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Wednesday, 21 July 2010

Where did it all go wrong?

When I set up this blog and the facebook group, I invited women who did not breastfeed their babies to share their stories with me.  I received a huge number of carefully written, sometimes lengthy, and emotional stories.  Clearly the women who replied were often deeply unhappy about the way things had turned out for them and their babies.  They felt sadness, anger and regret.  Some felt a huge amount of guilt.  Motherhood these days seems to be a battleground of breast versus bottle.  Even though we all want to do the best by our children many mothers 'give up' due to exhaustion, lack of knowledge, poor support and sometimes even because of poor medical advice.  These mothers live with guilt and frequently feel 'judged' by other mums.  But what's really going on?  

Why do so many women find it so hard to breastfeed?.

A UK-wide infant feeding survey (a) undertaken in 2005 and published in 2007 found that 75% of babies had received formula milk by the time they were six weeks old. Less than half of those babies were receiving additional breastmilk. The rate of babies being exclusively breastfed at 6 months (the minimum recommended by the World Health Organisation) was something in the region of 1%. In England the ratio of mothers who initiated breastfeeding was just under 8/10. In Scotland it was 7/10, slightly less again in Wales, and in Northern Ireland only 6/10 mothers even began to breastfeed their babies.
These are shocking statistics, despite the fact that they show a very slight improvement on previous years.

How did we get into this situation?  Unsurprisingly the answer lies in our past.

Over the last two hundred years or so, our way of life in the Western World has changed beyond all recognition. Prior to the agricultural and industrial revolutions of the 18th and 19th centuries, the vast majority of people lived in small rural communities. They worked close to their homes, combining farming with other occupations. This type of existence necessitated the maintenance of extended family relationships, where the father might work very close by or be home at mealtimes, and where granny and granddad often lived nearby. People were relatively self-sufficient, farming their own foods or making their own clothes.  Most people didn’t travel very far during their lifetimes, and women had a valuable place in the social structure.

This type of lifestyle supported breastfeeding. When a new child was born a mother could expect support from her extended family and the community. If she became unwell she could rely on some assistance to look after her other children, and if she became so ill that she was unable to produce enough milk for her new child, then it would be given to another mother to feed as formula milk did not exist (*happily this option is increasingly available once again through the work of breast milk sharing organisations such as 'Human Milk for Human Babies').

Because babies were breastfed, the natural contraceptive effect of lactation helped families to space their children, and breastfeeding was normal.  Children grew up watching their mothers, aunts and sisters breastfeeding and learnt by example. They saw animals doing it, and the ‘facts of life’ were not things that needed to be taught in schools or antenatal classes.  Breastfeeding was so normal that it was commonplace to see women breastfeeding – even in church!  It was not something to be embarrassed about; it was just ‘what you did’.  Due to the nature of daily work, baby-wearing was not something only the ‘hippies’ did – it was commonplace and necessary!

Skip forward a few years and things look very different. Between 1800 and 1850 the population of England grew by something in the region of 9 million.
“In the late 18th and early 19th centuries, improvements in agricultural productivity, and therefore a more reliable food supply, enabled this growth in population…. An increasing birth rate may also have been an important factor contributing to population growth during this period, with increased agricultural productivity meaning that people could afford to marry earlier and begin having children at younger ages.” (b)
The seismic changes which came as a result of an agricultural and industrial revolution forced people into city-living. It also forced women to leave their homes in order to work in the new industries (in factories, mills, mines etc), and this meant that they were increasingly unable to breastfeed their children effectively.

For long years the aristocracy had employed wet-nurses to feed their babies. The primary role of these aristocratic women was to provide heirs, and although some exceptional women chose to breastfeed their babies themselves, they were discouraged from doing so.

