Women’s Health Today

The quiet underground is quiet no more. “Extended” breastfeeding is officially out of the closet.

My first reaction to the now infamous 2012 Time magazine cover was to groan out loud. Like many of you, I was horrified by that cover’s mean-spirited tone. If we didn’t get the message from the picture, there was also the antagonistic caption: “ARE YOU MOM ENOUGH?” It wasn’t until later that I recognized that this cover, and the controversy that followed, actually reflected a positive shift. Many things had changed since I first became aware of this topic at the start of the 1990s.

In 1992, I was just finishing my post-doctoral fellowship at the University of New Hampshire and was expecting my second baby. My first experience had gone not particularly well, so I spent months educating myself about birth, breastfeeding, and postpartum. During this time, I became friends with Dr. Muriel Sugarman. We were both on the board of a local child abuse organization in Massachusetts. Muriel was a child psychiatrist at Harvard’s Massachusetts General Hospital and an amazing ally to the breastfeeding community. She was interested in long-term breastfeeding and had collected some data. (“Long-term” was operationally defined for that study as “six months or longer.”) We started working on it together, and bit by bit, had some findings to report.

We submitted one of our first articles on weaning ages to a well-known journal in pediatrics .  Consistent with studies in other parts of the world, when weaning was child led, it tended to occur at ages 2.5 to 3. So far, so good.

But then there were our outliers … the babies who weaned at age 5 and a couple of babies were even older. The reviewers, all women we later learned, went completely nuts. If it had been up to them, we would have both been rejected and flogged. (Eighteen years later, these are still the worst reviews I’ve ever received.) They hated us, our study, and mostly definitely our “weird” mothers.

I wasn’t sure what to do next, until a colleague handed me an article called, “Darwin takes on mainstream medicine.” It described how extended breastfeeding, babywearing, and co-sleeping  conferred a survival advantage for moms and babies, and was presented at the American Association for the Advancement of Science meetings. That was radical stuff in the mid-1990s. I sacked our introduction rewrote it using this framework.

Where to send the revised manuscript? I called a pediatric researcher I knew in Philadelphia who recommended Clinical Pediatrics, where we got a much more positive reception. The article came out. We were happy. End of story….or so we thought.

In 1997, The American Academy of Pediatrics (AAP) Statement on Breastfeeding was released. Controversy swirled around that statement for months, about one bit in particular: that women breastfeed for at least 12 months and “as long thereafter as is mutually desired.” I was going about my business, blithely unaware that Muriel and I were smack in the middle of the controversy. What reference did the AAP cite to support “as long thereafter as is mutually desired”? You’ve got it: Sugarman and Kendall-Tackett (1995)!

as long thereafter as is mutually desired

That paper taught me a lot. Ten years later, when I applied for APA Fellow, I identified it as one of the most important in my career. I learned firsthand about the intense negative stigma surrounding “extended” breastfeeding. I was equally amazed to discover a quiet underground of women who were defying cultural norms and nursing their older babies right under the radar of family, friends, and healthcare providers. Avery described this phenomenon as “closet nursing,” and noted that extended breastfeeding had a lot in common with revealing sexual orientation. Brave souls who chose to be up front faced marginalization—or worse.

Through much of the decade that followed publication of our article, Muriel and I, along with Liz Baldwin and Kathy Dettwyler, frequently had to write letters to courts and child protection agencies on behalf of mothers who were being investigated for child abuse. Their crime? “Extended” breastfeeding.

Which brings us up to the present time. The Time magazine article said mean things. But look at it this way: extended breastfeeding has been discussed in the mainstream ever since. In addition, thanks to social media, the “quiet underground” is quiet no more. I’ve been amazed at outpouring of support from celebrities and ordinary moms speaking openly and positively about sustained breastfeeding. It was something I couldn’t even imagine in 1995. I think it’s safe to say that extended breastfeeding is officially out of the closet and very visible in our news feeds, if not so commonly in our restaurants.

In closing, I’d like to suggest that we all owe a debt of gratitude to Drs. Ruth Lawrence and Larry Gartner, and the other brave members of the 1997 AAP Committee on Breastfeeding. Their statement did much to move natural-term breastfeeding out of the margins and into the public arena (and Muriel and I were happy to have a small part in that). We still have a ways to go. But we savored this small victory and saluted the members of the 1997 AAP Committee.

References

Avery, J. L. (1977). Closet nursing: a symptom of intolerance and a forerunner of social change. Keeping Abreast J, 2, 21227.

Kendall-Tackett, K.A., & Sugarman, M. (1995). The social consequences of long-term breastfeeding. Journal of Human Lactation, 11, 179-183.

Sugarman, M., & Kendall-Tackett, K.A. (1995). Weaning ages in a sample of American women who practice extended nursing. Clinical Pediatrics, 34(12), 642-647.

Photo with title courtesy Anna Bondarieva

Want to be a part of the Nurture and Care photography Project? www.thenurtureandcareproject.org

Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA