Breastfeeding

Overview


Breastfeeding is the predominant way that humans have fed their infants and young children for years. Breastfeeding has both biological and social implications that create different feeding experiences for women, their children, and their families depending on their culture. Anthropologists have been at the forefront of explaining the evolutionary benefits of breastfeeding for infants and mothers, as well as attempting to understand the complex cultural context in which breastfeeding occurs (or does not). Many anthropologists who have researched breastfeeding have gone on to use their research to advocate for increased utilization and duration of breastfeeding.

Health Impact


Breastfeeding has many benefits for babies, mothers, and society. These benefits are recognized by major institutions in the United States and abroad, including the American Academy of Pediatrics, the US Health and Human Services Department, and the World Health Organization.

It is recommended that mothers breastfeed infants exclusively (without any other supplementation of food or liquids) for six months, and that mothers should continue to breastfeed with supplementation of food and liquids for at least a year.[1]

Below is a summary of some of the major benefits of breastfeeding as currently accepted by scholars, health providers and researchers, and breastfeeding advocates. Unless otherwise noted, all of the below information is taken from the US Government’s breastfeeding summary page.[2]

  • Nutrition: No other food provides the perfect amount of nutrients for children, as it has been designed throughout time to provide what is necessary for growth and development. Breastmilk is also easier to digest than any formulas.

  • Growth and Development: Breastmilk also changes as infants grow. Additionally, allowing infants to feed on demand ensures that infants learn to regulate when they are full.

  • Immunity: Mothers pass antibodies to fight disease to infants breastfeeding. Breastfeeding is associated with lower risks and occurrences of ear infections, diarrhea, necrotizing enterocolitis (gastrointestinal disease), lower respiratory infections, asthma, obesity (throughout life), Type 2 diabetes, Type 1 diabetes, eczema, and childhood atopic dermatitis (a skin rash).

  • Decreased Mortality: Breastfed babies are more likely to survive infancy and less likely to die from SIDS as children who are not breastfed. Over 1,000 infant deaths a year could be prevented if 90% of families breastfed exclusively for 6 months.

  • Emotional: Mother and babies bond when they breastfeed. Babies who are held close have calm heart rates and less stress. Mother’s also release oxytocin, a hormone which promotes calmness and happiness.

  • Mother’s Health: Breastfeeding is linked to lower Type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression in mothers. Research is also looking at links between decreased osteoporosis and post-pregnancy weight loss.

  • Societal benefits: The US would save a lot of money in medical care costs. Breastfed infants spend much less because they usually have fewer doctor visits, prescriptions, and hospitalizations. Mothers who breastfeed also contribute more to the workforce, as they do not have to take off work as frequently to care for sick children. Additionally, there is no trash created by breastfeeding, helping the environment.

Medical Anthropology Research


Medical Anthropology research on breastfeeding approaches this issue from cultural, biological, archaeological, and biocultural perspectives. Medical anthropologists seek to explore the benefits and realities of breastfeeding for infants, mothers, and societies. Many medical anthropologists are not just scholars, but consider themselves advocates for breastfeeding. Breastfeeding is studied through multiple lenses, typically evolutionary biology and health, gender/feminist perspectives, and/or nutritional anthropology.

Biological anthropologists, especially evolutionary anthropologists look at the biological costs and benefits of breastfeeding to infants, mothers, and societies. Breastfeeding has evolved to have benefits for both the mother and the infant, but also has energy demands not necessary for males of the species. Examples of evolutionary benefits of breastfeeding the human body has hormonal responses from breastfeeding that help to begin the production of milk after birth and contract the uterus to normal size, utilize maternal fat stores help to maintain lactation, and promote lactational amenorrhea (not menstruating while breastfeeding) to avoid having children too close together.[3] [4] Some of the demands include energy and time constraints required by females to be reproductively successful. [5] Furthermore, the ability for humans to complementary feed children while continuing to breastfeed provides flexibility that allows infants to maximize the nutritional and immune-benefits from breastfeeding while reducing the energy costs to mothers. [6]

Dettwyler_Photo.JPG
Figure 1.1 Five months old twins from Islamabad, Pakistan. The bottlefed twin, a girl, was malnourished and suffered from frequent bouts of diarrhea. (Courtesy of Dr. Mushtaq A. Khan, Pakistan Institute of Medical Science, Islamabad.
Photo Credit[7]

