The breast milk "cure:" how can something so miraculous and cheap be resisted by women worldwide?

Nicholas Kristof asks, “What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesn’t require refrigeration? One that is free and is available even in remote towns like this one in Niger where babies routinely die of hunger-related causes?  Impossible, you say? Actually, this miracle cure already exists. It’s breast milk.” 

The belief that breast milk has nearly magical healing properties is at least 300 years old, and probably a lot older than that.  I have a Master’s student who’s working on a thesis about the rhetoric and beliefs about breastfeeding in the early U.S. Republic, and her research in the prescriptive literature by English and American physicians in the eighteenth and early nineteenth centuries has revealed a pretty static set of beliefs in breast milk’s power not just to ensure the health of infants, but also its uses in curing a variety of maladies in all sufferers, children and adults.  Breast milk was recommended both topically and internally for a variety of complaints in the eighteenth century, so it’s interesting to see Kristof reaching for the same language of healing and “cures” when touting breastfeeding in developing countries.   

While I think in general that Kristof is correct that promoting breastfeeding is a good thing, I also find that his column treats women’s bodies as mere vessels for the feeding of infants, and their time therefore as worthless.  Note his claim above that breastfeeding is “free.”  I suppose it might seem that way to some men, but it seems awfully condescending to women everywhere–not just in the developing world–to assume that their time, effort, and attention are without value.

Kristof thinks it’s a “paradox. . . that while [breastfeeding] seems so cheap and obvious — virtually instinctive — it’s also rare.”  He doesn’t consider that women in the developing world might have good reasons for their choices–like the poor quality of drinking water he notes is a problem for nursing infants but neglects to consider how unreliable or even dangerous water might be a problem for nursing mothers, who must remain well-hydrated and healthy in order to nurse successfully.  Kristof also fails to consider the other demands on women in the developing world.  What if a woman already has growing children, who need food beyond breast milk, and fuel with which to cook it? 

But if you see women’s bodies as a means to an end and you don’t see their time or labor as valuable, I suppose that Kristof’s analysis makes sense.  In his column, Kristof notes that the breastfeeding (that is, nursing exclusively for the first six months of life) rates in some African countries range from 3-14%, but also admits that in the United States the breastfeeding rate is merely 13%!  So even in a place where there is (for now, anyway) an adequate supply of clean water and organized medical advocacy for nursing, breastfeeding rates in the U.S. are one percent lower than in Senegal.

Why won’t those stupid b!tchez do what seems so “cheap and obvious?”  Why these hundreds of years of prescriptive literature in English instructing and haranguing and nagging women to do what’s “virtually instinctive?”   My question is, why doesn’t anyone ever assume that women are rational actors whose choices might make sense given the (often desperate) economic, social, political, and cultural conditions in which they live?  If outside experts decide that women should be making different decisions they ought to consider a wholesale reform of said economic, social, political, and cultural conditions rather than lecturing women as though they’re the ones who created said conditions.

45 thoughts on “The breast milk "cure:" how can something so miraculous and cheap be resisted by women worldwide?

  1. Oh, don’t get me started on this. Sure, breastmilk is a great way to nourish a baby, but there are so many reasons why breastfeeding is not always a viable option, from the mother who’s on medications, to the kid with a cleft palate, to problems with the water, to a work situation that’s untenable or outright hostile, to conflicting demands on the entire family. . . .

    Instead of sitting on high saying “If only those stupid women would sit down and breastfeed their kids, all their problems would be solved!” maybe these social engineers should try walking a few months in the shoes of men and women who they bewail about. But that’d be much more work than making pronouncements from on high!

    As you say, we historians have been reading this prescription for literally centuries and each time it’s put forward as if by just somehow changing the delivery of the message will transform childrearing and nutrition. You’d think these pundits would realize by now that maybe something bigger is at work in human lives than their own perspective suggests!


  2. “[E]ach time it’s put forward as if by just somehow changing the delivery of the message will transform childrearing and nutrition.”

    Exactly!!! These latter-day prophets of the benefits and virtues of nursing always present the “good news” as though it’s news. There is never any awareness of the Groundhog Day quality of this advice.

    I wonder if Kristof qualifies for the Whiggy (the Whig of Illusory Progress, which I haven’t awarded in quite a while now)? If I can track down some of the primary sources my student has used, perhaps I’ll make the award later on this week.


