Ethnographies of Breastfeeding: Cultural Contexts and Confrontations

Tanya Cassidy and Abdullahi El Tom (editors)

Bloomsbury, 2015, 255 pages

 

Ethnographies of Breastfeeding offers a timely insight into how milk feeding is confronted in multiple socio-cultural and political contexts. The edited volume comprises twelve chapters which together explore the boundaries and contentions that milk flows across. By aggregating the historical and ethnographic chapters, the reader can devise how ‘traditional’ or past practices (such as wet-nursing) are now taking on more emergent forms of distribution (such as milk banks and sharing). Offering much more than a study of conceptual shifts over time, the various takes on the ‘product’ and ‘process’ of milk feeding as a reproductive and socio-political conduct make the book a fascinating read.

In her bold foreword, Penny Van Estrik immediately challenges the reader to reconfigure their views and positionality of breastfeeding by referring to it as ‘human milk’ rather than the status quo of ‘breastmilk’. After all, she asks, ‘we don’t call cows’ milk udder milk – why stress the container over the species?’ Perhaps this simple change in how milk feeding is regarded will be a first step in pushing into the shadows the primary status of the breast in the ‘West’ as hyper-sexualized. This opportunity, however, is lost by Van Estrik’s term of reference remaining largely in the foreword and not being used exclusively in the volume’s successive chapters. It seems curious that there is no common stance, especially when ‘confronting’ practices of (breast)milk feeding is an obvious objective of the book and etched in the title. Whilst the editors note that ‘human milk comes with its own baggage’ (p. 9), the absence of a conceptual consensus in how to appropriately address (breast)milk arguably weighs it down further.

A range of chapters investigate the contentions that arise out of the intersubjective relations nurtured through milk. It is perhaps here that the breadth of the book really shows, with insights into how intersubjectivity is shaped by the channels that milk forges between people. This is broadly illustrated through processes of distribution that present interesting implications for social norms, ethical debates, and also the medicalization of reproductive conducts; such as milk sharing, kinship, donation, and ‘lactation surrogates’ and surrogacy.

The volume goes beyond these emergent processes of distribution to offer powerful accounts of how milk and infant feeding is problematized by social norms and protocols. These include debates of what is considered to be appropriate mothering and parenting, or what is considered an appropriate social education and ‘culture of taste,’ both discussed in the context of France. It also becomes clear how milk and infant feeding is entangled in conflicting discourses of biological and social risk (discussed below).

Milk feeding as an embodied process is seen firstly in the context of Brazil and the prenatal expectations and intentions of primigravida or first-time mothers. The conclusions that Alanna Rudzik raise based on her research in the margins of São Paulo are of global concern; along with the staggering abandonment of mothers nursing their babies, there has been a loss of embodied knowledge as to how milk feeding is a meaningful process – making medicalized representations of milk as a product often the sole or dominant construct.

De-medicalizing milk is a point taken up by Aunchalee Palmquist in her study of milk sharing, which she frames as both altruistic and an act of resistance to biomedical constructions of human milk as a biohazard. With public milk sharing showing no sign of being harnessed, the practice may become an interesting area of collaboration with health authorities, in order to avoid confusing and contradicting their messages that milk can be both ‘best’ and bio-hazardous. This argument is then made all the more interesting by the fluidity between emerging and historical forms of milk sharing (see Cassidy, chapter 3).

Whilst milk sharing is known to forge kin relations in Islam it does, by virtue of this, also create social restrictions for marriage that need to be navigated. Ethnographic chapters offer fascinating accounts of the interplay between socio-religious codes, constructions of kinship, and the anonymity provided by donor milks (as opposed to personal relations). This is illustrated in the context of Moroccan women who have migrated to Italy (Rossella Cevese) as well as a beautiful account of the Berti of Northern Darfur that is semi- auto-ethnographic (Abdullahi El Tom).

Taking chapters eight (Alice Desclaux and Chiara Alfieri) and nine (Anne Matthews) together, the relation of infant feeding to transmission risk of HIV/AIDS is both contextualized and compared. Here, we understand how mothers in their lived realities of sub-Saharan Africa actualize health messages for infant feeding. Guidelines create implications which mothers need to negotiate, particularly the strategies and tensions in balancing infant feeding alongside reducing the risk of transmission or complete risk elimination.

