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The Brouhaha Over Breastfeeding

Posted on April 27, 2009
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A few weeks back, I came across an article, published in the reputed magazine, The Atlantic, titled “The Case Against Breast-Feeding”. The blurb read:
“In certain overachieving circles, breast-feeding is no longer a choice—it’s a no-exceptions requirement, the ultimate badge of responsible parenting. Yet the actual health benefits of breast-feeding are surprisingly thin, far thinner than most popular literature indicates. Is breast-feeding right for every family? Or is it this generation’s vacuum cleaner—an instrument of misery that mostly just keeps women down?”

We struggled to breast-feed Maya. Shanthala never produced enough to satisfy Maya’s needs and so right off the bat, we used formula to supplement her nutrition. The hospital provided lactation consultants (people back home raised eyebrows at such terms) who tried to help us with breast-feeding. The advice began with different holding techniques to ensure that Maya latched properly. They followed it up with supplements to help her latch better, supplements such as nipple shields and supplemental nutrition system. That still didn’t produce enough milk for Maya. Shanthala and I began to lose even more sleep during those initial days as feeding her took a lot longer than usual.

After we returned home, we visited another lactation consultant, at a maternity center nearby. This lactation consultant suggested that Shanthala pump milk and we feed Maya through a bottle for a few days to give Shanthala some rest while continuing to keep the supply-demand chain of breast milk alive. The consultant hoped that giving Shanthala time to rest would allow her to pump more often. We rented a pumping machine from the center and purchased all the necessary accessories that go with it. To avoid what is called nipple confusion, we tried finding the right bottle with the right nipple so that Maya wouldn’t get too attached to the easier flow of milk from a bottle. In the beginning, I even tried drip-feeding her to avoid feeding her through a bottle. The technique consisted of attaching one end of a thin capillary to a bottle with pumped breast milk and taping the other end to my finger. Maya nursed by sucking on my finger. It took over an hour to feed her 3 ounces of milk. I gave up after the first two attempts.

Familiar with Indian herbal medicine as well as their Western equivalents to help boost milk production, the lactation consultant recommended that Shanthala try these. And so, Shanthala took these medications, going so far as to import an allopathic medicine from India that had fewer side-effects than the local variety. After two months of struggle, we gave up and switched to feeding Maya only formula, a decision that caused Shanthala much heart-ache.

One of the advantages as an immigrant is the potential to view with a less myopic eye, the practices of two different cultures, to discern ingrained ritual from a more scientific practice. So, when it came to breast-feeding and caring for the baby, we had chosen to eschew most of the Western practices in favor of what we practiced back in India. To be fair, we also eschewed some practices from India such as worrying about “spoiling” a week old infant by responding quickly to her cries or allowing her to cry it out a little.

Starting around the end of WWII and going on till about the late 70s, breastfeeding was considered second class, of a lower quality, used by those who couldn’t afford the superior, “scientifically” formulated infant formula. Breastfeeding in public was considered offensive, an indecent exposure. Just a few months back, San Jose Mercury News published a story about people protesting against Facebook’s decision to remove breastfeeding pictures on grounds that they were obscene. Till recently, no legal protection existed for a woman who wanted to breastfeed in public. If you cannot breastfeed in public, your range and excursions are severely limited. Even today, only 23 states allow breastfeeding in the workplace and seven states have no laws that protect a woman from breastfeeding in public. Still, breastfeeding has been gaining the upper hand starting in the 80s and according to a CDC survey report published last year, 77% of new mothers now breastfeed.

Safety concerns further add to formula’s disadvantages. In the 70s, many infants died due to lack of proper hygiene in the water and bottles for feeding the formula. The poor, unable to afford formula and weaned off breast milk by marketing and free samples, water down the formula as they cannot afford it. Last year, six infants died and 300,000 suffered from tainted milk formula in China. Even in the US, trace quantities of melamine were detected in the formulas sold here. Food safety, in general, has become a major concern. So much so, that the popular science magazine, Discover, considered it a top twenty story of 2008.

And so here was an article, gaining popularity (or notoriety, depending on your point of view) in the blogosphere and elsewhere that questioned the value of breastfeeding. I came across the article via the blog, Frontal Cortex, which I read daily. The article raises some good points about inconclusive studies from which more conclusive dogma is crystallized by the popular media and activists of all garbs. But to talk of “formula” as if it was a constant, unchanging thing seemed silly. Infant formula is constantly revised. For example, the formula manufacturers recently added DHA/ARA, a compound found in breast milk that helps in neural development. With big money behind them, infant formula manufacturers have the clout to seed doubt into the medical literature about the superiority of breastmilk, doubts that will take many years to either prove or discard.

The more I read, the more I realized that this was not an article that was about the science of breast milk or breast-feeding. The heart of the article is right at the start:
“I dutifully breast-fed each of my first two children for the full year that the American Academy of Pediatrics recommends. I have experienced what the Babytalk story calls breast-feeding-induced “maternal nirvana.” This time around, nirvana did not describe my state of mind; I was launching a new Web site and I had two other children to care for, and a husband I would occasionally like to talk to. Being stuck at home breast-feeding as he walked out the door for work just made me unreasonably furious, at him and everyone else.”

