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In The Picture of Dorian Gray, Oscar Wilde wrote, “Nowadays people know the price of everything and the value of nothing.” In our society, items are priced but value remains an abstract and often misunderstood concept. When it comes to breastfeeding, the valuations get even trickier. Our idea of value is based on what somebody is willing to pay for something, and that leaves the modern valuation of breastfeeding steeped in confusion. There is the actual cost of breastfeeding-related products and then there is the priceless value of the preventive health benefits and the monetary value of the time it takes a mother to provide it. How we value the huge time commitment for breastfeeding is directly related to the broader issue of valuing mothering in general.
As a society, we talk endlessly about the importance of family, yet the time and work it takes to nurture and manage a family is utterly disregarded. Pressed for time and money, unable to find decent affordable day care, racked with guilt at falling short of the mythic supermom ideal—working and nonworking American mothers alike have it harder today than they have in decades, and they are worse off by almost every measure than many of their peers around the world. Capitalist models would tell you that when you “corner the market” on a certain product or service, then by definition your value should increase—but the exact opposite has occurred for women, who have been actually devalued by their ability to bear children and exclusively feed them. Witness the ever-persistent gender gap. Women are paid 23 percent less than men even when we are doing the exact same work as a man. So how could we be properly valued for doing work, such as birthing and breastfeeding, that men cannot do? It is universally accepted that no one would work for free except mothers, yet no one has enough money to hire a good mom, which, in that framework, actually makes mothers priceless. This does not include Mother’s Day—when the commercial interest in celebrating mothers reaches a fever pitch. Beyond that, mothering is mostly considered thankless work. In some places, it can even be a penalty. A 2008 study documented the motherhood penalty showing that the bias toward mothers, the so-called “maternal wall,” is more of a problem than the glass ceiling is for all women. The study found that when female subjects were given identical resumes, one but not the other a mother, the mother was 79 percent less likely to be hired, 100 percent less likely to be promoted, offered an average of $11,000 less in salary, and held to higher performance and punctuality standards. Mothers are under stress coping with an outdated system built around the idea that families can afford for women not to work, yet mothers are being underpaid and undermined for their secular work and their maternal work. The contradictions are complex. So are the implications. The psychological impact of generations of undervalued mothers is hard to ignore.
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Excerpted from The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding (St. Martin’s Press, 2017) by Kimberly Seals Allers
At times, the language of feminism has led to the undermining of breastfeeding, starting with the word “choice.” The mere word conjures up thoughts of women’s liberation and reproductive justice and hard-won rights and freedoms earned by the feminist movement. In fact, the very essence of women’s liberation was the liberation to make individual choices, whether it be about work, family, or lifestyle. This was most strikingly the case after Roe v. Wade, when reproductive politics made the language of choice synonymous with women’s liberation. As the feminist writer, Summer Wood wrote of “choice” in Bitch magazine, “The word’s primacy in the arena of reproductive rights has slowly caused the phrase, ‘It’s my choice’ to become synonymous with ‘It’s a feminist thing to do’—or perhaps more precisely, ‘It is anti-feminist to criticize my decision.’” In the so-called mommy wars and specifically in the milk wars, we see the most perverse form of individualism, where individualizing and privatizing choices around motherhood and breastfeeding has created a dangerous environment. What was once the trademark for women’s rights has become a consumerist tool being used against women. What began as a highly politicized term, in the context of a right to decide to terminate a pregnancy, has now been depoliticized and used for consumer imperatives, as in the “right” to buy all sorts of products marketed to women, from antidepressants, moisturizers, and diet frozen pizzas to infant formula. Implicit in this tactic is that exercising your choice in these matters is in itself a feminist act. We see this tactic often in pop culture, such as an episode of the fan-favorite Sex and the City, where liberated consumer Carrie Bradshaw (in an episode fittingly titled, “A Woman’s Right to Shoes”) proudly justifies purchasing expensive footwear.
The problem with “choice” today is that it has been taken out of the context of women’s rights and misconstrued.
In its most disgusting reiteration it is being marketed to women and girls by corporate interests. We are being sold on the idea of choice. The combination of aggressive advertising, medical backing, and a love of consumer freedom has led to a free-market paradise where a host of instant foods are readily available and women have been led to believe that the choice between formula feeding and breastfeeding is merely a matter of personal inclination—a feather in the cap of the quest for liberation. And since choices are individual, they have no social consequences; women are therefore relieved of the responsibility of considering the broader implications of their decisions. And once I make my choice, no one is to challenge me.
Lately, choice has taken on a concerning meaning in third-wave feminist circles. One of the new iterations of feminism is called “choice feminism.” In contrast to political philosophies that explore the ways in which structural inequality limits freedom, choice feminism tells us that every individual is free to choose and that choice is empowering, no matter what the choice actually is. The result is that the term “choice” is now employed in feminist debates about everything from the sex industry to marriage and makeup to breastfeeding versus formula feeding. Choice feminism dictates that anytime a woman makes a choice, even if it’s to engage in prostitution or pole dancing, it is an act of feminism. This is dangerous thinking when the reality is that our “choice” has more limitations than many think and choices based on uninformed decisions founded on marketing propaganda is not true choice at all. It’s particularly dangerous because we fail to differentiate between those who have the privilege of choosing and those who do not, and it avoids any analysis of how race, class, and power actually affect a woman’s choice.