  3. Breastmilk does require refrigeration, unless your infant is more or less constantly at your side (er, breast) ready to drink.

    I’m personally hugely in favor of breastfeeding, but I’m sick and tired of arrogant attitudes like this which can’t possibly fathom the many reasons breastfeeding isn’t the best solution. I had two good friends whose breastfeeding plans went awry — one had twins and couldn’t keep up when both kids got sick and could only drink two ounces every hour (breasts are not conveniently marked with measurements!), and another who simply wasn’t producing enough. They were probably harder on themselves than anyone, but only because they believed so deeply that breastfeeding was The Ideal, and they had somehow failed. (And all kids, breastmilk and formula, are now bright, thriving, rambunctious first-graders.)

    And all of us were better off than the majority of mothers, anywhere in the world.


  4. I wonder if Kristof (who I usually agree with) has ever tried to nurse an infant.

    I have. Two of them. The first one (born 6 weeks early and without the ability to suck/swallow/breathe) never caught on. The other one took 6 weeks to figure it out. During which I pumped every 3 hours so my milk supply didn’t dry up.

    I wonder if Medela gives discounts to women in third world countries (and a supply of batteries).


  5. A few points:

    1) Under the Affordable Care Act businesses now have to provide places (not bathrooms) for women who want to pump their breast milk at work and they have go give those women time off to do so. The Obama administration should get some credit for this.
    2) Breastfeeding benefits women who breast feed, lowering the risk of breast cancer by a substantial amount and also reducing the risk of osteoporosis.
    3) Isn’t it worth commenting about the effectiveness of formula company marketing over the past century, big pharma’s investment in drug treatments for osteoporosis in this discussion?


  6. Thank you, Historiann; I also found Kristof’s column to be an infuriating bit of mansplaining (not crazy about that word, but it’s really appropriate here.) Do fathers who subject their young children to secondhand smoke receive anywhere near the amount of social condemnation as mothers who don’t breastfeed?


  7. @jgolden08 — how does the Affordable Care Act benefit Senegalese women? Is a mother who is struggling with feeding children really going to care about her personal breast cancer and osteoporosis risks?

    It is possible to to explore the seriously complex challenges to breastfeeding without being against breastfeeding — you seem to be suffering from the same tunnel vision as Kristof’s article.


  8. It seems to me that hunger and nutritional problems need to be solved first (as well as daycare, electrical supplies, etc.) before the “breastfeeding solution” can be applied — and then it becomes moot anyway. As a historian, albeit a modern one, it seems that breastfeeding was something that most infants did before the modern period, and it certainly wasn’t a boon for infant mortality rates. Blaming “recalcitrant” mothers NOT the solution. Available resources might be…


  9. “As a historian, albeit a modern one, it seems that breastfeeding was something that most infants did before the modern period, and it certainly wasn’t a boon for infant mortality rates.

    Thanks, joellecid. That’s a great historical point, too. I don’t think we in the developed world want to return to seventeenth or eighteenth-century infant mortality rates, when *everyone* was breastfed! (Before the advent of manufactured formula, mothers who either couldn’t or didn’t want to breastfeed their infants put them out to wetnurses, which frequently exposed the children to further harm/dangerous disease environments.)

    By comparison, modern formula when prepared properly is an absolute lifesaver, and not a risky choice at all. I hear what jgolden08 is saying–my mother boycotted Nestle in the 1970s because of the damage that formula did to many families in the developing world then. But the problem with using formula in the developing world is the water supply and using the food in the right concentration–the manufactured food itself is not the agent of morbidity and mortality. It’s that larger environment that I think Kristof misses here, both in terms of the literal environment (availabilty of clean water) as well as the other demands on women’s time and labor.


  10. And, to The15th, who asks: “Do fathers who subject their young children to secondhand smoke receive anywhere near the amount of social condemnation as mothers who don’t breastfeed?”

    Great question! Short answer: no.

    Mansplaning seems to be just right in this case, IMHO. I’m sorry I didn’t use the word in the original post!


  11. Typical Kristof: woman as instrument of progress for which she has to be used right, goshdurnit! Oh, and the ladyfeminists don’t get it; so we need his pronunciamenti. Whiggery, condescension, and cluelessness all in one tidy 900-word package.

