 1, 2018. hood and work on women’s poverty. J Women Polit Policy. Garland J, Rich MB. Duration of breast feeding: a comparative 2006;27(3–4):5–22. study. N Engl J Med. 1930;203(26):1279–1282. Mann HS. Breastfeeding as embodied care: on its goodness, aw- Gerrard ©JW. Jones Breast-feeding: & Bartlett second Learning,thoughts. Pediatrics. LLC 1974; fulness, and© irreducible Jones pleasure.& Bartlett In: Hall Learning, Smith P, Labbok LLC 54(6):757–764. M, eds. Breastfeeding, social justice, and equity. Amarillo, TX: Ghaly M.NOT Human FOR milk-based SALE industry OR DISTRIBUTION in the Muslim world: ­Praeclarus Press;NOT 2017:19–26. FOR SALE OR DISTRIBUTION religioethical challenges. Breastfeed Med. 2018;13(S1): Mead Johnson [Advertisement]. JAMA. 1930;95:22. S28–S29. Miller SA, Chopra JG. Problems with human milk and infant for- Glazier MM. Comparing the breast-fed and the bottle-fed infant. mulas. Pediatrics. 1984;74(4):639–647. N Engl J Med. 1930;203(13):626–631. Mirkovic KR, Perrine CG, Scanlon KS, et al. Maternity leave du- © JonesGreer & BartlettFR, Apple Learning, RD. Physicians, LLC formula companies, and © Jonesration &and Bartlett full-time/part-time Learning, work status LLC are associated with NOT FOR advertising:SALE OR a DISTRIBUTIONhistorical perspective. Am J Dis Child. NOT U.S.FOR mothers’ SALE ability OR to meetDISTRIBUTION breastfeeding intentions. J Hum 1991;145(3):282–286. Lact. 2014;30(4):416–419. Hassiotou F, Beltran A, Chetwynd E, et al. Breastmilk is a novel Mulford C. “Are we there yet?” Breastfeeding as a gauge of carework source of stem cells with multilineage differentiation potential. by mothers. In: Hall Smith P, Hausman BL, Labbok M, eds. Stem Cells. 2012;30(10):2164–2174. ­Beyond health, beyond choice: breastfeeding constraints and reali- Hendershot GE. Trends in breast-feeding.© Jones &Pediatrics. Bartlett 1984;74(4): Learning, LLCties. New Brunswick, NJ: Rutgers University© Jones Press; & 2012:123–132. Bartlett Learning, LLC 591–602. Muller M. The baby killer: a war on want investigation into the Hewlett BS. Diverse contextsNOT of human FOR infancy SALE cross OR cultural DISTRIBUTION promotion and sale of powdered babyNOT milks FOR in the SALEThird World OR. DISTRIBUTION TOC. In: Ember CEM, ed. Cross-cultural research: The journal London, UK: War on Want; 1974. Available at: https://­waron of comparative social science. Upper Saddle River, NJ: Prentice want.org/resources/baby-killer. Accessed March 1, 2018. Hall;1996:1–30. Oakley K, O’Connor J. The Routledge companion to the cultural Hinde K, Skibiel AL, Foster AB, et al. Cortisol in mother’s milk ­industries. New York, NY: Routledge; 2015. across© lactationJones reflects & Bartlett maternal Learning,life history and LLCpredicts in- O’Sullivan EJ, Geraghty© Jones SR, &Rasmussen Bartlett KM. Learning, Informal human LLC fant NOTtemperament. FOR Behav SALE Ecol. OR 2015;26(1):269–281. DISTRIBUTION milk sharing:NOT a qualitative FOR exploration SALE OR of the DISTRIBUTION attitudes and ex- Hrdy SB. Mother nature: maternal instincts and how they shape the periences of mothers. J Hum Lact. 2016;32(3):416–424. human species. New York, NY: Ballantine Books; 2000. Palmquist AE, Doehler K. Human milk sharing practices in the Hrdy SB. Mothers and others: the evolutionary origins of mutual US. Matern Child Nutr. 2016;12(2):278–290. ­understanding. Cambridge, MA: Harvard University Press; 2009. Pérez-Escamilla R. Breastfeeding and the nutritional transition © JonesHyer & BartlettM. Church Learning,council backs LLCboycott of Nestle Company. © Jonesin the &Latin Bartlett American Learning,and Caribbean LLCregion: a success story? ­Washington Post. November 10, 1978. Cadernos de Saude Publica. 2003;19:S119–S127. NOT FORJelliffe SALE DB. CommerciogenicOR DISTRIBUTION malnutrition? Time for a dialogue. NOTPowe FOR CE, Knott SALE CD, Conklin-Brittain OR DISTRIBUTION N. Infant sex predicts breast Food Technol. 1971;25(2):199–205. milk energy content. Am J Human Biol. 2010;22(1):50–54.