Cultural anthropologists have focused on how breastfeeding is incorporated (or not) into society, which reflects on women’s role in families, communities, and as productive members of the household. Although breastfeeding is often talked about in relation to pregnancy and childbirth, nutrition, and/or gender relationships, surprisingly few early ethnographies focused exclusively on the topic. [8] From the ethnographies that do exist,[9] [10] [11] it became clear that breastfeeding had socially constructed roles in poverty, child development, sexuality, and social relations. Recently, breastfeeding as a topic has been the focus of many cross-cultural comparisons, exploring issues such as social support, length of breastfeeding, location of breastfeeding, breasts as sexual objects (or not), and societal views of breastfeeding.[12] [13] [14] A major theme of feminist work has explored how women embody breastfeeding, whether experience intimacy and nurturing feelings or feelings of disgust and shame. [15] Additional cultural work, often taken from a critical feminist or political-economic view, explores the decrease of breastfeeding in in both industrialized countries and globally; these anthropologists argue that breastfeeding is typically positioned as an individual behavior, but needs to be examined through larger capitalist and globalizing economic forces and policies, including the marketing of infant formulas and the shift of labor and production out of the home. [16] [17] [18] [19] [20]

Anthropologists studying breastfeeding have been some of the strongest proponents for the importance of using biocultural methods, which explore how biological and cultural experiences of breastfeeding interact.[21] [22] New research examines how breastfeeding interactions are shaped by culture, economics, and child development.[23] [24] Anthropologists also examine how disparities have encouraged or discouraged breastfeeding in different ethnic groups around the world. For example, research into cosleeping as found to be beneficial for breastfeeding acceptance, despite biomedical fears.[25] More and more anthropologists are arguing that understanding the biological evolution of breastfeeding can have direct impacts on modern health, necessitating and understanding of the cultural contexts of infant feeding.[26] [27]

Weaning, including the evolutionarily and culturally accepted best ways to wean, has been approached from biological and cultural lenses and has been a large focus in studies of breastfeeding. Weaning also includes supplementation and complementary feeding.[28] Supplementation is when women add foods to a breastfeeding diet because they think it is not sufficient, while complementary feeding begins at around 6 months of age when mothers start to introduce solid foods in addition to continued breastfeeding. Stuart-Macadam[29] analyzed bone chemistry in pre/history to determine that feeding patterns can affect the health and mortality of children. Additional studies of skeletal remains and tooth enamel have also looked at lactation and weaning and the effects on childhood diet in pre/historic populations.[30] [31] [32] [33] [34] [35] Dettwyler examined non-human primates in an attempt to determine a “natural” age of weaning which she calculates as between 2.5-7 years of age.[36] Dettwyler has also explored the cultural context in which weaning occurs, specifically looking at extended weaning and the biological and physiological benefits to the mother and child.[37] Sellen[38] proposes that understanding the optimal feeding practices of infants should help to inform societies and public health practitioners how to improve actual feeding practices. Both argue that better professional recommendations can accompany a shift in cultural norms towards more support of extended breastfeeding.


Important Anthropologists in the Field


Katherine Dettwyler: Focuses on cross-cultural comparisons of breastfeeding, and the evolutionary and cultural implications for extended breastfeeding

Penny Van Esterik: Researches nutritional anthropology and gender and development, looking at the importance of breastfeeding in non-industrialized countries and the global impacts of the discovery of the transmission of HIV through breastmilk, she also considers herself an advocate anthropologist

Dan Sellen: Studies the evolutionary costs and benefits of breastfeeding and how current societal decisions regarding weaning and breastfeeding can be harmful compared to how we evolved

James McKenna: An expert on infant sleep, studies how human infants sleep better when co-sleeping with adults, especially aiding breastfeeding dyads and reducing Sudden Infant Death Syndrome (SIDS)

Wenda Trevathan: An evolutionary anthropologists who specializes in human reproduction, including the role of breastfeeding in maternal behavior, childbirth, and infant behavior

Peter Ellison: Dr. Ellison studies evolutionary biology and how it pertains to human hormone changes, metabolism, and reproductive behavior and factors

Applied Work


Many anthropologists who study breastfeeding have used their research to advocate for public health policies and interventions. Kathryn Dettwyler has been providing research-backed commentary for breastfeeding and parenting publications for the public since 1995.[39] She has been a strong proponent of extended breastfeeding, using data from weaning primates, as well as data from cultures where breastfeeding is common and accepted, to determine that the natural age of human weaning is most likely between 2.5 and 7 years.[40] Using this data and other studies, she publically argues that extended weaning is natural and healthy, despite actual weaning practices being influenced by culture.