For one, choice should be based on equal options. Is having the option of breastfeeding versus formula feeding really a choice when the options are not equal? They are so incongruous that it has taken billions of dollars in research and insidious marketing tactics to build the notion that infant formula is just as good. When one option gives your baby preventive health benefits and the other increases your baby’s risk for health problems, then that’s not an actual choice. The options are not equal. The options are not equal when the reasons people give for not breastfeeding include returning to work, perceiving formula as more convenient, and fear-based ideas such as it will hurt or that their breasts won’t produce enough milk. This is not the choice women need.
It’s easy to see why framing breastfeeding versus formula feeding around individualism is a win-win for the formula companies. Doing so means that the idea can’t be challenged. So, for example, when breastfeeding or formula feeding is framed as an individual choice, the economic interests of selling formula can be disassociated from the conversation. The billions spent on marketing to create doubt among mothers who are undermined from the day they leave the hospital with a free infant formula bag can be removed from the discussion. If breastfeeding is purely a personal choice, it need not have anything to do with greedy corporations, body politics, or a marketing industry that has sold women damaging messages. If breastfeeding is purely a personal choice, then we don’t have to connect the dots between the paltry breastfeeding rates in this country and high levels of childhood allergies, asthma, type 2 diabetes, and obesity.
Think back to reproductive rights. At this point many women see those rights as accessible, but the right to have an abortion is greater than access.
It touches on issues such as the wage gap, health care, education—issues that have as much if not greater impact on the real-life choices of women. Similarly, breastfeeding is far greater than a matter of choice when issues such as employer practices, child care, and the lack of federal maternity leave play such a large part in how a mother decides to feed her baby. But continuing to frame the issue around choice allows these greater, more influential factors to remain unmentionables. Most significantly, keeping breastfeeding as a private choice rather than a public health issue hampers momentum. After all, private choices do not provide the basis for a movement. In fact, framing breastfeeding as a personal choice erases the context of corporate interests and deep-pocketed marketing machines in which it typically occurs. In this context, choice is not liberation. It is suffocation.
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Excerpted from The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding (St. Martin’s Press, 2017) by Kimberly Seals Allers
The ultimate connection between breastfeeding and feminism is that in a truly equitable society, women would have the capacity to pursue both their productive and reproductive work without penalty. In that vein, breastfeeding becomes the perfect lens to see the misogyny of our culture as it impacts mothers: women are harassed and shamed and illegally evicted from public spaces for breastfeeding; women are threatened with losing custody of their children for breastfeeding for “too long”; women are ridiculed and bullied for trying to pump milk at work; women are described as freak shows for breastfeeding twins or tandem feeding; women are called names for breastfeeding; women are told they are sexually abusing their children for breastfeeding; women are told they’re not allowed to keep breast milk in communal fridges because it’s viewed as a bodily secretion and not as food; women are bullied into stopping breastfeeding because breasts are the sexual objects of men; women are told that it is obscene to breastfeed in front of other people’s children or other people’s husbands; women are told their bodies are too fat and too saggy and too veiny to be exposed while breastfeeding; women are told to stay at home with their babies until they are no longer breastfeeding; women are instructed to throw blankets over themselves and their babies if they wish to breastfeed outside the home. The list goes on. This is not the result of some peculiar sensitivity toward babies and small children eating; this does not happen with bottle feeding. This is unique to breastfeeding, and it is about policing women’s bodies and lives. You know, exactly the kinds of things feminists used to get riled up about. The fact that women are harassed and shamed for doing something that women’s bodies do as a routine part of bearing children is a severe societal flaw that should trouble all feminists.
• • • • • •
Excerpted from The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding (St. Martin’s Press, 2017) by Kimberly Seals Allers
It was the longest walk ever. Entering the double doors to the operating rooms and walking slowly down the cold hallway, the tears just streamed down my place. I had flashbacks of my pregnancy belly, my womb swelling with life. I was walking toward the end of my fertility and the sadness was overwhelming. The very kind nurse, a young woman, said her mother also had to have a hysterectomy and she cried on this same walk too.
I wondered how many women were carrying grief over having their wombs removed but were suffering in silence. As I climbed onto the surgical platform, and looked up into the bright lights, the last thing I remember was saying a prayer to God and a thank you to my uterus for giving me the two best things I’ve ever known—my children.
For the past 2 1/2 years I have been fighting to keep my womb, to avoid this exact walk to the operating room, the lights, the coldness—all of it— trying everything from Eastern medicine, restrictive diets, an IUD and having multiple surgical procedures to deal with the fibroids that just kept growing inside of me.
