Context is best—a reflection on last week’s breast vs bottle uproar

Dr Eva Neely from the Faculty of Health argues that it is the way media and society frames breastfeeding as an individual choice that is the real source of the problem in the debate around breastfeeding.

Last week clinical psychologist Dr Natalie Flynn was interviewed about the new release of her parenting book Smart Mothering.

In her book, she draws on scientific literature to provide parents with the up-to-date, state of the art research on varying parenting practices, one topic being infant feeding. Though the intentions sit in the right place, it is questionable whether more parenting books are the solution to ‘bombardment stress’ as Dr Flynn defines parental overwhelm. Do we need more books to determine whether or not to breastfeed? Or do we need to stop framing feeding as an individual choice and work towards the more important question: how can we support breastfeeding mothers better?

Dr Flynn holds a view that there are no consequences for mothers or their infants who are not breastfed. As usual, this topic unleashed a sea of mixed emotions flooding across social media. I argue here that it is the way in which media and society frames breastfeeding as an individual choice, or burden, that is the problem; and for the need to look to context instead.

At the heart of this debate lies the desire to determine the right way to infant feed, which of course we know, there is no universal ‘right’ way. These ‘milk wars’ distract us from addressing what actually matters. By allowing public discourse on mothering to be centred around which practice is superior to another we neglect the core factors that enable and disable feeding practices. Core factors could include things like social support or the need to return to work. Instead as parents we can, and should, challenge the system and collectively demand that services, systems, and resources are strengthened for everyone.

We don’t need another book to placate us about whether our choice is acceptable, we need more support. We need to challenge the profit-driven research agendas that are being pursued in the search for proof there is one right way or one wrong way to parent. We know that breastfeeding provides many benefits, and that formula offers a nutritious alternative for babies when needed. However, the question should no longer be which way is the better way, but what is the mismatch between mothers and the context within which they are expected to breastfeed.

From an evolutionary perspective breastfeeding is the norm, it is the ‘natural’ approach that brings about a range of benefits when it can be practised. However, when we decontextualise and promote a practice without its required context we create an illusion of how a particular practice can be carried out.

So the problem is that we are trying to pursue evolutionary, traditional, even ‘natural’ ways of parenting in a modern Western world. That is, the context does not match the practice in which it evolved. So instead of framing breastfeeding as an individual choice, let’s ask ourselves how we can recreate an environment, a context in which exclusive breastfeeding can occur. Let’s set the measures of failure on the environment rather than making mothers feel like they have failed. If we place the role of the environment at the forefront of breastfeeding success we can easily determine that the system, support and environment failed a mother in her journey to breastfeed. Contextual factors also include women’s history and life circumstances.

Historically, women were not in the workforce, nor were they isolated, but rather embedded within their communities. The context for new mothers was quite different. Yes modern tools such as the breastpump have enabled some women to manage work and breastfeeding, but clearly this isn’t the evolutionary way in which breastfeeding was supposed to occur. Equally, when women were closely connected within a community there was knowledge and support on hand, and wet nursing occurred when a woman could not feed. Furthermore, young girls were exposed to breastfeeding more readily (and as we know today, women who saw family and friends breastfeed from early in their lives are more likely to breastfeed themselves).

Collectively these examples demonstrate that we do not provide the right context for women to be able to ‘succeed’ in breastfeeding. So rather than setting up the research agenda that aims to dilute the benefits of breastfeeding and yet again find out why and how women don’t breastfeed enough, let’s change the research questions we ask. Let’s ask:

How can we create a supportive breastfeeding environment?
How can we ensure equitable breastfeeding support to all mothers?
How can we enable mothers to have the time to breastfeed?

Of course, I am not the first to raise these questions, and indeed there are some excellent scholars out therein pursuit of answers to similar questions. However, we also need to raise the profile of the practice-context mismatch in public and media domains to ensure public discussion can evolve and start using this language. When we start framing breastfeeding as reliant on support, systems and environments, rather than a choice, we will increasingly develop a broad research and political agenda that will ask the right questions and seek solutions that build a context for mothers that is conducive to breastfeeding. Hopefully, then this discourse and language will enable dialogue rather than fights, one in which we say “your context matters, nobody else’s does”. One in which we do not always need to seek ‘evidence’ on the benefits of practice X or practice Y, but simply put, in which we can determine which practices are achievable in this context.

The evidence shows that breastfeeding has a multitude of benefits, nutritionally and beyond, and we know that formula may not have the live bacteria or antibodies, but it sure does provide a nutritionally-sound option for babies. If we can challenge the discourse and change the discussion from a battle between the benefits of breastfeeding and formula to understanding context and its importance for breastfeeding practices (and, in fact, for any parenting practice) then we can come together and work towards sustainable and impactful change.

This piece was originally published on SciBlogs.