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Raina SK, Mengi V, Singh G. Determinants of prelacteal feeding 2012. Available at: https://www.unicef.org/eapro/A_Promise_ © Jones & Bartlettamong Learning,infants of RS Pura LLC block of Jammu and Kashmir, India© Jones. &Renewed_Report_2012.pdf. Bartlett Learning, Accessed LLC March 1, 2018. NOT FOR SALEJ Fam OR Med DISTRIBUTION Prim Care. 2012;1(1):27–29. NOT FORUnited SALE States Breastfeeding OR DISTRIBUTION Committee. Statement on infant/young Rawick GP, ed. The American slave: a composite­ autobiography. child feeding in emergencies. 2011. Available at: http://www ­Series 2, Vol. 1. Westport, CT: Greenwood Press; 1979: .usbreastfeeding.org/publications. Accessed March 1, 2018. 285–289. United States Congress. Patient Protection and Affordable Care Reisman T, Goldstein Z. Case report: induced lactation in a trans- Act Health-Related portions of the Health Care and Educa- gender woman. Transgender© Jones Health. & Bartlett 2018;3(1):24–26. Learning, LLC tion Reconciliation Act of© 2010. Jones Amended & Bartlett 2010. Available Learning, at: LLC Reyes-Foster BM, CarterNOT SK, FOR Hinojosa SALE MS. Milk OR sharing DISTRIBUTION in prac- http://housedocs.house.gov/energycommerce/ppacacon.pdf.NOT FOR SALE OR DISTRIBUTION tice: a descriptive analysis of peer breastmilk sharing. Breast- Accessed March 1, 2018. feed Med. 2015;10(5):263–269. United States Department of Health and Human Services. The Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and Surgeon General’s workshop on breastfeeding and human lac- what it will take to improve breastfeeding practices? Lancet. tation. Publication No HRS-D-MC 84-2. 1984. Available at: 2016;387(10017):491–504. https://profiles.nlm.nih.gov/NN/B/C/G/F/. Accessed March 1, Rotch© Jones TM. An &historical Bartlett sketch Learning, of the development LLC of percentage 2018.© Jones & Bartlett Learning, LLC NOTfeeding. FOR New SALEYork Med ORJ. 1907;85:532–537. DISTRIBUTION United StatesNOT Department FOR SALE of Health OR and DISTRIBUTION Human Services. Fol- Satcher DS. From the Surgeon General: DHHS blueprint for ac- lowup report: The Surgeon General’s workshop on breast- tion on breastfeeding. Public Health Rep. 2001;116:72–73. feeding and human lactation. Publication No HRS-D-MC Simopoulos AP, Grave GD. Factors associated with the choice 85-2. 1985. Available at: https://profiles.nlm.nih.gov/ps/access and duration of infant-feeding practice. Pediatrics. 1984; /NNBCTH.pdf. Accessed March 1, 2018. © Jones & Bartlett74(4):603–614. Learning, LLC © JonesUnited & Bartlett States Department Learning, of Health LLC and Human Services. ­Surgeon NOT FOR SALESmith JP.OR “Lost DISTRIBUTION milk?” Counting the economic value of breast NOTmilk FOR General’sSALE call OR to action DISTRIBUTION to support breastfeeding and human lacta- in gross domestic product. J Hum Lact. 2013;29(4):537–546. tion. Washington DC: U.S. Department of Health and Human­ Smith LC, Ramakrishnan U, Ndiaye A, Haddad LJ, Martorell R. The Services, Office of the Surgeon General; 2011. importance of women’s status for child nutrition in ­developing United States Department of Health and Human Services. ­Women’s countries [Abstract number 131]. Washington DC: Interna- preventative services; required health plan coverage guidelines. tional Food Policy Research Institute; 2003. Available at: http:// 