    In fairness to Kristof I will say he admirably dropped his call for the distribution of menstrual supplies as a source of improved attendance at school after a pair of female researchers disproved the value of that intervention.


  12. To return to jgolden08’s point about the marketing of breastmilk, I do think it’s important to situate NK’s comments in the context of ’60s and ’70s development rhetoric which told African women that formula was this new! modern! (dare I say civilzed?*) way to nourish their babies. According to this logic, African women’s breastmilk was precisely lacking in all the nutrients and sanitation that scientifically calibrated formula provided.

    And formula does cost money *beyond* what the woman needs for her own nourishment, meaning that the woman then must enter herself into a formal, capitalist economy. At this moment it’s hard to imagine anyone who’s not part of that economy, but the same was not quite as true in the 60s/70s. And it’s worth noting that the profits of formula (as jgolden08 notes) were not local.

    This is not to defend NK, by any means, but to point out that 1) his article is just another installment in the ongoing series “Black Mothers, You’re Doing It Wrong” (the (neo)colonial edition), and 2) the magical powers of breastmilk are limited– or at least the belief in them– depending on who and where those breasts are. Black women in Africa: not so much.

    *There are some awesome (by which I mean horrifying) late 19thC-early 20thC colonial anthropologies that bewail how much those African women breast. They touch their babies too much! And there’s not one clear father! How will those babies ever grow up to be responsible, hard-working colonized subjects?1!111!!!


  13. Am I missing something here? We’re all agreed that breast-feeding is desirable, but that a number of obstacles exist that make it difficult for women in first-world countries to breastfeed (apart from individual physiological problems). So things like the Affordable Care Act that make it easier for American women (who can and who want to) to breastfeed, are a good thing. Right?

    Kristof’s language of “miracle cure” was ill-advised, sure, but is there something wrong with thinking it’s a good idea to make breast-feeding more widely available to women in third-world countries, too? I didn’t realize until reading his article how uncommon the practice is, and I found the numbers (for the US as well as abroad) troubling.


  14. I agree with the points made here about the lack of value placed on women’s time etc. More worrying to me in the original article, however, is it’s approach of “these silly Africans with their superstitious beliefs! How can we make them follow the science?” Kristof focuses for instance on women feeding babies water in addition to breast milk (and implies that if they had not done so they would not have lost so many babies in the past – nicely focusing blame for global inequalities on poor mothering.) There certainly are severe dangers for children and anyone else in drinking unsafe water. Still, considering the widespread malnutrition in the areas of Africa he focuses on and the fact that these women will be doing hard physical labor, it seems at least an open question as to whether there may be some benefits for mothers and /or babies in practice.

    I also wondered about the effects of HIV infection on breastfeeding advice. A quick google search led me to a pro-breast feeding site that argued in line with WHO-advice that in most developing world situations HIV-infected mothers should still breastfeed. However it acknowledged that there’s a severe lack of research done into the effects of breastfeeding on the health of a *mother* with HIV and that there may indeed be negative consequences (strangely all but 2 studies focus only on the babies. Go figure!) It then threw in this gem, that “all mothers should increase their food intake and eat nutrient-rich food during lactation.” I’d hazard a guess that that might be quite difficult for many poorer women around the world, but especially in, say, Mauritania.

    So I guess while I find the gender politics troubling, it’s the “civilizing mission” rhetoric that leaps out at me. Of course, as this article, highlights, the discourses are often interwoven. The article’s an interesting example of how developmentalist projects often place responsibility for a family’s (or nation’s) health solely on women.


  15. Thanks sensible and Rachel for your comments on the broader historical and colonial contexts for these conversations about African women’s mothering (and European and American obsession with African breasts, esp.)

    good enough cook: Personally, I am highly skeptical that making breastfeeding spaces in American workplaces more available will do much to change the breastfeeding rate in the U.S. Some individual states had those laws 10-20 years ago, at least–maybe someone has done a study to see if it helped? In any case, it seems to me that most women in the developing world have bigger problems and bigger decisions to make than breastfeeding exclusively or not. (HIV, dysentery, safe shelter and food for other family members, etc.)

    Here in the U.S. breast-pumping rooms are a pi$$hole in the snow. I wonder how Canadian and Scandanavian rates for breastfeeding compare to those in the U.S., considering the generous paid maternity leave policies in those countries? That I think would be probably the best thing the U.S. could do to promote breastfeeding, but I think the sad fact of the matter is that the U.S. doesn’t really care about breastfeeding if it means spending money on it. We’d much rather use it to decide who’s a good mother and who’s a bad mother.


  16. The question of “exclusive breastfeeding” also might be skewing things to look worse. Far more than 13% of US infants are breastfed to some extent, while Kristof concentrates only on those who have only breastmilk for six months (both for the US and other countries). The number gets higher if you instead look at infants who get at least some breastmilk, or who are breastfed for 3 months.

    Regarding Canadian rates, from The Globe and Mail:

    In Canada, about 90 per cent of new mothers start breastfeeding when their children are born –- an excellent rate. But by three months, only half of them are still exclusively breastfeeding, while about two-thirds combine breast and bottle feeding, according to a study of more than 6,400 Canadian mothers published in the journal Birth in June, 2009.

    By six months, just 14 per cent of Canadian mothers are exclusively breastfeeding their babies, the study found. Only 54 per cent of mothers were doing any breastfeeding by that time.

    (That’s about the same rate of exclusive feeding, and I think very slightly higher combined feeding.)


  17. Thanks, Erica! This is really interesting. I wonder if the initial rates of breastfeeding in Canada are much higher than the U.S.–at least to me, 90% sounds off the charts compared to what’s going on in the U.S.

    The question of exclusivity versus just some breastfeeding is really interesting. It makes perfect sense to me that many women, if they have the choice and the means, would incorporate other formula and/or foods before 6 months. Why shouldn’t women make use of technological innovation like other humans?

    It seems to me like the advice about breastfeeding in the U.S. urges longer and longer breastfeeding–that is, it used to be that physicians encouraged the introduction of cereals and other foods gradually beginning at 4 months, and now they’re saying breastmilk only to 6 months is the ideal. Anecdote: My mother always boasted about breastfeeding my brother and I back in the late 60s/early 70s, when it was still kind of counter-cultural. When I asked her recently how long exactly she breastfed me, she said, “6 weeks.” In additon to the lengthening call on women’s labor, prolonged and exclusive breastfeeding would seem to really interfere with family sleep habits. Don’t babies start sleeping longer and more soundly once they’ve got some solid food in their bellies to tide them over?


  18. I think a couple of commenters have already mentioned this, but I don’t see him acknowledging the fact that breastfeeding takes a lot of energy, and poor women often do not get enough food to meet their *baseline* energy needs, much less enough extra to allow them to produce milk. (Many also choose to eat even less of the little they have, so that their older children can have more.)

    And Rachel makes a terrific point about HIV transmission, too.

    It *is* like he thinks women’s bodies are some sort of magical, inexhaustible vessel … not just that their time and labor don’t matter, but also that they are somehow protected from the biological constraints on human men’s bodies by virtue of the Magic of Motherhood or something.


  19. I also typically agree with Kristof, but he was shortsighted on this one. The choice to breastfeed is complex and multifaceted, but that does not negate the fact that is grossly under-supported. In the industrialized North, we lack the social supports that might allow more women to stay home with their infants and/or continue nursing once they go back to work. In the world’s poorer nations, add the limited access to health care and inadequate clean water supply.

    And nice summation re: the situation in the United States, Historiann.


  20. CDC statistics seem to show it’s around 75-80% for any breastfeeding “early postpartum” (so, in the hospital I guess?)

    Feeding babies is definitely a very changeable “standard of care” — my mother’s six-week breastfeeding stint was also a point of pride with her, and she was delicately horrified when I said my daughter wasn’t on formula (or cereal) at five months. I think that solid food leading to better sleep habits might be sort of mythical — e.g., the baby usually starts sleeping more soundly around the time you start switching foods around anyway. (A friend had a special-needs child who was on a liquid [formula] diet for almost two years, and she slept well enough.)

