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281 The collected chapters in this work make it clear that pushing women to breastfeed for health reasons alone is a weak strategy. Such encouragement does not address the complexity of decision making that is created by the constraints and realities of women’s lives. In continuing to discuss breastfeeding as a choice, we fail to appreciate that most women do not have a source of unbiased information, or the economic, social, and clinical support and resources needed to freely choose whether or not they will breastfeed beyond the first few weeks of their babies’ lives. In and of itself, this is not news. Nevertheless, the injunction to mothers to breastfeed because “breast is best” or because it is good for baby’s health are the default messages that leave public health workers, clinicians, and mothers frustrated. This volume presents the argument that the way forward involves a more concerted focus on reducing the constraints in women’s lives formed by gender inequalities in institutions (including health care), labor, power, and sexuality. Today most women are physically separated from their babies shortly after birth and are not offered economic, social, or even emotional support for being together, let alone for breastfeeding. Yet much of the health promotion discourse enjoins women to breastfeed (since that is what “good mothers” do), making infant feeding a moral minefield that has the potential to undermine not only breastfeeding but also women in their roles as mothers and as paid laborers. Political, economic, and social constraints undermine women’s choices by creating and sustaining structural forces outside their individual control. Indeed, if those opposed to women’s equality had schemed to devise a socioeconomic and political milieu to undermine breastfeeding, they might Conclusion Beyond Health, Beyond Choice: New Ways Forward in Public Health Paige Hall Smith, Bernice L. Hausman, and Miriam Labbok 282 P. H. Smith, B. L. Hausman, and M. Labbok have devised the environment that most women in the United States find themselves in today. This volume argues that unless we refocus attention on how women experience breastfeeding, motherhood, and their own lives, and use these experiences to create and support new public policy, health promotion, and clinical services, breastfeeding rates and practices in this country will not improve. Indeed, the backlash by both feminists and others against breastfeeding that is created by the lack of attention to such constraints further suggests that initiation and continuation rates may decline, because, in the current situation, breastfeeding often exacerbates tensions that continue to plague mothers seeking to integrate their multiple roles into one whole life. Lactation is a biological capacity of female mammals that, in humans, is often associated with traditional gender roles and exclusive maternity. Some could, and have, argued that it is precisely the changing roles of women— changes that lead women toward employment and away from full-time mothering—that are the cause of limited breastfeeding. Such critics might further argue that women do not want to breastfeed, and public health efforts to promote it are flying in the face of women’s new roles and, perhaps, indirectly seeking to reengage women in a full-time, sometimes constraining motherhood role. We see lactation and breastfeeding as different phenomena. While lactation is the biological action of milk production, breastfeeding also involves a social practice and a skill. Historically, breastfeeding was normative in human communities, practiced by most parturient women (mothers), as well as by other women who cared for both their own and other children. As a social practice, breastfeeding is affected by the social norms, values, expectations, and standards held for mothers, paid workers, children, and social institutions. Infant feeding decisions are affected not just by women’s preferences for feeding or how they want to use their bodies, but also by the support they receive for breastfeeding or formula-feeding, as well as for the full range of their multiple roles as mothers, workers, and individuals. Our analysis demonstrates that women receive very little support for their mothering practices in general, let alone for breastfeeding. This lack of support for mothers is compounded by the extraordinary forces (both material and ideological) working against successful breastfeeding. The sociocultural, economic, and institutional forces that work against the biology of breastfeeding astonish us, and we have to ask why that is so. There are potentially numerous answers to this question, and we put forward two that represent overarching themes that emerge from the chapters in this book. The first is that women’s...


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