This was a cry against what seemed another step in the ladder to impossibly high standards set on women by societies around the world. I gained a more nuanced perspective about this reading the first two chapters of Sarah Blaffer Hrdy’s “Mother Nature: A History of Mothers, Infants, and Natural Selection”. The two chapters are titled “Motherhood as a Minefield” and “A New View of Mothers”. I read about a male-dominated scientific establishment that tried hard to use science to push rather Victorian views of women (selfless mothers, possessed of a natural maternal instinct, stay-at-home to care for infants etc. etc.), substituting dogma for data.

She writes: “… (in 1770), the French physician Jean-Emmanuel Gilbert was convinced that women should follow nature’s eternal and unchanging precepts by nursing each child they bore. Gilbert and others like him looked to the animals not to make unbiased empirical observations but to use nature to confirm their own and society’s preconceptions about how humans should behave.” In the 1860s, Herbert Spencer, who coined the phrase “survival of the fittest” and was a popularizer of the theory of evolution, believed that the supreme function of women was to rear children and so they were less evolved than men. Even Darwin convinced himself that men were superior to women in all spheres except child rearing. Dr. Hrdy writes: “It did not occur to his (Darwin’s) Victorian imagination – as it would immediately occur to a !Kung forager – just how resourceful a woman would have to be to keep children alive and survive herself.“

Dr. Hrdy writes that this Victorian vision has followed us into the modern age and into the study of evolutionary psychology and other subjects of modern biology. She writes how all this clashed with feminism: “Attachment theory rubbed precisely the spot where evolutionary acid burns deepest into feminist sensibilities. … The way many feminists saw it, an infant “attached” meant a mother enchained. … One obvious way for these feminists to avoid this painful and irreconciliable dilemma was to deny that biology is relevant to human affairs or even deny that infants have innate needs for highly personalized care.“

Science, the only known method whose practice can alter theories to fit the data (rather than the other way around as practiced by every other form of knowledge acquisition such as religions and “isms” of various nature), works slowly, far too slowly for this fast-paced world requiring authoritative answers yesterday rather than tentative stabs a month from now. Scientists like Dr. Hrdy and others have begun making forays into this dogma and raising awareness. But for many feminists, breastfeeding can seem like just another Victorian link in the chain binding a woman at home, while her husband can invest far less and feel neither socially ostracized nor less of a parent.

This is then, the rather strange brand of feminism that I find in America. Women trying to be more like men. Equality that comes from being more like the other, rather than allowing for and fighting for diversity. And children are a casualty in this war. In Ann Hulbert’s book “Raising America”, Margaret Mead is quoted as saying that experts opinions on child-rearing: “throw light on the explicit and changing ideals of the adult culture and only to a very limited degree on the practice to which living children are subjected”.

Shanthala, wise as ever, pointed out another important problem with the breastfeeding article. Yes, it is unquestionably hard for a woman to raise a child. In a nuclear family. So, rather than talk about the ill effects of nuclear family, we chose to ravage breastfeeding. We accept practices such as Ferberization as good for the infants with nary a thought to the infant’s view of the matter. Sarah Blaffer Hrdy opines similarly, as I’ve written earlier. We need more allomothers in raising children, not just a mother.

Update: BBC is carrying the same story today.

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Babies Make Us Human

Posted on March 4, 2009
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All things baby interest me, especially if they’re related to evolution or cognitive science, because in the end those fields help us understand what it means to be human. In today’s NYT, there is a fascinating article by Natalie Angier (of the Canon fame) about the ideas of a renowned primatologist and anthropologist, Sarah Blaffer Hrdy, specifically the idea that we “became the nicest apes before the smartest apes” and this had to do with infant rearing. From the article:

“Through its ability to solicit and secure the attentive care not just of its mother but of many others in its sensory purview, a baby promotes many of the behaviors and emotions that we prize in ourselves and that often distinguish us from other animals, including a willingness to share, to cooperate with strangers, to relax one’s guard, uncurl one’s lip and widen one’s pronoun circle beyond the stifling confines of me, myself and mine.”

It is generally accepted that raising kids in a nuclear family of two adults is a post-WWII, US and Western Europe-centric habit. Throughout most of human existence on this planet, and even today in many cultures outside US and Western Europe, infants are reared by more than two people. Joint families that include living with at least the parents on the father’s side is very common in India, for example. In many cultures including India, the older siblings share the responsibility of raising a younger sibling, especially after the infant has been weaned. My father, the eldest son, told me how as a child, he had to rock the cradle while his younger sister slept. He said, “If she was awake, I was off the hook. I’d get so bored sometimes rocking the cradle, I’d pinch the baby and wake her up.”