Penny Van Esterik is known for her research on infant feeding and her advocacy efforts.[41] She is a founding member of the World Alliance for Breastfeeding Action (WABA) and is a strong backer of breastfeeding internationally. She combines academic and advocacy writing for the public to use, making her research accessible and applied.[42] She was one of the first scholars to argue that breastfeeding is a feminist issue, and has contributed to the fields of nutritional and gender/feminist anthropology through her work on infant feeding and women’s health.

James McKenna has become a leading expert on infant sleep, which he ties directly to the success and importance of breastfeeding. As an advocate for breastfeeding, he is publically recognized as supporting co-sleeping for the health of infants.[43] McKenna also promotes the use of Arms Reach furniture, cribs designed to fit snuggly next to parent’s beds.[44]

Finally, more researchers are using their knowledge to attempt to make changes to institutions. For example, research into how medical care and birth events help encourage or discourage breastfeeding is being used to help improve breastfeeding outcomes, maternal satisfaction and safety.[45] Furthermore, another important area of applied worked in breastfeeding is the incorporation of breastfeeding into the workplace. The University of Rhode Island received an Elsevier Foundation grant to create a model lactation program for the institution, called the Transitional Support Program.[46] Led by Professor of Sociology and Anthropology Helen Mederer and Carolyn Sovet, Director of the Women’s Center, the program helped to create breastfeeding options on campus to improve workplace wellness. They won the 2009 Breastfeeding Friendly Workplace Award from the Rhode Island Department of Health. Anthropologists have been key researchers in changing societal and political acceptance of breastfeeding in the United States.

Online Resources


A Biocultural Approach: From La Leche League International

Dr. Van Esterik discusses kitchens to improve breastfeeding



Dr. Ellison speaks of Reproductive Ecology and Disorders
"In the summer of 2011, the National Evolutionary Synthesis Center (NESCent) co-sponsored "Evolutionary Foundations for Medicine and Public Health," a one week intensive course for medical practitioners and clinicians. This was the first Continuing Medical Education course on evolutionary medicine."



The Biology of Human Sleep from Dr. McKenna



Dr. McKenna and co-sleeping advocacy



Just in case you need more reason that Dr. McKenna is cool



Further Reading


Greiner T., R Van Esterik, and M. C. Latham. (1981) The insufficient milk syndrome: an alternative explanation. Medical Anthropology, 5:233-247.

Gussler, J. D. and L. H. Briesemeister. (1980) The insufficient milk syndrome: a biocultural explanation. Medical Anthropology, 4:145-174.

Hellman, C. G. (1994) Culture, Health and Illness. Oxford: Butterworth-Heinemann Ltd.

Konner, M. and C. Worthman. (1980) Nursing frequency, gonadal function, and birth spacing among !Kung hunter-gatherers. Science, 207:788-791.

Maher, Vanessa., ed. (1992) The Anthropology of Breast-Feeding: Natural Law or Social Construct. Herndon, VA: Berg Publishers Limited

McKenna, James and Thomas McDade (2005) Why babies should never sleep alone: A review of the cosleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews 6:134-152

Nesse, Randolph M, and Williams, George C. (1994) Why We Get Sick. New York: Random House

Scheper-Hughes, N. (1982) Virgin mothers: the impact of Irish Jansenism on childbearing and infant tending in Western Ireland. Anthropology of Human Birth. Margarita Artschwager Kay, ed. Philadelphia: F. A. Davis Co.

Office on Women’s Health. (2011) Breastfeeding. US Department of Health and Human Services. http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-important/

Sellen, D. W. (2009) Evolution of human lactation and complementary feeding: Implications for understanding contemporary cross-cultural variation. Advances in Experimental Medicine and Biology, 639: 253-282

Sellen, D. W. (2007) Infant and young child feeding practices: evolution, recent cross cultural variation and contemporary public health challenges. Annual Review of Nutrition, 27: 123-147

Sellen, D. W.(2006) Lactation, complementary feeding and human life history. In: The Evolution of Human Life History. R.L. Paine and K. Hawkes, eds., Santa Fe, NM: School of American Research Press. pp. 155-197