What’s worse as friends and loved ones saw me trying all sorts of things and still suffering, they just couldn’t understand why I didn’t just have the hysterectomy already.
“Well, it’s not like you want more children?” (Correct, I do not.)
“You have two children and some women don’t get to have that.” (I understand I am blessed.)
“You’re lucky you didn’t get fibroids until your late 40s.” (Black women have higher rates in their 20s and 30s.)
“Just get rid of it,” I was told.
It came to a point where I just stopped talking about it so I would not be judged. Was I crazy to care so much?
Hospital physician residents threatened me and fear mongering was a common tool whenever I had to be admitted into the hospital. I was scolded that I needed “definitive management”—which was callous-speak for removing my uterus. Definitive management??? Is that the best language modern medicine has to offer?
It was like removing a uterus was akin to removing a finger or a wisdom tooth. You can manage just fine without it. Yes, I may function just fine, but what about my feelings. The devaluation of women’s bodies and the medical establishment’s control over our reproductive organs has left little space for how women actually feel about these things. In fact, many women have adopted this normalization, perhaps as a survival mechanism but certainly as part of social conditioning.
Women are too often told what should matter to them. Whether we are grieving over a loss of a breastfeeding relationship, a pregnancy loss or the loss of our wombs, there is a “remove and replace” or “just get over it” mentality that is dangerous to our bodies, our psyches and our souls. Our grief is not validated. We are silenced into sadness. This is happening across the reproductive spectrum.
But the truth is, keeping my uterus mattered to me. For me, it was connected to my identity as a woman. I grew and nurtured my beautiful children there. I saw my womb as a source of creativity and life energy. And as a Black woman, it was a form of resistance to a medical system that has disproportionately controlled and unnecessarily exterminated Black women’s reproductive organs with no regard. (Black women are three times more likely to have a hysterectomy than white women)
I know the history of eugenics in this country. You will not take mine without a fight.
For me that fight looked like trying everything else first and making sure hysterectomy was the last resort. I tried Eastern medicine and acupuncture—at one point flying out to San Francisco frequently to see a highly recommended reproductive specialist. I had an IUD inserted. I tried restrictive diets. I’ve had a few surgical procedures including embolization and endometrial ablation. But my fibroids were mostly submucosal—which means they were literally embedded in the lining of the uterus and it seemed like nothing helped.
Though fibroids themselves are benign growths, they cause excessive bleeding and for me, 10-12 day periods every month that led to severe anemia. Many times, my period would come twice a month. One day, I remember driving my children to school and being so weak, my head was leaning against the driver side door window and I asked my 16-year old (who had a learners permit and was in Drivers Ed at the time) to help me steer. I dropped them off, drove to the closest ER and ended up being admitted. My hemoglobin count was at 5. A low hemoglobin count is generally defined as less than 13.5.
Later, the ongoing anemia meant rounds of weekly iron infusions, sitting in a room with mostly cancer patients receiving intravenous treatments. It was becoming too much. Balancing my wellness and my perceptions of womanhood, became too much.
And even though I could rationalize that this was the right decision for me. I was still sad. Even though I can look back and feel comfortable that I had tried every other pathway, I am still sad. Losing something that matters to you, even after a fight to save it, is still a loss.
It mattered to me. And right now, I am grieving.
Right now, there is an empty space inside of me literally and emotionally and I am working through it.
I hope one day soon we can have a more meaningful and nuanced conversations about how grief shows up across the reproductive spectrum. So that women don’t feel silenced or shame. Nor should they think that only other women who have had the experience will show up in word and deed to support them. We all need a new language for the losses across the reproductive spectrum. We deserve a medical system and physicians who value our reproductive organs even when they are not being used to do so.
And we all could use more honest discussions about womanhood and what that really, truly means.
A Women’s History Month that only celebrates our productive work and not our reproductive work is dangerous and counterproductive.
By Kimberly Seals Allers
Women’s History Month is an important time every year as we reflect on the many accomplishments of women and their contributions to our society. Now that’s over, it’s time to face a glaring omission so that its not repeated next year. This year, I was particularly concerned that the month’s over-focus on the secular and professional accomplishments of women brings an unintended consequence to undermine mothering, as valuable work equally worthy of high fives, GIFs, reposting and tweeting. Women’s History Month is not complete unless women are being honored for their productive work and their reproductive work.
That means acknowledging the work that women aren’t paid to do yet makes a significant contribution to society via infant health, childhood development, education and the general ongoing existence of the human race. Instead of celebrating mothering work as an important subset of work women do, we find it cut out of women’s celebrations and relegated to one day in May —which has become so overrun with commercial interests, it’s hard to see the true issue.
