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64 Nancy Chin and Ann Dozier Chapter 5 Athena is a twenty-six-year-old single mother who lives alone with her five children. After a high-risk pregnancy and premature delivery, she fully breastfed her newborn, Clifford, for four months while attending a community college full time and caring for her four other children. She did this absent a partner or family support while relying on the supplemental nutrition program Women, Infants, and Children (WIC), public transportation, and day care. After four months, she added solid foods to Clifford’s diet. At seven and a half months, she switched Clifford over to formula and discontinued breastfeeding. She said of formula, “Yeah, I don’t have a problem with it.”1 If Athena had shown up in a national database on infant feeding as a set of numbers and demographics, she would have fallen into several groups at high risk for not initiating or sustaining breastfeeding. Despite having partially breastfed her other children, she had four strikes against her in trying to breastfeed her newborn: she was low-income, African American, had no actively involved partner, and had a premature infant in the Neonatal Intensive Care Unit (NICU). Rather than view Athena as a set of numbers and risk factors, we look in detail at her story, her own voice. The focus on the gritty biographical details of a single low-income mother serves multiple objectives. First, it gives voice to those whose suffering is often ignored. Second, it is only through these details we can trace the links between structurally distal events of the social ecology, such as unequal drug laws and the disappearance of fathers from poor communities, and more structurally proximal events, such as the breakdown of families and the decision to feed formula. Third, this approach underscores the constant tension between individual choice and lack of opportunity to The Dangers of Baring the Breast Structural Violence and Formula-Feeding among Low-Income Women The Dangers of Baring the Breast 65 exercise it. Using the Social-Ecological Model in conjunction with the concept of structural violence, we will highlight how, despite her commitment to breastfeed, Athena’s efforts were thwarted rather than supported by the very institutions that she depended on and the community in which she lived. We hope to show that the choice to use formula under these conditions, despite the documented risks, is a rational choice made among a plethora of risks over which she has minimal control. Structural Violence Structural violence originated in the work of sociologist Johan Galtung, founder of peace and conflict studies.2 Structural violence refers to the indirect violence perpetrated on the poor through the higher order structures of the social ecology that leave the poor materially disadvantaged and at great risk for harm. By decreasing the number of available options for action, denying access to resources, and inflicting emotional and physical suffering on individual people, structural violence limits agency and negates the idea of choice. A number of anthropologists working with poor and relatively powerless communities throughout the world have used this framework to better understand the rapid global spread of HIV among poor women; drug addiction and its community consequences in East Harlem; and excess infant mortality in Brazil and Syracuse, New York.3 Structural violence coming as it does through the structures of society has no identifiable agent, which makes it difficult to think in terms of preventive interventions. Nevertheless, understanding the problem of infant feeding in terms of violence originating at multiple levels beyond the individual gets us away from the “educating the mother” interventions so often used. Shifting the focus can stimulate interventions designed at multiple levels to change policies, institutions, and cultural attitudes. Athena’s Story Athena was highly motivated to breastfeed, but beyond her individual motivation she also had to develop strategies to manage multiple risks in her environment . Over the past ten years we conducted dozens of interviews with poor women about the challenges and successes in maintaining their health and the health of their children. Athena’s interview is remarkable for her indefatigable persistence in trying to breastfeed her youngest child. In a sixty-minute home interview, surrounded by her children, Athena described the social context in which she made decisions about infant feeding: I have epilepsy and I averaged about thirty-six seizures in the seven months that I was pregnant with [my fifth child, Clifford]. It just so happened that the day that I...


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