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Chapter 23 269 At the 2010 Breastfeeding and Feminism Symposium, I asked the attending feminist scholars, activists, and clinicians, “How many of you practice with the assumption that mothers who were sexually abused as children will be difficult patients, for whom the best therapy is likely to give ‘permission’ to not breastfeed?” Not surprisingly, nearly all the clinicians in the room indicated that this was the case. I then argued, as I do in this chapter, that these assumptions are not based in fact. We can learn from women about the complex relationship between child sexual abuse (CSA) and breastfeeding, which includes opportunities for healing and empowerment, as well as struggle. The belief that mothers with a history of childhood sexual abuse may be vulnerable while breastfeeding is based in more general research that found CSA survivors experience certain challenges more frequently than women who were not abused. These challenges include traumatic memory triggers, avoidance, dissociation, low interdependency, decreased self-efficacy, selfdistain , and vulnerability to messaging from health care institutions and corporations.1 However, there has been only one published study investigating the effect of CSA survivorship on women’s breastfeeding experiences, which found that mothers who experienced CSA are 2.5 times as likely to breastfeed their children as women who do not report having been sexually abused.2 The research presented in this chapter can help us understand how CSA may impact breastfeeding experiences. I highlight mothers’ own representations of their experiences in order to model the feminist practice of listening to women and privileging their direct commentary on their struggles and solutions. Intersections Child Sexual Abuse and Breastfeeding Emily C. Taylor Child Sexual Abuse, Feminism, and Public Health One in four girls in the United States report having been sexually abused before their eighteenth birthday, and millions more may endure this trauma and never disclose at all.3 Rates of child sexual abuse continue to rise, as do attempts to quantify the violence so commonly inflicted upon girls in the United States.4 Despite the epidemic prevalence of CSA, most existing treatment and prevention frameworks are highly individualized and private.5 Since the 1960s, feminists have called upon women and girls to “break the silence” that enshrouds their experiences with childhood sexual abuse.6 Speaking out, feminists contend, will empower the speakers and increase potential for healing. Speaking out is also intended to raise community consciousness of the issue.7 Consciousness-raising is a fundamental feminist approach to motivating social change, but it cannot achieve this objective until oppositional actions are in effect. Public health professionals are ideally suited to take action by helping to situate this epidemic within our models of population-level (primary, secondary , and tertiary) prevention. Public health has a responsibility to respond to epidemics, and often does so by creating and supporting social change. To date, public health has responded to CSA by characterizing the population of victims and articulating some of the risk factors for CSA and its outcomes.8 We can move toward fulfilling the public health responsibility by implementing three fundamental feminist ideals: listening to women, politicizing their stories, and complementing theory with practice. Survivor Mothers and Breastfeeding In this chapter, I present direct quotations from a qualitative, exploratory study I conducted in winter 2010. Women were recruited via informal social networks and wrote about their experiences with CSA and breastfeeding in a structured, open-ended questionnaire. The ten themes that emerged stand alone but also intersect, reflecting survivor mothers’ propensity to persevere through adversity to success. The primary themes identified include strong intention to breastfeed, difficulty in getting started, fear of becoming perverted, being triggered during feedings, dissociation during feedings, public breastfeeding evoking shame response and inciting a familiar cycle of feeling abused, determination, therapeutic processes, globalized sense of healing and empowerment, and reclamation of self. Strong Intention to Breastfeed Supporting Prentice et al.’s finding about high breastfeeding initiation rates, 89 percent of respondents to this qualitative study asserted strong intentions to 270 Emily C. Taylor breastfeed, saying specifically that it seemed “integral to pregnancy,” and “natural,” and that they “never doubted” this choice both before and after giving birth. One woman wrote, “There was never any doubt in my mind that I wanted to breastfeed, despite how nervous I was that I would be able to be comfortable doing it. . . . It was a choice very opposite of what I was taught and what my experiences would have dictated, but...

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