Louise XIV and his wet-nurse (C17th)

The fashion amongst the aristocracy changed during the C18th and they elected to use more and more male-midwives and doctors when birthing their babies. It was generally assumed that their knowledge was superior to that of the wise-women and female midwives who had done the job for centuries. Those same doctors went on to advise their clients that it was:
‘no longer appropriate for women to breastfeed, especially since the first infant formula had already been invented in Europe by Baron Justus von Liebig in 1867. By 1869, Liebig’s concoction was being marketed in the US as an equal substitute to breastfeeding. Soon after, Nestle created his version of infant formula along with a creative marketing plan that said his milk was superior to breast milk.’ (c)

Nestle advertisement (1910)

Nestle advertisement (1935)
(This image brings to my mind thoughts of health and opulence which seem quite at odds with the notion of providing a milk substitute to save a child’s life…)

It wasn’t long, though, before concerns about the safety of this and the other formula milks began to surface. The method of production of early substitute milks was far from sanitary and its constitution was crude. Quickly making the link between formula feeding and an increase in rates of illness and death from diarrhoea/ gastroenteritis, doctors were quick to offer ‘personalised’ formulas for the children of the rich. Formula manufacturers soon began to seek-out the endorsements from the medical profession in order to retain credibility (*incredibly, this still happens today).

Baby feeding bottle (1911)

Quite a number of doctors were also concerned that a widely available commercial formula milk meant that women could source alternative sustenance for their child without resorting to (and paying for) medical supervision. Surely a mutually beneficial arrangement could be found?  Sadly, these days, you could be forgiven for thinking that things are no different.

Advertisement in the Journal for the American Medical Association (1912)

In 1911 Mead Johnson tested a new type of formula called ‘Dextri-Maltose’ in the baby ward at a New York hospital.  Such testing would never be allowed today, but shows just how much power the industry had within medical circles at the time.  From 1912 administration of this cutting-edge formula was restricted to doctors.

The formula was given medical endorsement and the doctors got plenty of business. In 1915 SMA (Synthetic Milk Adapted) was launched as a brand at a meeting of the American Paediatric Society. It had also been tested on babies in a different hospital in Cleveland, Ohio and advertisements instructed use under the care of a physician. Nestle followed suit with a prescription formula in 1924.

Now the ‘best’ formula was restricted to the well-heeled, just as wet nurses had been in the past. Many medics were concerned by this turn of events, but by this stage the advertising industry was in full flow and the tide of popular opinion had turned in favour of bottle over breast.

During the last century this shift from breast to bottle became ingrained in our culture. The practise of breastfeeding became more and more uncommon and breasts being used for the purpose of infant feeding became less visible. Although some publications voiced opposition to this shift
‘There is a growing disinclination among mothers to nourish their infants as nature intended’ (d)
formula milk was widely advertised in the press.

Recipes were published for home-made formula and a movement advocating scheduled feeding re-enforced the shift.  Milk was bulked up with bread crumbs, rusks, sugar, egg and barley water (d).

By the 1950’s huge quantities of formula milk were being given away free to hospitals and the practice of giving free samples to new mothers was commonplace.  It is possible that our grandmothers were fed bottled formula milk in the '20’s and '30’s. Our mothers would likely have received it in '40’s and '50’s. We ourselves are more than likely to have been given it as babies in the 70's and '80's and so, quite without thought, our generation has made the same choice for our children.

It is largely due to the work of the World Health Organisation and other leading Health bodies that we now understand the huge gulf between bottle and breast in every respect.  We now know that no science can replicate the protective and psychological benefits of feeding our babies our milk ourselves.  New reports about the risks of formula feeding seem to arrive every day.  However, what we know on a cerebral level is not translating into a cultural shift.

A new mother visiting home with her growth-spurting-constantly-feeding-and-fussing 3 week old baby will still be advised to ‘give that child a bottle’ by a well meaning relative. The relative simply doesn’t understand what is normal in a breastfed baby - it’s not something we see in daily life anymore and we have grown up watching adverts for formula on TV. 

What can I say?  I was that person.  I know better now. 

