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Whose nipples are they, anyway?

If you see a woman breastfeeding a three-month-old baby, are you shocked? What about a two-year-old? A four-year-old? Ten years ago, in 2005, Scotland introduced the Breastfeeding etc. (Scotland) Act, making it an offence to prevent someone breastfeeding an infant in public. Since then, awareness has been raised significantly about the benefits of initiating breastfeeding and increasingly mothers are feeling confident enough to breastfeed their newborns in public. The same cannot be said for mothers of older babies or toddlers, however.

It has been a struggle for society to accept public breastfeeding at all, never mind breastfeeding beyond infancy. One possible reason could be the hypersexualisation of breasts; breasts have become sexual rather than maternal symbols to the extent that they are now largely disassociated from their original function of milk and comfort provision, instead being seen by many purely as objects of desire. Exposing your objects of sexual desire in a public place in order to breastfeed a child becomes seen as immodest or indecent.

In my experience, breastfeeding newborns does seem to have become increasingly normalised, at least in Scotland. I, and most mothers I interviewed, experienced no issues breastfeeding newborns in public. Things changed for me when my baby was about nine months old and started walking and talking: turning into a toddler. Already at eight months, I was aware that breastfeeding was starting to make some people feel uncomfortable as I sat in a cafe with a friend and she whispered “are you still feeding her yourself?” so no one would hear. A month later, another friend mentioned that they thought breastfeeding a baby that could walk was “creepy”. Mothers I interviewed reported similar reactions, most commonly eye rolls and “you’re STILL breastfeeding?”

In many societies, allowing a child to wean at their own rate is not at all exceptional, and even in the UK and US it is now recognised that there are huge benefits in continuing to breastfeed beyond infancy. The World Health Organisation (WHO), UNICEF and the American Academy of Family Physicians (AAP) all recommend breastfeeding until a child is at least two.

Before I became a mother I took it for granted that the benefits of breastfeeding toddlers (nutritional benefits, the independence it instils, the immunity it provides to name but a few) were fairly common knowledge. I knew there was still some stigma, but I thought by and large no one would think twice when I continued to breastfeed past the first year, especially since so many other mothers had told me they breastfed their children until they were two, three or even older.

The hypersexualisation of breasts means that people are uncomfortable seeing them put to the use they were designed for.

I found I underestimated the level of ignorance around this topic, but I massively underestimated the degree to which society finds breastfeeding toddlers so distasteful. Many mothers experience increased pressure to give up breastfeeding after their babies turn one, receiving comments such as “After x months, it’s for the mother’s benefit, not the child’s”, “(S)He’s never going to be independent”, “I don’t want to see that.”

I put this stigma down to two main reasons; firstly the hypersexualisation of breasts means that people are uncomfortable seeing them put to the use they were designed for, and secondly because breastfeeding toddlers isn’t perceived to be common practice it is assumed that it can’t be beneficial to the child - it has not been normalised so therefore can’t be right.

Common practice and best practice are two very different things, however. It used to be common practice to drink and drive, something we now accept as a society to be a dangerous activity. The previous generation of mothers often gave solids to very young babies; now giving solids before six months is generally considered a bad idea because of the health risks, including the risk of developing food allergies. The reason for the changes in perception are down to active education and information-sharing campaigns.

I don’t suggest that not breastfeeding a baby or toddler is going to damage a child’s health or that everyone should breastfeed into toddlerhood if they can’t or don’t want to; people should do what’s right for their family. But for all those parents out there who are fielding misguided comments suggesting that their child should be weaned from the breast, I hope this article will go some way towards raising awareness and normalising breastfeeding.

Current advice is to breastfeed exclusively to six months and to continue while introducing solids until the child is at least one year old, ideally longer. The AAP, WHO and UNICEF recommend breastfeeding until a child is at least two and the natural age of weaning for humans according to the AAP is estimated at being between two and seven years. Despite the myths, breast milk continues to provide valuable nutrition, vitamins and immunity as babies grow into toddlers and toddlers into children, adapting to the growing child’s needs.

