James Akre enjoins health professionals and breastfeeding advocates to protect, promote and support breastfeeding with humility, now that this century belongs to breastfeeding!
Where health professionals responsible for caring for mothers and children are concerned, this is what I would like to say.
I have enormous respect for your knowledge, training and hard-won experience, but I have zero understanding or tolerance for any fence-sitting you may still be engaging in concerning breast milk and breastfeeding. If you have a cultural blind spot or two to overcome, that’s fine; go ahead and do it. After all, your health degree doesn’t make you any less a product of the larger society and culture in which you were born, came of age and were educated. But do you really think you have a valid excuse for not coming down routinely on Mother Nature’s side? If so, I wonder what it might be. It seems to me that the abundant, readily available, and overwhelmingly clear and convincing scientific and epidemiological evidence speaks for itself—and certainly a lot louder than I can.
As a group, you are seen as authorities on every aspect of maternal and child care and nutrition; thus, you are in a unique position to influence the organization and functioning of health services for mothers before, during and after pregnancy and delivery, which of course is what the successfully implemented Baby-friendly Hospital Initiative is all about. But health professionals who are knowledgeable about breastfeeding and motivated to promote it energetically don’t fall from the sky. Further upstream you and your professional associations and training institutions need to ensure that appropriate teaching curricula and policies are in place so that all members of all related professions are actively prepared to protect, promote and support breastfeeding as they should.
As you strive to serve mothers and babies, perhaps you would like to reflect on the following: the possible relevance, for your attitude toward the original default food and feeding system, of what philosopher and social critic Ivan Illich¹ had to say about experts and professionalization:
The medical establishment has become a major threat to health. The case against expert systems like modern health care is that they can produce a damage which outweighs potential benefits; they obscure the political conditions that render society unhealthy; and they tend to expropriate the power of individuals to heal themselves and to shape their environments.
And while I have your attention, I’d like to invite you to join me in declaring a moratorium on using the overworked, unhelpful and often misappropriated slogan “breast is best”; or perhaps we could even agree to banish it altogether from our collective vocabulary.
My observations directed toward breastfeeding advocates, including me, of course, are as follows. If we’re not careful, we can easily come across to some mothers as if insisting that we’re the only ones knowledgeable about feeding children and that they should just keep quiet and dutifully follow our instructions. My superficially paradoxical response here is that we need to be both more aggressive—that is more rigorous—within the virtual organization I have imagined, the International Breastfeeding Support Collective, and less aggressive, by acting always with generosity and humility, in our dealings with those who have not yet joined.
We also need to be aware of the pitfalls of the expert trap. Experts and an expert culture always call for more experts. Experts also have a tendency to cartelize themselves by creating ‘institutional barricades’—for example proclaiming themselves gatekeepers, as well as self-selecting themselves. Finally, experts control knowledge production, as they decide what valid and legitimate knowledge is, and how its acquisition is sanctioned. ²
Browbeating mothers is at best counterproductive for today and, at worst, counterproductive for always. Meanwhile, of course, we should be unrelenting in our efforts to re-shape culture, and society and its institutions, to ensure not only that mothers, because they are genuinely informed, choose breastfeeding every time, but also that they are fully supported in their choice.
Taking a long look at history, I sometimes have the impression that few topics have been as thoroughly obscured by unsound information, contradictory beliefs and illogical thinking as child feeding. Yet I don’t think it would be excessively boastful if I were to affirm that we are collectively becoming ever more knowledgeable … about our ignorance.
The key messages are clearer now: that during the early years the nurturing role of mothers is central to children’s healthy physical, intellectual and emotional development; and that babies are indeed born to be breastfed. Neither nurturing nor nourishing naturally can be entirely safely substituted; the best we can hope to accomplish is to minimize the inherent risks.
I’ll put it this way. Considering 260 million or so years of mammalian evolution, we’re finally beginning to see routine recourse to the paltry pay-off of a century and a half of laboratory fiddling for what it really is: monumental short-sighted scientific hubris. Whether growing awareness of our ignorance and the hard-won scientific facts accompanying it will be enough to influence political and economic events, and thereby markedly improve global society’s child-feeding practices, remains to be seen. Attempts to derive social policy from biological concepts are not risk-free. Yet, as we have learned—both in terms of the importance of breastfeeding and the risks of artificial feeding—the alternative conjures up a truly appalling vision of nurturing and nutritional mediocrity for children, mothers and society as a whole.
¹ Illich I. Medical Nemesis: The expropriation of health, London, Marian Boyars, 1975.
² Finger M, Asún JM. Adult Education at the Crossroads. Learning our way out. London, Zed Books, 2001.
James Akre’s international public health and development career spans five decades, including more than 30 years with agencies of the United Nations system (International Labour Office, United Nations Children’s Fund, and the World Health Organization). He is a member of the editorial board and reviewer for the International Breastfeeding Journal, and he is also a reviewer for Pediatrics and Maternal & Child Nutrition. He is a member of the Scientific Advisory Committee of LLL France and a past member (2004–2010) of the Board of Directors of the International Board of Lactation Consultant Examiners (IBLCE).