    @Lindsay — Oh, Kristof addresses maternal energy and nutrition needs! “Even when the mother is herself malnourished, her body will normally provide enough milk for a baby, nutritionists say.” See, we don’t need to worry about feeding the mother at all!…


  21. Nothing profound to add, but the historical note is very important. Most pre-modern societies found a way for non-mothers to feed children. So the notion that it is *solely* the mother’s role to do so is historically new — and puts a greater burden on women. To put that another way, I don’t know of a society with 100% breastfeeding *by the biological mother*. Now, that wasn’t always a good thing, as the mortality rates for children at the London Foundling Hospital in the 18th C show, but it’s a good counter to the false nostalgia.

    Oh, and the 17th C images of African women certainly focused on them nursing, with a famous image of a woman passing her breast over her shoulder to feed the baby on her back. That managed to emphasize breast size AND the African woman as source of endless nourishment all in one image… (See Jennifer Morgan’s work on this.)


  22. This is tangential but on idealizations of motherhood, my conclusion as the daughter of an SAHM is that having one puts too great a burden of responsibility on the children.

    We were always rushing home and/or not making plans to go anywhere because we knew Mom was lonely/bored and because her identity was in caring for us. This meant in fact that we had to care for her, which we resented, which was not good for her.

    SAHM was what Mom wanted to be, it was her idea of the best career, but we all had to make special arrangements in our lives to accommodate this career and I think it was unhealthy for the family and the individuals in it in several ways.


  23. P.S. I’m being told that experiments with monkeys indicate that it’s the sitting on lap / in arms the kids need, less than the breast milk per se.


  24. We were always rushing home and/or not making plans to go anywhere because we knew Mom was lonely/bored and because her identity was in caring for us. This meant in fact that we had to care for her, which we resented, which was not good for her.

    It’s easy to see how this might lead to resentment, but perhaps this was more your mother than the SAHM part. My mother was also a SAHM, but it never occurred to me that I owed her my time. She was involved in Brownies and coached my soccer team, but she also took photography classes, played in a community orchestra, and then went back to school to finish her degree when my youngest sibling was in junior high. She had her own friends and her own things.


  25. The whole question of how we define “breastfeeding” is an important one. My sister has a two-month old. She breast fed exclusively for the first week, but the baby was losing weight. It turns out that my sister–who is fit, healthy, and unmedicated–just does not produce enough milk. As it turns out, this was a problem for our mother as well. Once she began supplementing with formula, the baby started putting on weight and sleeping better.

    Furthermore, since she and her husband want to share childcare responsibilities (and she wants to get some hours of uninterrupted sleep), she pumps so that they can trade off middle-of-the-night feedings and so that he can feed her if she happens to be attending to a client (they are both CPAs who work from home).


  26. I liked the point about the water, Historiann. It takes a lot of hydration to get the milk flowing, and if that water’s dirty, what are you going to do?

    I’d also like to stress that for all of those pre-modern breastfed babies, a lot of them went to wet nurses or had milk siblings. Pre-modern women had wet nurses–sometimes because they HAD to, other times because they were privileged enough to employ them.

    In fact, 20th century women had wet nurses (my great aunt was one, interfamilial style. Her sister died in childbirth, and so my great aunt nursed her sister’s newborn until the baby was weaned.)


  27. There definitely were breastmilk substitutes available in the 18th and 19thC- I think usually watered down animal milk. I believe the mortality rates for babies on such diets was extremely high, but this is hard to disaggregate from the fact that such children were usually abandoned or unable to breastfeed and so perhaps had a higher risk of death anyway?

    I believe that a lot of the science around breast is best is unproven- like it stopping women from getting breast cancer. They haven’t really been able to distinguish whether it is breastfeeding, or social class that gives you a smaller risk (and the size of the risk is actually very small in the single digit percents). Indeed, your risk of getting breast cancer is higher if you live in an urban environment, than if you don’t breastfeed, but you don’t see women being told to move to the countryside!

    Australian Feminist Studies, 19(45) (2004) is a whole special edition on the politics of breastfeeding;


  28. Oh, yeah, and if you want a debunking of the ‘science’ around breastfeeding, see: Jules Law, ‘The politics of breastfeeding: assessing risk, dividing labour’, Signs, 25(2) (2000), pp. 407-450.


  29. I just want to point you to a new development in this discussion — recently, Chinese “researchers used cloning technology to introduce human genes into the DNA of Holstein dairy cows before the genetically modified embryos were implanted into surrogate cows” — the goal is to get cows to produce something like human breastmilk, which they plan to market commercially.