Mothers of breastfeeding older children don’t necessarily set out with the intention of breastfeeding until a certain age, although frequently they do believe that weaning should be child-led rather than parent-led. Complete weaning rarely happens before the age of two without encouragement from parents. Arguments against are often along the lines of it not being nutritionally necessary; however, not being necessary for survival beyond a certain age is different to not being nutritionally beneficial.

Challenging the myths

It is a myth that breast milk loses its nutritional content after the first year: “Human milk expressed by mothers who have been lactating for more than one year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.” (1) In the second year, 448 ml of breast milk provides the following percentages of a child’s daily requirements: 29% energy, 43% protein, 36% calcium, 75% vitamin A, 76% folate, 94% vitamin B12, 60% vitamin C. (2)

Breast milk also provides nourishment, hydration and comfort when infants are too ill to eat much solid food or even drink from a cup (and toddlers who go to playgroups get ill a lot from chewing the already saliva-covered toys). According to studies (3), breastfeeding reduces the number of illnesses, length of illness and morbidity rates in children aged one to three. This is probably because “antibodies are abundant in human milk throughout lactation” (4) and certain immune factors even increase in the the second year of breastfeeding (5). Longer-term breastfeeding also helps protect mothers from cancers and osteoporosis.

The mothers I spoke to were frequently quizzed by friends and relatives about the frequency of feeds, even regarding newborns who can’t overfeed, with onlookers obsessing about whether a given feed was for comfort and not necessarily for nutrition. Viewing milk purely as a nutritional need is to an extent commodifiying the breast yet again. Midwives, by comparison, recommend feeding on demand because babies don’t overfeed at the breast and it helps establish a good milk supply and a strong bond.

Some describe breastfeeding as ‘creepy’.

Breastfeeding isn’t just about the milk as a source of fuel for the body, it provides comfort, quiet mother and child bonding time, and a time when active children can rest and calm down. Rather than holding children back, the comfort and security provided by breastfeeding has actually been linked with more confident, independent children; achieving independence at their own pace rather than being forced into it prematurely makes them more secure in their independence, says Elizabeth Baldwin.

“Meeting a child’s dependency needs is the key to helping that child achieve independence. And children outgrow these needs according to their own unique timetable.” (6)

The science is heavily behind natural-term breastfeeding, so why the taboo? I would suggest it is in no small part because breasts have become symbols of sexuality, something to be covered up outside a sexual context. Ironically, covering up sexualises breasts even further if the only time breasts are seen is in a sexual context. Fetishes are created by selectively covering then revealing something in a sexual context, which is what western society has been doing with breasts for some time now.

Because of this hypersexualisation, many people feel uncomfortable seeing an infant nurse where they feel only a sexual partner has any rights, leading some to describe breastfeeding as “creepy”. It even prevents some mothers from initiating breastfeeding in the first place, as one mother (who was proud of her breasts) told me, the idea of it “made my skin crawl. I never wanted to breastfeed, EVER”. Sometimes breastfeeding just isn’t possible, and then formula is of course a lifeline, but many of the mothers I interviewed told me that they never even tried to breastfeed, or that the women on their ward didn’t try.

A few years ago the deputy editor of Mother and Baby, Kathryn Blundell, caused a stir by revealing that she chose to bottle-feed. She talked about her breasts: “They’re part of my sexuality, too – not just breasts, but fun bags. And when you have that attitude (and I admit I made no attempt to change it), seeing your teeny, tiny, innocent baby latching on where only a lover has been before feels, well, a little creepy.”

It seems like an extreme reaction, but is not uncommon. Intellectually at least, the western world seems to have woken up to the idea that initiating breastfeeding is tremendously beneficial to both mother and child, even if some mothers still have a hard time reconciling this information with the way they have been programmed to feel about their breasts.

Lack of education and information plays a part in failure to initiate breastfeeding according to UNICEF. Today, new mothers have more ready access to information about the benefits of breastfeeding, although it appears more effort could still be made regarding the psychological barriers. However, little information is offered about the benefits of breastfeeding beyond infancy. Many people who are fine seeing newborns breastfeed feel uncomfortable with children breastfeeding once they have teeth, or can talk or walk. All of these developments can happen before a baby is even one year old. If a mother breastfeeds beyond this age she might be accused of not wanting to let her child grow up, or be told that it’s wrong to breastfeed a child who can ask for it. This leads many mothers to hide the fact that they are nursing their toddler.