Equally interesting are the cultural and socio-political conditions which make guidelines difficult, and perhaps impossible, to achieve. The demand on HIV-infected mothers to comply with protocols (either exclusive milk or formula feeding) can, for instance, reveal their status by virtue of having to avoid certain social norms or gestures. This enmeshes women in competing notions of “risk,” in terms of child health but also social stigma. By illustrating the cultural, socio-political, and ethical implications of guidelines, chapters eight and nine offer a particularly pragmatic edge to the volume.

Tanya Cassidy and Abdullahi El Tom’s edited work adds to the body of anthropological literature on milk feeding, such as ‘The Anthropology of Breastfeeding’ (edited by Vanessa Maher, 1995) and ‘Breastfeeding: Biocultural perspectives’ (edited by Patricia Stuart-Macadam and Katherine Dettwyler, 1995). Putting aside the edited collection’s achievements and opportunities, it does have some notable limitations.

Studies that consist of interviews and short-term observations are not necessarily ‘ethnographic’. Like all anthropological studies of health, understanding the contexts in which people encounter and navigate milk feeding requires substantial and immersive participant-observation alongside multiple methods to synthesize results. This allows, as Melissa Parker and Ian Harper assert, researchers to ‘define and re-define the questions as they grapple with trying to understand the interaction between people and ideas’ (2006: 3). Whilst some chapters offer a fantastic plurality and integration of research methods, others seem to rely on data only from interviews and might therefore not be seen as ‘ethnographies of breastfeeding’.

An ‘ethnography’ implies a written analysis of participant-observation. By virtue of this, an ‘ethnography’ should offer a holistic insight into the cultural and socio-political terrain in which a particular group relates to health and the body (see Russell and Thompson 2000 for a lengthier take on this). Although this does not discount knowledge produced through interviews alone (which presents its own advantages), such results might not be fully immersed in the contexts they are born from. For this reason, perhaps the volume is better described as a compendium or anthropological anthology of breastfeeding. Many chapters also appear as ‘ethnographic’ essays, and few of the contributors engage in theoretical debates to situate milk feeding in the broader anthropological analysis of emerging forms of reproductive care and cultures, as well as the control they are subjected to. From this perspective, the collection does not fulfill its potential.

Tying many of the book’s threads together, Vanessa Maher offers a concluding chapter that succinctly demonstrates, to me at least, why the study of milk feeding is neither marginal nor an issue confined to feminist theory or women’s health. It is instead entangled in issues of heath cultures, conducts, and cosmologies; power and governance of sexuality and the body; as well as the rigidity of social norms and expectations which all impact on maternal and infant health. It should therefore be seen as an area of critical enquiry, par excellence, for medical anthropology and aligned disciplines.

Emphasizing human milk as a ‘product’ in previous studies and public health strategies has weakened our understandings of milk feeding as a ‘process,’ a resolve offered by this book. The contexts and controversies that are unravelled in Ethnographies of Breastfeeding makes it a great addition to undergraduate and postgraduate studies of reproductive care and maternal and infant health. However, its merit should not be contained in the academy, and offers case studies for advocacy and stakeholder groups to inform their approaches to – and advocacy of – milk feeding.

 

Ben Kasstan is a Wellcome Trust funded (Society & Ethics) PhD candidate in the Department of Anthropology, Durham University (UK). His research explores the complex ways in which Haredi Jews navigate mainstream healthcare services, in the specific context of maternal and infant care.

 

Works cited

Maher, Vanessa. 1995. The anthropology of breast-feeding: Natural law or social construct. Oxford: Berg.

Parker, Melissa, and Ian Harper. 2006. The anthropology of public health. Journal of Biosocial Science, 38: 1-5.

Russell, Andrew, and Mary S. Thompson. 2000. Introduction: Contraception across cultures. A. Russell, E. J. Sobo, and    M. S. Thompson (eds), Contraception across cultures: Technologies, choices, constraints. Oxford: Berg, pp. 3-25.

Stuart-Macadam, Patricia, and Katherine A. Dettwyler. 1995. Breastfeeding: Biocultural perspectives. New York:    Aldine de Gruyter.