  30. I have some more fundamental critiques of Kristoff and WuDunn regarding their book, Half the Sky. My review was posted in February 2010 at Critical Investigations into Humanitarianism in Africa:
    I am not such a fan, so was not as surprised as some readers at the attitudes expressed in this particular article.


  31. Kathie–that was brilliant. Thanks for linking to your review. I really liked your emphasis on the false dichotomy implied when Kristof and WuDunn urge us to focus on “changing reality, not changing laws,” as though women’s “reality” is somehow not profoundly shaped by politics and the law.

    Sheesh. But as you suggest, it’s evidence once again of attempts to reform a set of practices as though they’re not part of a much larger and more complex system. Yes, charitable organizations are doing some good work as you note, just as it’s a good thing if an individual woman decides to breastfeed her infant, but neither of them amounts to much more than a hill of beans in terms of systemic change.


  32. @Historiann

    “Don’t babies start sleeping longer and more soundly once they’ve got some solid food in their bellies to tide them over?”

    Not necessarily. First kid slept through the night (which is defined as 5 or 6 hours straight) at one week. Second kid waited until almost 2 to consistently sleep through. By that point, 2nd was eating solids enthusiastically.

    It was a looong two years.


    “Is giving a child frozen breast milk not breastfeeding somehow?”

    Opinions vary, in my experience. If the mom–a working mom almost by definition–believes passionately in the benefits of breast milk, then she’ll bend over backwards to make sure that it’s what her child eats, regardless of the delivery system. The subgroup of mothers believing that it’s not just about the eating but about being with your kid 24/7 might have issues with it. It’s not an argument I ever care to get into. What I do with my kids (1st did have breastmilk from the bottle; 2nd didn’t, mostly because she wouldn’t take a bottle from anyone) is pretty much my business and no one else’s.

    Historiann, my mom had about the same experience as yours re breast feeding my siblings and I–though I think for my elder sister she went longer than 6 weeks. The amount of time went down with each kid, not too surprisingly.


  33. Kathie, thanks for your review. I hadn’t seen any other studies of “Half the Sky” that mention patriarchy, the elephant in the global room. Your analysis makes me dislike Kristof even more. He mines oppression for professional profit. If patriarchy went away, he’d be out of a job.


  34. Just a follow-up on HIV/AIDS. Yes, it’s still recommended that HIV+ women breastfeed in some circumstances, but not all. I’m writing from South Africa, where clean water is generally (though not universally) available and HIV rates for pregnant women approach 40%, it is not recommended in such cases. And in this circumstance, public health messages promoting breastfeeding risk identifying and stigmatizing HIV+ women who are attempting to provide the medically recommended care for their children.


  35. Erm, there is a lot of ignorance about breastfeeding in this article. I’m a healthy, middle-class American, in a job that allows me to pump during the day, and I’ve struggled to pump enough to feed my little boy (who will be 6 months next week). We’ve had to supplement with formula while I’m at work. I don’t know about other women, but my supply is very sensitive to how often my baby feeds and to how much water I’ve taken in for the day. It isn’t easy to breast feed exclusively and I think this whole, ‘geez, if only they’d realize the answer is in their boobs’ response is offensive to say the least. While I don’t believe in a mother instinct as society likes to suppose all women have, I do believe that mothers want their children to thrive and will do whatever they think is best to achieve that- it is shame he didn’t ask them why they don’t breastfeed and write about their answers.


  36. Exactly, nicolec! But that’s how the ideology of (as Digger put it) “selfish magical factories of goodness” plus “instincts” works: your environment, economic means, time, or personal judgement are meaningless. Welcome to motherhood, the marvelous uncompensated work that everyone feels free to criticize and let you know that “U R doin’ in rong!”

    (Happy half-birthday to your little boy!)


  37. I breastfed and I was happy to do it, but I know first-hand that nursing, pumping, working full-time, losing sleep and being off medication for a chronic condition is absolutely *exhausting*. After 8 months of it I lost my damn marbles and had to take a month off work. I respect the hell out of anyone who pulls it off.


  38. Pingback: Back in the saddle again : Historiann : History and sexual politics, 1492 to the present

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