This is a separating of women—of the different roles we play. Mother, wife, career person, lover, sister, daughter, friend. Instead of celebrating the complete woman, we are stuck parsing out the career woman —the women that broke barriers against men and putting the others selves aside for another time, another month. Given the history of the suppression of women, it is absolutely important to document and note the ways we have overcome those struggles, but what about the roles of women, that only women uniquely do? Only celebrating our accomplishments in fields dominated by men and ignoring the mothering work women uniquely do, feels decidedly anti-feminist. It would seem that a Women’s History Month worth its spot on the calendar would also do that. If we are celebrating women, let’s celebrate the whole person—and all the roles women play in their lives.
Since about 80% of women become mothers in their lifetime, we should be talking about the structural inconsistencies such as a woman who devotes her time to the work of mothering cannot earn social security benefits for this time, whereas if she has a paying job, she and her day care earn credits toward financial security in old age. We should be talking about living in the only industrialized nation without a federal paid maternity leave, which does give women time to recover from birth and establish their maternal rhythms.
The continued devaluation of mothering as important work is built on an outdated system based on the idea that families can afford for women not to work, yet mothers are underpaid and undermined for their secular work and their maternal work.
The motherhood penalty known as the “maternal wall” has been found to be more of a problem than the glass ceiling. One study found that when subjects were given identical female resumes, with one being a mother, the mother was 79 percent less likely to be hired, 100 percent less likely to be promoted, offered an average of $110,000 less in salary and was held to higher performance and punctuality standards.
Feeling fed up???
Join my live webinar: Female Fury: Understanding Its Content & Complexity to Advance Maternal Health, Breastfeeding & a New Feminist Agenda. April 10 At 8pm! Register Here!!
Historically, much of the feminism that began in the mid-mid-twentieth century focused on fighting for equal rights with men and freeing women from the imperative to mother. Important work. But in our quest to be viewed as equal to men we forgot to fight for the things that make us uniquely women—like our ability to birth and lactate. No one should be forced to mother, but women who choose that journey deserve policy, social and structural support. Otherwise, we are failing women.
If women don’t value mothering as important work, who will? In The Picture of Dorian Gray, Oscar Wilde wrote: “Nowadays people know the price of everything and the value of nothing.” In our society, items are priced. Accomplishments can be noted. But value remains an abstract and often misunderstood notion. Our idea of value is based on what somebody is willing to pay for something and that leaves the modern valuation and celebration of mothering as valued work steeped in confusion. It is universally accepted that no one should work for free except a mother, yet no one has enough money to hire a good mom, which, actually makes mothers priceless.
Being priceless and worthless at the same time is a terrible state of affairs. And the psychological impact of generations of undervalued mothers is hard to ignore. Many find a torrent of disappointment, fear, frustration and anger at the beginning of their mothering journey. Post-partum depression is on the rise. By some estimates it affects one in nine mothers in America.
Last week’s announcement of a new FDA-approved postpartum drug is an important development. But instead of a $34,000 per treatment drug that requires 60 hours of in-hospital IV treatment, what about more support and validation for motherhood? What if mothering was valued with paid family leave? Along with post-partum home visits as a standard practice of care and high-quality affordable child care. And what if, not viewing mothering as outside of the women’s experience worthy of celebrating, was a part of that support. When we are told that mothering doesn’t matter, the stress of being “productive” (because caring for yourself and your baby is not “work”) as a new mother is exhausting, overwhelming and anxiety-producing.
We need a new social construct. One where mothering and caregiving is properly conceptualized as real work, rather than women being applauded for their career accomplishments and mothers being relegated to an overpriced brunch. We can end some of the isolation of motherhood and dangerous separation of women’s “selves” and it should start at Women’s History Month. Next year, let’s do better.
I Did Not Attend the Breastfeeding & Feminism conference
Let me start by saying I am writing this as an informational post and a caution to others. I do not want to disparage the BF& Fem conference, which is an important convening, but its organizers need to continue their work on creating safe spaces for women of color. This will not be a permanent post on my blog.
However, every year there seems to be drama at the BF & Fem conference, most of it leaving black women and other women of color harmed. So, I will try to explain this tragedy in 3 Acts.
The Scene:Erica Morrell, a visiting Assistant Professor of Gender, Sexuality, and Feminist Studies at Middlebury College, Sociology/Women’s Studies, is a danger and a threat to black women and their research, in my opinion. The Academy of Breastfeeding Medicine issued a correction for her article upon my insistence after she summarized my concepts and work, directly mentioning the cities where I worked, and findings from my research without proper citation or attribution. She misrepresented my ideas as her own. Even worse, I did not even receive a professional courtesy call –since she had been emailing me and calling for two years prior. Erica pursued me and my work, at times, offering to help me but in the end she only wanted to further her own book and academic interests. (You can read the full story in The Prequel section below.)
Act 1: Because of my experience with Erica, I was deeply concerned to see her on the Breastfeeding & Feminism agenda doing a panel entitled Circulating Black Feminist Thought Across the Color Line to Dismantle Breastfeeding Barriers, along with three black women academics. I was deeply concerned that Erica might do to them what she had already done to me. As I looked at her website and other work, it was clear that attaching herself to black women was her modus operandi. I immediately emailed the organizers and planning committee about my concern and I also clearly stated that Erica would not be allowed to be in the room during my presentation because I only share ideas in trusted spaces and she has proved herself untrustworthy.