Allomothers is the technical term used for like-a-mother caregivers of an infant. Cooperative breeding is another term used to describe the same principle. It is a reproductive strategy that has the potential to allow the females to reduce the time between offspring by reducing the burden that she alone has to carry. In apes such as chimpanzees and gorillas, primatologists observed that the mother was left to raise her offspring on her own. Another male or female is likely to kill another’s infant to increase the chances of survival of their offspring. A mother therefore guards the baby and refuses it to be carried or handed over to another member of the group.

For a behavior to be selected, there must be an advantage to all parties involved. The benefit to the mother in allomothering is clear, but what is the benefit to the allomother ? If it is the father, the benefit is again clear, his offspring survive. But if the allomother is not related, what is the benefit ? The currently accepted hypothesis is that caring for other’s infants makes a female a better mother and therefore increases the chances of survival of her offspring. If this hypothesis were true, then inexperienced females should tend to provide allomothering compared to experienced females and the offspring of allomothers should have a higher survival rate than those of non-allomothers. Sarah Hrdy’s study of Hanuman Langur monkeys at Mount Abu in India provided support for this hypothesis. She found that females who had not been mothers yet were willing to be allomothers more often than females who already were mothers. Lynn Fairbanks found that in vervet monkeys, females with high alloparenting experience had a 100% success rate in raising their offspring to maturity while the inexperienced females had only a 50% success rate.

Multiple points of data support the idea that humans evolved to be cooperative breeders. A recent article in ScienceDaily quoted a study by an anthropologist, Barbara Piperata, which stated that because of social support during the breast-feeding phase (upto about 18 months), mothers are able to conserve their energy and become fertile more rapidly compared to other apes which lack such a social support. Another theory that I came across in Meredith Small’s “Kids:How Biology and Culture Shape The Way We Raise Our Children” is based on the observation that humans are unique among the great apes in having a childhood, a stage where an infant has been weaned but is still dependent on adults for feeding and protection. Other apes go from infancy to juvenile phase without passing through a childhood phase. The reason we evolved to have a childhood, according to this theory (by Dr. Barry Bogin), is because older siblings can be alloparents, reducing the burden on mothers and freeing them to reproduce sooner. These two theories state that these are the reasons why humans can reproduce every 2 or 3 years, double or triple the rate of our other great ape cousins, the gorilla and the chimp, which reproduce only every six or seven years.


When I explained all this to Shanthala, she told me about the evolutionary reason for menopause. It’s called the “Grandmother Hypothesis”. Women have menopause because this allows them to be allomothers, help raise their grandchildren instead of continuing to invest in their own offspring. Dr. Hrdy argues that recent research has overturned the idea that humans are a patrilocal society i.e. women join the husband’s family. When it comes to raising an infant, women frequently return to their birth homes, using the experience and help provided by her mother. This custom is true in Indian culture. My mother (and I suspect that’s true for most of my generation) came away to her parent’s place when she was in the final stages of her pregnancy. My father was not even there when I was born and it would be six more months before my mother and I returned to join my father. This tradition continues with a slight twist for all of us immigrant families. Since most immigrants to this country consider it advantageous to give birth here than back in their home country, the women’s parents come to stay with them for an extended period during this time. In many cases, it is the only time the wife’s parents ever come to this country to visit their daughter.

All this is old hat, in some sense. What the NYT article talks about is Dr. Hrdy’s hypothesis that many facets of human behavior are better explained because we’re cooperative breeders than by the fact that we have complex brains. For example, to allow others to raise your infant, you must be willing to trust them; both must evolve a theory of mind i.e. be able to place themselves in the other’s shoes and empathize with them, be able to understand what they might think and feel in a given situation and respond appropriately. She argues that we developed our complex emotional behavior long before we evolved larger brains. She offers evidence of cooperative breeding in other animals such as lions and meerkats that you don’t need large brains to evolve cooperative breeding.

According to the NYT article, Dr. Hrdy has her bias in putting forth this new theory. From the article:

“Dr. Hrdy wrote her book in part to counter what she sees as the reigning dogma among evolutionary scholars that humans evolved their extreme sociality and cooperative behavior to better compete with other humans. “I’m not comfortable accepting this idea that the origins of hypersociality can be found in warfare, or that in-group amity arose in the interest of out-group enmity,” she said in a telephone interview. Sure, humans have been notably violent and militaristic for the last 12,000 or so years, she said, when hunter-gatherers started settling down and defending territories, and populations started getting seriously dense. But before then? There weren’t enough people around to wage wars. By the latest estimates, the average population size during the hundreds of thousands of years of human evolution that preceded the Neolithic Age may have been around 2,000 breeding adults. “What would humans have been fighting over?” Dr. Hrdy said. “They were too busy trying to keep themselves and their children alive.”

Having returned from a five week visit to India, I’m now alone again in caring for Maya the days that Shanthala is at work. In India, the task was made somewhat simpler because of all the help that we had in caring for Maya from our parents and friends to household help. All this talk of cooperative breeding makes me rather envious, and a little sad.

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