2018. Available at: https://www.hrsa.gov/women­ s-guidelines www.ifpri.org/publication/importance-womens-status-child© Jones & Bartlett Learning, LLC /index.html. Accessed December© Jones 1, 2018. & Bartlett Learning, LLC -­nutrition-developing-countries.NOT FOR AccessedSALE MarchOR DISTRIBUTION 1, 2018. Valenze D. Milk: a local and NOTglobal history.FOR NewSALE Haven, OR CT: DISTRIBUTION Yale Smith P. Breastfeeding and the status of women. In: Hall Smith University Press; 2011. P, Labbok M, eds. It takes a village: the role of the greater com- Van Esterik P, O’Connor RA. The dance of nurture: negotiating munity in inspiring and empowering women to breastfeed. ­infant feeding. New York, NY: Berghahn Books; 2017. ­Amarillo, TX: Praeclarus Press; 2015:36–43. Walker M. Still selling out mothers & babies: marketing of breast Smith© Jones P, Hausman & Bartlett BL, Labbok Learning, M. Breastfeeding LLC promotion milk ©substitutes Jones in the& BartlettUSA. Bethesda, Learning, MD: National LLC Alliance through gender equity: a theoretical perspective for public of Breastfeeding Advocacy; 2007. NOThealth FOR practice. SALE In: Hall OR Smith DISTRIBUTION P, Hausman BL, Labbok M, WeinbergNOT FR. Infant FOR feeding SALE through OR the DISTRIBUTION ages. Can Fam Physician. eds. Beyond health, beyond choice: breastfeeding constraints 1993;39:2016–2020. and ­realities. New Brunswick, NJ: Rutgers University Press; West E, Knight RJ. Mothers’ milk: slavery, wet-nursing, and black 2012:25–35. and white women in the Antebellum South. J South Hist. Starr P. The social transformation of American medicine: the rise 2017;83(1):37–68. © Jones & Bartlettof a sovereign Learning, profession LLC and the making of a vast industry.© Jones Wickes & Bartlett IG. A history Learning, of infant feeding:LLC part I: primitive peo- NOT FOR SALENew York, OR DISTRIBUTION NY: Basic Books; 1982. NOT FOR ples;SALE ancient OR works; DISTRIBUTION Renaissance writers. Arch Dis Child. Tanovic D. Tigers [Film]. India/France/United Kingdom. Cinemor- 1953a;28(138):151–158. phic Pvt Ltd, Sikhya Entertainment Pvt Ltd, A.S.A.P. Films; Wickes IG. A history of infant feeding: part II: seventeenth 2014. and eighteenth centuries. Arch Dis Child. 1953b;28(139): Thorpe J, Tyson R, Neilsen N. Understanding the unpaid econ- 232–240. omy. 2017. Available© Jones at: https://www.pwc.com.au/australia-in & Bartlett Learning, LLCWickes IG. A history of infant© Jones feeding: & part Bartlett III: eighte­ Learning,enth LLC -transition/publications/understanding-the-unpaid-economy and nineteenth century writers. Arch Dis Child. 1953c;28 -mar17.pdf. AccessedNOT March FOR 1, 2018. SALE OR DISTRIBUTION(140):332–340. NOT FOR SALE OR DISTRIBUTION United Nations. Millennium development goals. 2015a. Available Wilson E, Perrin MT, Fogelman A, et al. The intricacies of induced at: http://www.un.org/millenniumgoals/. Accessed March 1, lactation for same sex mothers of an adopted child. J Hum 2018. Lact. 2015;31(1):64–67. United Nations. Transforming our world: the 2030 agenda for sus- Witkowska-Zimny M, Kaminska-El-Hassan E. Cells of human © tainableJones development. & Bartlett 2015b. Learning, Available at: LLC https://sustainable breast© milk. Jones Cell Mol & BiolBartlett Lett. 2017;22(1):11. Learning, LLC NOTdevelopment.un.org/post2015/transformingourworld#. FOR SALE OR DISTRIBUTION Wolf JH.NOT Don’t FORkill your SALE baby: ORpublic DISTRIBUTION health and the decline ­Accessed March 1, 2018. of breastfeeding in the nineteenth and twentieth centuries. United Nations International Children’s Emergency Fund. Inno- Columbus, OH: Ohio State University Press; 2001. centi Declaration on the Protection, Promotion and Support World Alliance for Breastfeeding Action. Breastfeeding: a key to of Breastfeeding. 