In 1995, Kathleen Kendall-Tackett and Muriel Sugarman published two papers (7) that led in 1997 to the AAP releasing a statement on breastfeeding that created a storm of controversy, specifically where they recommended that women breastfeed for at least 12 months and “as long thereafter as is mutually desired”.

The current recommendations by the AAP go even further and suggest that weaning before two is not a good idea: “As recommended by the World Health Organization, breastfeeding ideally should continue beyond infancy, but this is not the cultural norm in the US and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and availability of a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer… Emerging research on nutrient content of human milk into the second year of lactation suggests that breast milk continues to offer significant nutritional and immunological benefits… If the child is younger than two years, the child is at increased risk of illness if weaned.” (8)

Extended breastfeeding is actually more common that you might think, but because of social stigma many mothers stop feeding publicly at some point after their child’s first birthday. Kendall writes about her research saying she was “… amazed to discover a quiet underground of women who were defying cultural norms and nursing their older babies right under the radar of family, friends, and healthcare providers. Avery described this phenomenon as ‘closet nursing’, and noted that extended breastfeeding had a lot in common with revealing sexual orientation. Brave souls who chose to be upfront faced marginalisation—or worse.

“Through much of the decade that followed publication of our article, Muriel and I, along with Liz Baldwin and Kathy Dettwyler, frequently had to write letters to courts and child protection agencies on behalf of mothers who were being investigated for child abuse. Their crime? Extended breastfeeding.”

It seems unfathomable that women would face such extreme marginalisation despite incredibly strong medical evidence in favour of breastfeeding beyond infancy and support from the AAP, WHO and UNICEF. However, there remains deeply ingrained social stigma attached particularly to breastfeeding toddlers and young children.

Bettina Forbes, co-founder of breastfeeding advocacy group Best for Babes says: “You’re talking about a culture uncomfortable with breastfeeding a six-week-old… We’ve sexualised the breast so much that people have forgotten breasts are for breastfeeding.”

Indeed, only last year Ashley Clawson from Texas was told she couldn’t breastfeed her four-month-old baby in lingerie store Victoria’s Secret (in a cubicle): a store that specialises in bras and where women presumably take their bras off in cubicles all the time to try new ones on. This seems mystifying until you enter the mind of the sales assistant, socially conditioned to think of breasts as purely sexual - beautiful lace bras aren’t designed for practicality, they are designed to look alluring when clothes are removed and to create a pleasing cleavage or shape under clothes. They are about sexual appeal. So, in the mind of the sales assistant, a nursing infant had no place in that context.

The May 21 2012 edition of Time magazine brought extended nursing to the attention of the public by featuring Jamie Lynne Grumet nursing her four-year-old son, the image provoking some extremely strong reactions. Grumet herself was breastfed her until she was six and describes her memory of it in an interview with Time magazine: “It’s really warm. It’s like embracing your mother, like a hug. You feel comforted, nurtured and really, really loved. I had so much self-confidence as a child, and I know it’s from that. I never felt like she would ever leave me. I felt that security. But people have to realise this is biologically normal. It’s not socially normal. The more people see it, the more it’ll become normal in our culture. That’s what I’m hoping. I want people to see it.”

Having interviewed several mothers, it became clear to me that breastfeeding into toddlerhood or beyond really is more common than it first appears and intellectually increasingly accepted by those who didn’t nurse toddlers themselves. Despite this, even those who support it on an intellectual level find it uncomfortable. As one mother said: “It is just a personal opinion but I, for unknown reason, do find it a bit less comfortable to watch when a child can verbalise they want to feed and organise the mother’s clothes to suit them. I suppose I’m saying I personally get less comfortable after 14-18 months, but in terms of being good for child I’m not sure a maximum age should exist.”

