Beyond Health, Beyond Choice: Breastfeeding Constraints and Realities

Chapter 21 Breastfeeding in Public: Women’s Bodies, Women’s Milk

Chapter 21 249 Breastfeeding takes place within cultural contexts where women receive conflicting messages about their bodies, breastfeeding, and role as mothers. Although the public health message is “breast is best,” cultural associations between women’s bodily fluids, dirt, and pollution mean breastfeeding is often seen as dirty and not for public view. Women’s difficulties with breastfeeding in public may be a barrier to exclusive and long-term breastfeeding. We synthesize the relevant public health and feminist literature, considering how women’s understanding of their milk affects their experiences of breastfeeding in public so that public health practitioners may work to support them. Breastfeeding in public raises issues of private and public places and how these are experienced, interpreted, and enforced. Drawing on the literature about the cultural construction of women’s bodies, bodily fluids, and breastfeeding , we argue that ideas of normality and deviancy, as well as modernism and primitivism, shape public and private understanding of breastfeeding, and we illustrate how this influence impacts on women’s experiences. Western cultures articulate significant tensions and conflicts around the nature and function of breasts (particularly the sexualization of breasts). Various public health approaches could address these issues, as a public health model would focus the issues around breastfeeding in public and help to identify solutions. We adopt a broad social-ecological approach that “recognizes that behaviors and health are influenced at multiple levels from the individual to families to larger systems and groups and then to the broadest level, the population and ecosystem,” to address the issue of breastfeeding in public.1 Other feminists have used the Social-Ecological Model (SEM) to identify Breastfeeding in Public Women’s Bodies, Women’s Milk Sally Dowling, Jennie Naidoo, and David Pontin multiple layers of influence on women’s decisions to initiate and continue breastfeeding.2 We extend this discussion by exploring how the SEM may inform public health approaches to breastfeeding in public. The crux of our argument is that for women to be successful at breastfeeding, they have to be able to breastfeed in public. Breastfeeding in Public International and national health policy focuses on increasing breastfeeding initiation and maintaining duration rates so that babies have six months of exclusive breastfeeding.3 Babies need frequent feeding due to the composition of human milk, but this requirement is not generally appreciated, and the implications of reduced feeding frequency are poorly understood. Unless women stay secluded at home and feed their babies alone, they have to face the fact that they must breastfeed when others are present. To be successful breastfeeders , women must feed their babies when they are hungry—wherever they are. Many women restrict their activities to avoid exposing their breasts to others, or schedule other activities to fit around breastfeeding. Others abandon their original intention and use formula milk or expressed breast milk in public. This may compromise lactation and baby health and cause maternal distress as well as reinforcing formula-feeding as normal.4 Many women feel shame or embarrassment when breastfeeding in public, and when they do many strive to be invisible to reduce their anxiety. Where breastfeeding in public is more acceptable, initiation and duration rates appear to be higher, and there is evidence that social class and ethnicity indicate which women are most likely to breastfeed in public.5 Breastfeeding women face complicated decisions and negotiations about space and place. Understanding and thinking about how we experience spaces and places, and our location in terms of identity and power relationships, have been illuminated by insights from human geography.6 Women experience places differently once they become mothers, as the distinction between private and public spaces becomes less clear. Women used to negotiating public space only for themselves may develop different meanings when they are “negotiating space and two bodies.”7 Breastfeeding in public is determined by the public space in which it happens and in turn changes the general understanding of that place. The public spaces occupied by women are predominantly spaces of consumption (shops and cafés); paradoxically, these are the very places where many women find it most difficult to breastfeed.8 Notions of private and public are interpreted and experienced differently by women at different times when they are breastfeeding. Breastfeeding has 250 S. Dowling, J. Naidoo, and D. Pontin been constructed as a feminine, private activity, most appropriately done at home. However...