To be fair, planning committee members, particularly Catherine Sullivan and Tina Sherman were immediately responsive and apologetic and sought to make immediate contact with the panelists and Morrell. I also reached out the black women on the panel. I felt huge regret that I had not publicly shared Erica Morell’s name as a warning to my community. These amazing young black women academics and researchers hold so much promise for our community and our work and were perhaps, trustingly, as I was, engaging with Morrell. I was concerned. And on the phone with one panelist from London at 2 am.
Act 2: After having several conversations with the panelists there were several abject failures: Erica Morrell needed to be removed from that panel. Period. Full stop. Instead, Erica was allowed to be an equal decision maker in the future of the panel and chose to center herself in the process saying, in effect, “I will leave, if you want me to.” This assumes power parity, when there is none, and put the black women in a very uncomfortable position. That was not their burden to carry–the organizers should have removed Erica from the process completely. Instead, when the black women did not feel empowered to tell Erica to kick rocks as I would have done, the whole panel was cancelled. Epic fail!
So the very important conversation of black feminist thought is derailed at at the only conference focused on breastfeeding and feminism because one white woman with a history of harmful behavior toward black women and their work was allowed to be a decision maker. Where was the support for my sisters? Where was the commitment to maintain the equity of the conference content by ensuring this important topic went on and was bigger than the one white woman? By the time I returned to the States and heard that the panel was cancelled (confirmed by Erica’s own smug email to me) I was fuming!!
Act 3: Another evening call with the panelists. I had to convince them that they had support in their decision. I had to reassure them that they were the most important voices in that panel and I would do everything in my power to make sure their voices were still heard. I listened to how the panel developed and heard multiple red flags about Erica’s tactics in attaching herself to black women to legitimize herself and then centering herself in decision making. The fact that I had to play this role is another failure of the conference organizers. Let me be clear, my young sisters have so much respect for me and the work I do –they hold me in high regard and that means the world to me. I am happy to always support them anyway that I can. However, by the time I got to the women, who were, in heart, ready to proceed with the panel with me promising to support them and be the go-between with the conference organizers (Why me??), one of the key members had already dismantled the arrangements she made to attend. She was unable to put them back together.
Act 4: On another note, I had already reached out to some white allies I respect and offered to have a facilitated conversation with Erica at BF & Fem to resolve this issue and help her see how she has caused harm. (I am always trying, always hopeful). However, apparently after others spoke with Erica about the panel issue, I was told that Erica was clearly not “ready” for that type of conversation (still not taking any accountability) and that engaging with her at this point would only cause me more harm. Wow!! I so appreciated that. But wondered if your conversations indicated that Erica could still cause harm, then why not actively protect my sisters who were directly involved with her. Why not buffer and protect them –knowing what you did about Erica’s resistance.
This is too much. Every year, this conference is disrespectful to black women in some way. Last year, there was an issue. And every year, I feel like I have to prove myself as a legitimate speaker and thought leader when my book is the only recent book directly and explicitly talking about breastfeeding and feminism!! It’s literally in the title!! (However, decades old writers on the subject, who are white women, are always invited and prominently supported!)
I will not show up where my sisters have been silenced. The three women are the reasons I did not attend the conference. I will not continue to step into spaces that don’t respect my work or protect black women when faced with white women behaving badly. I do not need to leave my house or my children to be triggered.
I apologize to those who were looking forward to hearing me speak. I will make it up to you. Also, I am working on giving the three black women–our rising, shining academic stars–a platform to share their thoughts because that platform was theirs and should have never been taken away from them. Please stay tuned and I hope you will support them.
The Prequel/Origin Story: For several years, Erica pursued me to learn about my “first food desert” work, my First Food Friendly Community Initiative in Detroit and my other projects. At one point, she suggested a joint paper and I shared unpublished documents about my projects that had only been shared with the funder. At another time, I wrote a recommendation letter for her for one of her projects as I thought we were developing a relationship. After a year of me being too busy to connect, she flew all the way to NYC just to meet with me for a few hours, where I shared many concepts and ideas about my past, present and future work. Later, she apparently spoke of my concepts and work and then turned that speech into a paper that was published in the Academy of Breastfeeding Medicine, without full and proper attribution. After years of emails and constant calls, Erica never notified me that she was writing about my work in this journal nor did she contact me to confirm what was publicly citable, she did not ask if she could share details that had only been shared with the project funder. And I only learned of the article because a program officer at the funder saw it and called me expressing concern that the article was talking about me and my work without proper credit.
When I called Erica immediately after the journal article was published, she immediately began crying telling me how much respect she has for me and she would never hurt me. Classic. I tried to talk to her about intent vs. impact but this is a concept she still struggles with.
After much back and forth with the journal editors and resistance from Erica, a correction was published. (The title itself, is the name of my Detroit presentation and event that I led and was my thesis theme for my time as an IATP Food and Community Fellow.)