Historical taboos

You might think that we live in liberated times and that if breastfeeding is taboo now, it must have been even more so in the past. However, society wasn’t always so uncomfortable with breastfeeding. Historically, from the middle ages to the renaissance, breastfeeding mothers have been the subject of many paintings, starting mainly in churches with the Madonna nursing her child, and not discreetly either. Looking at paintings by artists such as Jean Fouquet, Luca Signorelli and Pablo Picasso, we can see breastfeeding babies and even toddlers is a common theme until around the 1930s. Then the breastfeeding images seem to reduce and images of breasts are instead increasingly seen in a sexual context.

Meanwhile, infant formula began to be used more routinely from around the 1950s when companies started aggressively marketing it at new mothers in hospitals. As formula feeding became more commonplace, the link between breasts and breastfeeding presumably became less automatic. How many newborn baby cards do you see with an image of a nursing mother compared to images of bottles?

While uptake of formula rose, so did the frequency with which increasingly sexualised images of breasts started to emerge in the media. From page three to “lad’s mags”, music videos and advertising, highly sexualised images of breasts were suddenly everywhere. The more sexualised breasts become, the more likely it is that women may feel embarrassed about breastfeeding in public since revealing breasts has become reserved for sexual contexts. By overly sexualising them, breasts become obscene, even, or perhaps especially, in the context of breastfeeding. Women being made to feel like they should cover up or hide in a toilet only adds to the stigma and insecurity, resulting in less public breastfeeding, which in turn makes it seem less normal.

Fetishes are created by selectively concealing then selectively revealing in a sexual context. This is what society has done with breasts, disassociating them from their intended function and associating them much more heavily with sex instead. The degree to which breasts should be covered up has varied greatly throughout history in different cultures. In Europe centuries ago, revealing ankles or legs was more risqué than breasts. At times it was even fashionable for women to wear gowns that exposed one or both breasts. Now breasts are more frequently seen as objects in a sexual context from adverts to pornography than in art where they would be more likely to be the subject than the object. In real life, they are almost always covered up. Covering up breasts adds to the mystery, sexualising them even further.

The stigma associated with extended breastfeeding is quite possibly in no small part due to the hypersexualisation of breasts in western culture. Breasts have become a commodity to sell cars, films… well anything really. We have forgotten that they were designed to nourish our children. The more people are educated about the benefits of breastfeeding, the more confident women will feel to continue it. And the more women who publicly breastfeed infants, toddlers and children, the more normalised the practice will become.

Normalising breastfeeding would help undo some of this stigma. To this end we would do well to advocate blatant public breastfeeding for anyone feeling brave enough to practise it. Breasts aren’t just commodities to be used for selling cars and magazines; by breastfeeding on demand wherever you are rather than scurrying off to a smelly public toilet, we can begin to reclaim breasts to enough of an extent that as a society we can remember what their primary role was actually intended to be.

References

(1) “Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation” – Mandel 2005 http://pediatrics.aappublications.org/content/116/3/e432.abstract?etoc

(2) “Nutrition, growth, and complementary feeding of the breastfed infant” - Dewey 2001 (http://www.ncbi.nlm.nih.gov/pubmed/11236735)

(3) “Prolonged breast feeding, diarrhoeal disease, and survival of children in Guinea-Bissau” - Mølbak 1994 http://www.ncbi.nlm.nih.gov/pubmed/8019249, “The relationship between breast-feeding and early childhood morbidity in a general population” - van den Bogaard 1991 http://www.ncbi.nlm.nih.gov/pubmed/1936731, “The effects of breastfeeding on toddler health” - Gulick 1986

(4) “Nutrition During Lactation” - Hamosh 1991

(5) “Concentration of immunologic components in human milk collected during second year of lactation” - Lawrence & Lawrence 2011, “Immunologic components in human milk during weaning” - Goldman 1983, Goldman & Goldblum 1983

(6) “Extended Breastfeeding and the Law” - Elizabeth N. Baldwin, Esq.

(7) “The social consequences of long-term breastfeeding”. Journal of Human Lactation and “Weaning ages in a sample of American women who practice extended nursing.” - Kathleen Kendall-Tackett and Muriel Sugarman 1995

(8) http://www.aafp.org/about/policies/all/breastfeeding-support.html

Image: © Julia Shilova - Fotolia.com

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