Beyond Health, Beyond Choice: Breastfeeding Constraints and Realities

Chapter 2 Breastfeeding Promotion through Gender Equity: A Theoretical Perspective for Public Health Practice

Chapter 2 25 The connection between gender inequality and women’s breastfeeding practice has been recognized since the early days of the breastfeeding movement. Numerous documents produced or endorsed by the breastfeeding movement have articulated the link between women’s status and breastfeeding practice. Breastfeeding advocate Ted Greiner, for example, parallels the desired agendas of the breastfeeding movement with those of the women’s movement: “improved working conditions and maternity benefits for working women; help with the burdens of child care and household tasks, especially during the first weeks after delivery; health care that is more sensitive to the needs of women; the opportunity to space babies as they choose; and freedom from the fear and suffering caused by poverty and malnutrition.”1 Most health behavior change interventions have focused attention on how to change critical factors at the individual, interpersonal, community, or organizational level, but rarely do public health interventions focus directly on reducing gender inequality; this neglect may be because we do not know enough about how to reduce the structures that sustain inequality. This chapter outlines a theoretical perspective on how gender inequality affects the maternal practice of breastfeeding, ultimately articulating some principles for breastfeeding protection, promotion, and support that may improve breastfeeding through gender equity. A theory of gender is critical to breaking down the monolithic and onedimensional terms gender inequality and women’s status in ways that allow us to understand and study how gender inequality arises and is sustained. For purposes here, gender inequality refers to the difference in economic, political, Breastfeeding Promotion through Gender Equity A Theoretical Perspective for Public Health Practice Paige Hall Smith and social status between men and women. My framework interweaves theories of gender developed by Christine Oppong and R. W. Connell to understand, study, and document how women’s roles and status affect their breastfeeding practices.2 Setting the Stage: Gender Role Differentiation Over twenty years ago, Christine Oppong, then a senior scientist with the International Labor Organization, developed a theoretical framework to further the understanding of women’s status in society, their roles and productive contributions, and how these affect demographic changes and economic development. According to Oppong, status has three dimensions: economic, political, and social. She proposes that women’s status is configured through the activities, expectations, resources, and authority associated with seven different roles: occupational, domestic, partner, parent, community member, kinship and family, and individual. As daughters (kinship) we are often accountable to our parents’ values, and we often must care for them as they age. If we are part of a couple (partner ) we engage in reciprocal care, support, love, and sex. As a mother (parent) we must help feed and raise our children, and if we have a home we usually have to maintain it (domestic). In addition, we may wish or need to enter the paid labor force (occupational) and contribute to the life of our community through volunteer service and participation in the public life (community). Last, and often least, we may want to engage in activities that improve our own mind and body or that are just good fun (individual). Each role comes with its own unique set of expectations, constraints, and stressors. The more roles we take on, the more responsibilities we have and the greater the constraints on our time. However, each role also provides unique opportunities, benefits, and resources, expands our social network, exposes us to new ideas, and provides opportunities for joy and love. For each of us, then, life involves a series of decisions and turning points about how to best allocate our resources—our time, our money, our possessions, our energy, our bodies—across our different roles over time so that we obtain what we need for a meaningful and secure life. Oppong highlights four noteworthy aspects to women’s roles. First, women’s multiple roles and their characteristics combine to shape women’s economic, political, and social status. Economic status is affected by the activities we perform in the roles, social norms, values, legal protections, perceptions of our work performance, whether and how we acquire the knowledge and skills needed to perform well in the roles, and the extent of our acquisition 26 Paige Hall Smith of financial and nonfinancial resources. Political status, or personal power, is affected by the control and authority we have over resources, opportunities, and decisions that require action by others. Social status...