I also filed an ethics complaint with Middlebury College. I had not heard from Erica since but it is clear that she still has work to do. Proceed with caution.
Every October we’re inundated with pink. We are told to buy pink, wear pink, eat pink and donate pink–all in the name of breast cancer awareness. But with all the talk about breast cancer every October, there’s very little conversation about how breastfeeding actually helps lower the risk of breast cancer. Female breast cancer is the most commonly diagnosed cancer and a leading cause of death from cancer among U.S. women. Yet the body of evidence connecting breastfeeding with a reduced risk of breast cancer is growing and increasingly irrefutable.
Breastfeeding mothers reduce their relative risk of breast cancer by 4.3 percent for every 12 months they breastfeed. Another study found that breastfeeding could prevent an extra 20,000 deaths from breast cancer every year.
This connection is even more critical for groups of women with high rates of breast cancer mortality and low rates of breastfeeding–such as black women. Black women in the U.S. have lower rates of breastfeeding and nearly twice the rates of triple-negative breast cancer (the most aggressive type) compared with white women. Breast cancer is the second-leading cause of cancer death in African-American women, who are 41% more likely than white women to die of the disease.
Meanwhile, the literature linking breastfeeding to reduced breast cancer risk is growing. A 2002 landmark study that pooled approximately 50,000 breast cancer cases from 47 epidemiologic studies in 30 countries found that the relative risk for breast cancer in parous women is reduced by 4.3% for every 12 months a woman breastfeeds and is reduced by 7% for each birth independently.
Yet, a new study published in Breastfeeding Medicine found that 16 percent–or fewer than one in five women surveyed–said their doctors had told them breastfeeding has health benefits to mothers and babies. (Read the NY Times article on the study)
According to the survey, while 60 percent of white women surveyed knew breastfeeding could reduce their breast cancer risk, only 47 percent of African American women knew.
So why aren’t we talking more about breastfeeding during breast cancer awareness month? The problem is rooted in the framing of breastfeeding in the U.S. When breastfeeding is framed as a “choice” it prevents us from talking about what is really is–preventative medicine for babies and mothers. Breastfeeding has proven health benefits for mothers, including a reduced risk for endometrial and ovarian cancers and reduced risk for chronic conditions that are also risk factors for cancer, such as hypertension and diabetes. The health benefits to infants include reduced incidences of diarrhea, ear infections and lower respiratory infections and a lower risk of sudden infant death, diabetes, asthma and childhood obesity.
But when we are caught up in a “choice” dialogue, as if breastfeeding is a lifestyle option akin to going vegan or using cloth diapers, then we miss the critical conversation about how these “choices” impact our health outcomes. The framing of choice silences us, because anything personal should not be discussed. It leads us into emotional places about so-called “guilt” and “shame” instead of having productive, fact-based conversations on the known health benefits and risks. Telling me the facts about smoking or health risks of not wearing a seat belt is not to make me feel guilty, it is to make me aware. Nobody should be made to feel guilty about not breastfeeding, especially when it is so damn hard to do for any meaningful period in this country, but the discourse has deteriorated to the level where anytime someone mentions the very real health benefits of breastfeeding versus formula feeding they are blindly accused of shaming.
This literally has life or death consequences for some women–particularly black women. And serious health implications for all women.
Perhaps the breast cancer folks are aware of the emotional quagmire of breastfeeding and prefer to avoid it all together, opting to push for mammograms and self-exams instead. Even worse, much of “buy pink” product promotion comes from the dairy industry, which has a vested financial interest in formula sales.
In our country, there are various medical specialties for a diseased breast– we are in the middle of a national awareness month to prevent and cure the diseased breast–but physicians are woefully under educated about a functioning healthy breast. There is no physician dedicated to the functioning of a healthy breast. Physicians receive very little training in lactation management in medical school. How ironic, that the thing that could help women prevent future disease in their breasts is one of the least taught fields of medicine.
So to breast cancer researchers and advocates, if you really care about breast cancer PREVENTION, not just marketing promotion and attracting research dollars, then you must talk about breastfeeding. Often. And loud for the people in the back. And directly and explicitly to the black community.(Also, I’ll be reaching out for your support for Black Breastfeeding Week too!)
To do anything less in the face of the scientific evidence is unethical and unconscionable.
WARNING: The following is a brief sampling of the growing body of research concerning breastfeeding reducing the risk of breast cancer. If you confuse Fact-ing with Shaming, then please do not trigger yourself by continuing to read. Thank you.
“Breastfeeding is of particular interest for breast cancer prevention because it is a modifiable risk factor. Breastfeeding not only reduces breast cancer risk but also confers other health benefits to the mother including reduced risk for endometrial and ovarian cancers8 and reduced risk for chronic conditions that are also risk factors for cancer, such as hypertension and diabetes.9,10 Additionally, breastfeeding provides many benefits to the infant, including fewer episodes of diarrhea, ear infections, and lower respiratory infections and a lower risk of sudden infant death, diabetes, asthma, and childhood obesity” —Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers, Am J Prev Med. 2017 Sep; 53(3 Suppl 1): S40–S46.