Until we can breastfeed openly, without embarrassment, and until our children can grow up seeing babies being breastfed; until we have responsible advertising and the myths surrounding sleeping and feeding patterns are dispelled; until doctors and health professionals make understanding breastfeeding a real priority and consider advocating stopping only as a last resort; until we re-learn the ‘womanly art of breastfeeding’, and our workplaces, families and partners support us in doing so; until women refuse to be denied their birth right and the birth right of their children any longer, we are all fighting a losing battle.

We need to demand our rights in the workplace and in the hospital, at the doctors and in the shopping centres. If we feel we haven’t received good advice and have not been supported we need to complain loudly about it.

We need to take infant feeding out of the hands of the pharmacists and the misogynistic multinational companies and put it back into the hands of the (wise) women.

It’s time we put 'breast versus' bottle to one side and concentrated on supporting each other to achieve our mothers, and our human, rights.

(a) http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/infant-feeding-survey/infant-feeding-survey-2005
(b)  http://www.statistics.gov.uk/downloads/theme_compendia/fom2005/01_FOPM_Population.pdf
(c) Toni Hall Parker – ‘A historical look at the impact of infant formula on breastfeeding’ http://www.examiner.com/x-17146-Dallas-Womens-Health-Examiner~y2009m8d3-A-historical-look-at-the-impact-of-infant-formula-on-breastfeeding
(d) 'The Woman’s Book' Published T.C. & E.C. Jack, London, 1911

Additional Reading:
'The Weaker Vessel' - Antonia Fraser,  Published Methuen, 1983
'Breastfeeding Older Children' - Ann Sinnott, Published Free Association Press 2010
'The Politics of Breastfeeding' - Gabrielle Palmer, Published Pinter & Martin Ltd, 2009


  1. Very well said, educational and I note just how many of those adverts are by Nestle, the most boycotted company in the world

  2. Fantastic blog... yet again! Thank you!!! Mxoxo

  3. it is most definitely a lack of support that forces even the most determined breast-feeding mum to switch to bottle. Back in the 80s I was fortunate enough to find La Leche league for my second baby and have a wonderful woman come to my home and help me with my positioning and reassure me. My mother told me I was mad to keep wanting to try and breastfeed my daughter after the trouble I had with my first - BUT I was determined and fed her for a year afterwards and also my next 2 babies as well.

    I also found the hospitals to be less than helpful.

    Thank you for this blog. :)

  4. very well put ! i am reading gabrielle palmer's book at the moment and it is truly shocking that the industries creating formula have so much power, we do need to fight back and re-educate and i feel it needs to start in schools or even pre school so breast feeding is considered the normal thing to do. i would like to see a talk for teenage girls in class rooms pretty much like the period talk where the myths are dispelled fun is had but the message is clear the normal thing to do to give a child the best start in life is breast feed.

  5. Fantastic post, very eloquently put:) Clare x

  6. my teenage daughter wanted to breast feed her baby but was not supported well by the health professionals. When her baby did not put on weight as quickly as they wanted her to (in fact she did not put on much weight when I breastfed her 19 years ago)they suggested 'topping up' with a bottle. It was only days before she was fully bottle fed. I still feel very sad for both of them. I seem to remember the same pressure on me but was confident that my baby was fine - and my baby wouldn't even take expressed milk from a bottle so formula was never an option anyway. My daughter has no confidence and bowed down to pressure from helth professionls no matter what I said. :(

  7. Thank you for this well-written, informative post! I am constantly amazed at the power multi-national corporations and advertisers have over our culture. It makes me angry that I'm seen as a "hippie" for breastfeeding, wearing, and bedsharing with my twins. All I'm doing is what women did naturally for eons before Nestle and their ilk came about. But it is the pervasiveness of bottle feeding images that has soaked into the collective consciousness that makes it seem so to those who don't know. So, to all of us who are spreading the good word, we must keep at it! Thanks again!