References


  1. ^ American Academy of Pediatrics (2012) Policy Statement: Breastfeeding and the use of human milk. Pediatrics, 129:e827-e841. doi: 10.1542/peds.2011-3552
  2. ^ Office on Women's Health (2011) Breastfeeding. US Department of Health and Human Services. Retrieved from http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-important/
  3. ^ Ellison Peter. (2001) On Fertile Ground. London: Harvard University Press
  4. ^ Stallings, JF, CM Worthman, C Panter-Brick. (1994) Biological and behavioral factors influence group differences in prolactin levels among breastfeeding Nepali women. American Journal of Human Biology, 10:191-210.
  5. ^ Ellison Peter. (2001) On Fertile Ground. London: Harvard University Press
  6. ^ Sellen, Daniel. (2007) Evolution of infant and young child feeding: Implications for contemporary public health. Annual Review of Nutrition, 27:123-148. doi: 10.1146/annurev.nutr.25.050304.092557
  7. ^ Stuart-Macadam, Patricia. and Katherine A. Dettwyler, eds. (1995) Breastfeeding: Biocultural Perspectives. New York: Aldine De Gruyter. pp. 14
  8. ^ Van Esterik, Penny. (2002) Contemporary Trends in Infant Feeding Research. Annual Review of Anthropology 31:257-258 doi: 10.1146/annurev.anthro.31.040402.085428
  9. ^ Scheper-Hughes, Nancy. (1992) Death Without Weeping: The Violence of Everyday Life in Brazil. Berkeley: University of California Press.
  10. ^ Kwiatkowski L. 1999. Struggling with Development. Boulder, CO: Westview
  11. ^ Howard, M and A Millard. (1997) Hunger and Shame: Child Malnutrition and Poverty on Mount Kilimanjaro. New York: Rutledge
  12. ^ Hadley, Craig, Crystal L. Patil, and Carolyn Gulas (2010) Social learning and infant and young child feeding practices. Current Anthropology 51(4):551-560. doi: 10.1086/655998
  13. ^ Dettwyler KA. 1995. Beauty and the breast: The cultural context of feeding in the United States. In: Breastfeeding: Biocultural perspectives. P. Stuart-Macadam and KA Dettwyler (eds). New York: Aldine deGruyter.
  14. ^ Stuart-Macadam, Patricia. and Katherine A. Dettwyler, eds. Breastfeeding: Biocultural Perspectives. Aldine De Gruyter, New York, 1995.
  15. ^ Van Esterik, Penny. (2002) Contemporary Trends in Infant Feeding Research. Annual Review of Anthropology 31:257-258 doi: 10.1146/annurev.anthro.31.040402.085428
  16. ^ Van Esterik, Penny (1995) The Politics of Breastfeeding: An Advocacy Perspective. In Breastfeeding: Biocultural Perspectives. Patricia Stuart-Macadam & Katherine Dettwyler, eds. Pp. 145-166. New York: Aldine de Gruyter
  17. ^ Kukla, Rebecca (2006) Ethics and Ideology in Breastfeeding Advocacy Campaigns. Hypatia 21(1):157-180
  18. ^ Rudzik, Alanna EF (2012) The experience and determinants of first-time breast-feeding duration among low-income women from Sao Paulo, Brazil. Current Anthropology, 53(1):108-117. doi: 10.1086/663593
  19. ^ Tomori, Cecilia (2011) The Moral Dilemmas of Nighttime Breastfeeding: Crafting Kinship, Personhood and Capitalism in the U.S. Dissertation, Anthropology, The University of Michigan
  20. ^ Van Esterik, Penny. (2002) Contemporary Trends in Infant Feeding Research. Annual Review of Anthropology 31:257-258 doi: 10.1146/annurev.anthro.31.040402.085428
  21. ^ Van Esterik, Penny. (2002) Contemporary Trends in Infant Feeding Research. Annual Review of Anthropology 31:257-258 doi: 10.1146/annurev.anthro.31.040402.085428
  22. ^ Fouts, Hillary N., Hewlett, Barry S., Lamb, Michael E. (2012). A biocultural approach to breastfeeding interactions in central Africa. American Anthropologist 114(1):123-136. DOI: 10.1111/j.1548-1433.2011.01401.x
  23. ^ Fouts, Hillary N., Hewlett, Barry S., Lamb, Michael E. (2012). A biocultural approach to breastfeeding interactions in central Africa. American Anthropologist 114(1):123-136. DOI: 10.1111/j.1548-1433.2011.01401.x
  24. ^ Dettwyler KA. 1995. Beauty and the breast: The cultural context of feeding in the United States. In: Breastfeeding: Biocultural perspectives. P. Stuart-Macadam and KA Dettwyler (eds). New York: Aldine deGruyter.