“Similarly, a 2013 review of 32 studies concluded that the risk of having breast cancer was 14% lower among parous women who had ever breastfed compared with parous women who never breastfed. The protective effect of breastfeeding persisted regardless of the number of births and was even greater for women who had cumulatively breastfed for 12 months or longer; they had a 28% lower risk of breast cancer.13 Victora and colleagues14estimated that existing global breastfeeding rates prevent almost 20,000 annual deaths from breast cancer and that an additional 20,000 could be prevented by increasing breastfeeding duration to 12 months per child in high-income countries such as the U.S. and to 2 years per child in low- and middle-income countries.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069526/
In 2014, a study led by Christine Ambrosone, PhD, Senior Vice President of Population Sciences at Roswell Park Comprehensive Cancer Center, revealed a way to lower the higher mortality rates among African-American women, who are more likely to be diagnosed with a more aggressive form of breast cancer.Now she and her colleagues are working to get the word out to African-American women who are expecting: Protect yourself by breastfeeding your babies.
There are different types of breast cancer, according to whether or not they express the estrogen receptor (ER). In ER-positive breast cancer, estrogen — a hormone — encourages the cancer cells to grow. Having children tends to lower the risk of ER-positive breast cancer — the type that’s more common in white women. But having children also increases the risk of ER-negative breast cancer — the more aggressive type that more often found in black women.
However, reviewing their own research, as well as research from other institutions, Ambrosone and her team discovered something astonishing: African-American women who breastfed their babies did not have an increased risk of ER-negative breast cancer.
“I was amazed by those findings,” says Dr. Ambrosone. “I thought, Why isn’t this on the front page? This is so important. If the risk of aggressive breast cancer increases a lot by having kids but goes away if you breastfeed, everybody needs to know that.” Read the full article.
Lately, in my presentations I’ve been extremely intentional and deliberate about one particular slide. This is what it says:
Why is this so important?
Because for so long, we have sought an interpretation of breastfeeding , as in, how do we use studies and data to better understand how to connect with women. What are the benefits that we need to know and tout to better message to women. While this is important stuff, I firmly believe that what we really need to better message and better support families is a deeper UNDERSTANDING of their lived experience.
This is particularly true for communities of color–who have mostly missing from the data and not included in much of the research. More importantly, their viewpoints and decision making about breastfeeding is so complex that these basic interpretations haven’t worked to engage them to initiate and continue breastfeeding. We’ve been looking at those numbers for far too many years now.
What all women deserve is an UNDERSTANDING of their lives and their lived experience of breastfeeding. But we can’t get to understanding if we are only relying on interpretation models –scientific journals, evidence-based research and so-called best practices that have only been practiced on one type of audience. An understanding requires conversations, spending time in the community and actually listening and learning. It involved cultural humility to allow your “expert knowledge” to fall back and the mothers “knowing” to take the lead. It means moving beyond cookie cutter responses and one-size-fits-all promotion efforts.
Case in point: Recently during Black Breastfeeding Week, we had the glorious experience of a FB Live with about eight black men from all walks of life, including the Assistant Health Commissioner of New York City, a local Congressman who actively supports breastfeeding and a group of fathers from all walks of life. For about an hour, they talked about love, life, their struggles as a father, the realities of being a black man in the current climate and the perceptions of breastfeeding. It was honest, raw, vulnerable and nearly brought me to tears–a powerful demonstration of seeing inside the lives of black men.
While this beautiful demonstration was occurring there were obviously many questions and comments, but some people were looking for one-size-fits-all answers. You would see in the comments, things like, “can you tell us what to say to black men about breastfeeding?” We intentionally did not respond to those. Why? Because we offered the community an opportunity for understanding –an opportunity to sit and listen and learn from black men, hearing them talk about their lives in their own words amongst their peers. How many of you have ever had that experience?? But instead of appreciating the opportunity for some UNDERSTANDING of black men, some were still looking for a quick INTERPRETATION.
The way forward for all families, and particularly those in communities of color, is about listening and learning not about arming ourselves with a different set of cookie-cutter phrases.
For me that understanding also includes an understanding of their community environment and influences. That’s what my upcoming online event is all about. To be clear: this is no talking head webinar. It’s a full body experience because that’s how I roll. Step into my “studio” for a talk-show style, no holds barred conversation with Simran Noor, of the Center for Social Inclusion Race Forward, as we talk about the role of equity in centering the community in our programs. Check out our behind the scenes pic!!
AND, you’ll meet the mothers who were community change agents in the Detroit pilot of the First Food Friendly Community Initiative, the innovative WKKF-funded project I led that empowered local residents to make their own community more breastfeeding supportive.