  8. very clearly put. The roots are so deep seated change may take some time. I'm fascinated and horrified that formula was used in hospital trials. And it also makes sense why older generations offer well meaning advice. But what makes me squirm even more is those pretty packaged little bottles "served" in maternity wards even today and the flippant ways mothers can be undermined by hcp.

  9. Very well said. I am still Breast feeding my son at just over 12 months and it feels the most natural thing in the world. The pressure to formula feed is outrageous. Even my midwife tried to make me switch or "top up" in the very early days when I was most inexperienced and vulnerable. I'm so glad I went with my gut instinct that my son was fine & was determined - there is much more to feeding than just the nutritional value - I feel the mothers who formula feed have sadly missed out on the rest breast feeding has to offer.

  10. I remember my paternal grandmother, who passed away 2 years ago at age 94, talking about her memories of her own mother nursing. She told me that a neighbor once came to their home, panicked that she had no milk, and my great grandmother nursed the baby for her. Also, my grandmother herself breastfed all 3 of her children, who were born in the 1930's and 1940's. She told my father "they didn't encourage it, but they left the choice up to the mother."

  11. I am currently breast feeding my 13 day old daughter. It has not been an easy road. She had low blood sugar at birth (I had gestational diabetes) and was given formula top ups at less than a day old. I sat and cried as I watched the midwife give it to her, feeling like I had failed her already. There followed a week spent in hospital, in which I tried to express enough to tube feed her, because she was too ill with an infection to suck. We eventually came home exclusively breastfeeding. I still wish we had avoided the formula in the first place, but at least I know I am doing the best I can for her now.

  12. Gosh - that is hard! Well done for keeping your goal in mind and leaving hospital ebf! What a wonderful achievement :) There are several ladies on the board who know quite a bit about managing diabetes, so don't be afraid to ask if you need any more advice about that, or anything else! I can sympathise with your experience in hospital, and I know how long that week will have felt. You have a long nursing journey ahead of you now though, where I'm sure you will be able to put all the bad feelings behind you. Good luck! ~ a

  13. I am a Mum of an 18 month old nursling and I wanted to say I love your article. So informative. Thank you.

  14. Very well said. I was taken aback at your second-to-last paragraph, though. I am a pharmacist, and I breast-feed. In fact, I'm struggling right now to integrate pumping with my working life, as the work conditions for most retail pharmacists are not very conducive to pumping. I'm not clear why you made my profession out to be part of the problem. We don't really have much to do with this. Formula is sold in our stores, yes, but it's also sold at grocery stores, and that doesn't mean the grocers have set out to undermine breastfeeding. This is the formula manufacturers, not us. (And maybe your prescription is taking a while to fill because the pharmacist has to express milk?)

  15. You're quite right! The meaning of the paragraph would be clearer if it said pharmaceutical companies, not pharmacists. I certainly didn't mean the individual pharmacists who work in chemist shops! However many qualified pharmacists work for the pharmaceutical companies who produce formula.
    Congratulations on your commitment to your child - I know sometimes it can be very hard :( Will change the wording when I get on the pc. X anne

  16. I agree it is mostly lack of support and even embarrassment that stops you from breastfeeding. You feel like a freak sometimes in public. Now I could care less but I struggled a lot with my first daughter and almost switched to formula several times just because of social reasons. Luckily my husband really supported me and told me to just do whatever I felt was best for baby. Block out the world and look at my babies face and let my feeling tell me what is right. Now I will breastfeed anywhere I want. It's not really a big deal. Just survival. I think that is part of the problem too. Back in the day everyone was just surviving. Now we have too much time to judge and criticize and compare breastfeeding to sexual acts.

  17. Honestly this is one of the best, most accurate, honest, 'hitting nail on head!' reports I have ever read. Well done you!
    I am currently breastfeeding my sixth baby, he is now 11 months old, is thriving and gorgeous and I can't imagine how difficult it must be to incorporate bottle feeding and sterilising etc into a day? Breast feeding is one of the most amazing things Mother nature has ever created and I am blessed to be doing it again. Thank you for your words, loved reading them, Mandy x


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