  25. ^ McKenna, J. J., H. L. Ball, and L. T. Gettler (2007) Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. American Journal of Physical Anthropology Supplement, 45:133-61
  26. ^ Sellen, Daniel. (2007) Evolution of infant and young child feeding: Implications for contemporary public health. Annual Review of Nutrition, 27:123-148. doi: 10.1146/annurev.nutr.25.050304.092557
  27. ^ Trevathan, Wenda (2010) Ancient Bodies, Modern Lives: How Evolution Has Shaped Women’s Health. Oxford, Oxford University, Press
  28. ^ Van Esterik, Penny. (2002) Contemporary Trends in Infant Feeding Research. Annual Review of Anthropology 31:257-258 doi: 10.1146/annurev.anthro.31.040402.085428
  29. ^ Stuart-Macadam, Patricia. and Katherine A. Dettwyler, eds. Breastfeeding: Biocultural Perspectives. Aldine De Gruyter, New York, 1995
  30. ^ Blakely, RJ. (1989) Bone strontium in pregnant and lactating females from archaeological samples. American Journal of Physical Anthropology, 80:173-185
  31. ^ Herring, DA, SR Saunders, and MA Katzenberg. (1998) Investigating the weaning process in past populations. American Journal of Physical Anthropology, 105(4):425-439
  32. ^ Katzenberg, MA, DA Herring, and SR Saunders. (1996) Weaning and infant mortality: Evaluating the skeletal evidence. Yearbook of Physical Anthropology, 39:177-199
  33. ^ Moggi-Cecchi, J, E Pacciani, J Pinto-Cisternas. (1994) Enamel hypoplasia and age at weaning in 19th-century Florence, Italy. American Journal of Physical Anthropology, 93(3):299-306
  34. ^ Sillen, A. and P Smith. (1984) Weaning patterns are reflected in strontium-calcium ratios of juvenile skeletons. Journal of Archaeological Science, 11:237-245
  35. ^ Wright, LE and HP Schwarcz. (1998) Stable carbon and oxygen isotopes in human tooth enamel: Identifying breastfeeding and weaning in prehistory. American Journal of Physical Anthropology, 106(1):1-18
  36. ^ Dettwyler, Katherine. (2004) When to wean: Biological versus cultural perspectives. Clinical Obstetrics and Gynecology, 47(3):712-723. doi: 10.1097/01.grf.0000137217.97573.01
  37. ^ Dettwyler, Katherine. (2004) When to wean: Biological versus cultural perspectives. Clinical Obstetrics and Gynecology, 47(3):712-723. doi: 10.1097/01.grf.0000137217.97573.01
  38. ^ Sellen, Daniel. (2007) Evolution of infant and young child feeding: Implications for contemporary public health. Annual Review of Nutrition, 27:123-148. doi: 10.1146/annurev.nutr.25.050304.092557
  39. ^ Dettwyler, Kathryn. (2008). Kathy's Commentaries. Retrieved from http://www.kathydettwyler.org/dettwyler.html#comments
  40. ^ Dettwyler, Katherine. (2004) When to wean: Biological versus cultural perspectives. Clinical Obstetrics and Gynecology, 47(3):712-723. doi: 10.1097/01.grf.0000137217.97573.01
  41. ^ Van Esterik, Penny (1995) The Politics of Breastfeeding: An Advocacy Perspective. In Breastfeeding: Biocultural Perspectives. Patricia Stuart-Macadam & Katherine Dettwyler, eds. Pp. 145-166. New York: Aldine de Gruyter
  42. ^ Van Esterik, Penny. Department of Anthropology, Faculty of Liberal Arts and Professional Studies. Retrieved from http://www.yorku.ca/esterik/index.html
  43. ^ McKenna, J. J., H. L. Ball, and L. T. Gettler (2007) Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. American Journal of Physical Anthropology Supplement, 45:133-61
  44. ^ McKenna, James. (2012) A message from Dr. James McKenna. Arm's Reach Concepts, Inc. Retrieved from http://www.armsreach.com/?main_page=news&article_id=74
  45. ^ Klingaman, Kristin, and Helen Ball. (2007) Anthropology of caesarean section birth and breastfeeding: Rationale for evolutionary medicine on the postnatal ward. Durham Anthropology Journal 14(1). Retrieved from http://www.dur.ac.uk/anthropology.journal/vol14/iss1/klingaman_ball/
  46. ^ Elsevier Publishing. (2009). The University of Rhode Island's Transitional Support Program. Retrieved from http://www.youtube.com/watch?v=CfSi4W-deU0