1990. Available at: https://www.unicef.org/ sustainable development: UNICEF and WHO joint message for © Jones & Bartlettprogramme/breastfeeding/innocenti.htm. Learning, LLC Accesse­ d March© 1,Jones &World Bartlett Breastfeeding Learning, Week. 2016. LLC Available at: http://waba.org 2018. .my/archive/breastfeeding-a-key-to-sustainable-development NOT FOR SALEUnited OR Nations DISTRIBUTION International Children’s Emergency Fund. ComNOT- FOR -unicef-world-breastfeeding-week-2016-message/.SALE OR DISTRIBUTION Accessed mitting to child survival: a promise renewed. Progress report August 12, 2019.

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46 Chapter 2 Breastfeeding and Lactation: Roots and Wings

World Breastfeeding Week. Breastfeeding: a key to sustainable guiding_principles_for_feeding_infants_and_young_children_ © Jones &development. Bartlett AugustLearning, 1, 2016. AvailableLLC at: http://worldbreast © Jonesduring_emergencies.pdf?ua & Bartlett Learning,=1. Accessed LLC March 1, 2018. NOT FOR feedingweek.org/2016/.SALE OR DISTRIBUTION Accessed March 1, 2018. NOTWorld FOR Health SALE Organization. OR DISTRIBUTION Baby-Friendly Hospital Initiative: World Health Assembly. Infant nutrition and breast-feeding. 1974. ten steps to successful breastfeeding revised. 2018. Available Available at: http://apps.who.int/iris/handle/10665/92534. Ac- at: http://www.who.int/nutrition/bfhi/ten-steps/en/. Accessed cessed March 1, 2018. October 1, 2018. World Health Organization. International code of marketing of World Health Organization, United Nations International Children­ ’s breast-milk substitutes. ©1981. Jones Available & at:Bartlett http://www.who Learning, LLCEmergency Fund. Tracking progress© Jones for breastfeeding & Bartlett ­policies Learning, LLC .int/nutrition/publications/infantfeeding/9241541601/en/.NOT FOR SALE OR DISTRIBUTION and programmes: global breastfeedingNOT FOR scorecard. SALE 2017. OR DISTRIBUTION Accessed March 1, 2018. ­Available at: http://www.who.int/nutrition/publications/infant- World Health Organization. Global strategy on infant and young feeding/global-bf-scorecard-2017/en/. ­Accessed March 1, 2018. child feeding. 2003. Available at: http://apps.who.int/iris Wright AL, Schanler RJ. The resurgence of breastfeeding at /bitstream/10665/42590/1/9241562218.pdf?ua=1&ua=1. the end of the second millennium. J Nutr. 2001;131(2): ­Accessed March 1, 2018. 421S–425S. World Health© Jones Organization. & Bartlett Guiding Learning,principles for feedingLLC in- Yourkavitch J, Rasmussen© Jones KM, & PenceBartlett BW, et Learning, al. Early, regular LLC fants NOTand young FOR children SALE during OR emergencies. DISTRIBUTION 2004. Available breast-milk pumpingNOT FOR may leadSALE to early OR breast-milk DISTRIBUTION feeding at:http://www.searo.who.int/entity/emergencies/documents/ cessation. Public Health Nutr. 2018;21(9):1726–1736.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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