Every year when Black Breastfeeding Week occurs there is some sort of kerfuffle related to the act of black leaders determining what is best for their community. This year, a disappointing chatter began among those who strictly monitor the WHO Code– very important work with critical historical context. BBW received no monetary contributions, but two pump companies, Medela and Evenflo, donated pumps as giveaways for community events.
The messages I received and conversations I had centered around if some white organizations would be able to support BBW this year because of those donated items. I was questioned as to whether having the donations was worth the “risk”– risk to whom?
Let’s be clear. Black Breastfeeding Week was not created for the approval of white organizations nor for the structures and systems created by predominantly white organizations that have not always had our community’s contextual landscape in mind. We serve and respond to the community. Point blank, period.
And I don’t need to remind anyone, that BBW only exists exactly because those organizations and systems, including its many monitoring mechanisms, have not fully supported our communities, closed the 40-year racial disparity, or adequately protected our infants who are still dying before their first birthday at rates comparable to developing countries.
It is not for white organizations or its members to attempt to police, chastise or otherwise engage in back-channel chatter questioning the decisions of black-led efforts. That kind of paternalistic approach does not serve the movement well.
It is also interesting to note that one of the organizations where members engaged in this conversation has a history of being completely disconnected from communities of color. In our 5 year history, organizational leaders have not sought to make a monetary contribution, buy a pump to donate, offer the gift of free lactation support or any other gesture. In all the prior years of BBW we have not received an email, snail mail or pigeon note expressing a desire to support or otherwise be involved in BBW. That speaks volumes.
People who show up to criticize but have never put one square millimeter of skin in the game, on the ground, or in the conversation should check themselves first before doing so. In fact, just don’t.
Please be clear. The WHO Code is critically important especially as it relates to egregious infant formula marketing, which I have outspokenly exposed and will continue to do so. But pumps, and the necessary byproducts of pumps such as bottles and teats are not so black and white in a country where women are returning to work 2-3 weeks after giving birth. In many low- income communities, some return even sooner. Black women, who have the highest rates of pre-term and low-birthweight babies, are more likely to have infants with infant feeding challenges. For those families, information about bottles and teats is an important part of their breastfeeding plan.
Those nuances are lost with a global mandate that does not take into account the unique racist history, policy gaps and socio-economic landscape of the U.S.
Many so-called advocates are more focused on a 36-year old Code, unknown to many moms and dads of all colors, than the actual lived experience of women, especially black and brown ones.
In Detroit, where I often work, mom and pop retailers have taken to opening up packages of single serve infant formula powder packets and selling them like “loosies” for $2.50 each. You do the math. And then feel free to ask my comrade Kiddada Green about how this exploitative practice breeds desperation and cripples families. While you are in a Facebook group about the WHO Code, we are battling the Street Code, a more pernicious, financially debilitating force among low income communities that the WHO Code does not address. We’d love your help on that.
Because what every mother, every where really needs is a WHO Code 2.0. A twenty-first century version that considers all experiences and realities in its mission.
Which brings me to my most important point, I find it very odd that those focused on WHO Code violations are relatively mute on the biggest WHO code violator in the US– the WIC program. WIC is the largest purchaser and marketer of infant formula in the U.S. The program is literally financially dependent on the rebates received from the infant formula companies, who fight royally for a lucrative state contract, knowing what that means in on-the-comeback sales. While many state WIC programs are making great improvements supporting breastfeeding, the fact remains that WIC is the infant formula companies’ greatest distribution system, specifically targeting low-income people. It is therefore its de facto marketing arm– and with 60% of U.S babies being born WIC eligible, this is a really big deal. Talk about The Big Letdown. Nor does WIC have a national policy to prevent the street level predatory marketing by independent retailers as seen in Detroit (read my 2014 piece about previous street advertising by WIC retailers in Detroit; they changed this policy following the post).
Those who want to be “armchair activists”– doing their bidding via Facebook messaging, online groups but don’t show up for the heavy lift, really need to rethink their objectives.
It seems real easy and quite frankly disgusting to attempt to undermine a volunteer effort by three community advocates instead of chasing the real culprits and working to make the WHO Code more relevant to all–that is, if you actually care about misleading marketing to communities of color.
If you think a pump donation to a community event merits discussion or consideration for non-support, when you have not seen or fought against aggressive infant formula marketing in low income communities, then that is absolutely your call. BBW will go on.
This year, we reached new milestones with over 70 self-organized community events all over the country. In Detroit, I spearheaded an effort to open Detroit’s first community lactation lounge and mother’s empowerment hub–a place to truly support moms meet their mom goals and their breastfeeding goals (check out the pictures!) BBW online events featured a groundbreaking conversation with black men (over 4,000 views) an honest dialogue on same-gender couples and Breastfeeding (over 6,000 views), a salute to unsung heroes, and tonight we wrap up BBW with the phenomenal story of a mother who has breastfed twins, quintuplets and triplets. This is what we do.
We do not have time for those who, in Biblical terms, want to “strain out the gnat but swallow the camel.” In the desert-like environments where I work, camels matter.