For many, breastfeeding is associated with stay-at-home or attachment parenting and with traditional women’s roles. For this reason, there is a notion in the feminist world that breastfeeding holds women back. There is well-documented conflict between work and home roles. But do these tensions mean that particular feeding choices adversely impact women’s status?
At her presentation at the 2013 Breastfeeding and Feminism conference, Paige Hall Smith Director of the Center for Women’s Health and Wellness and associate professor of Public Health Education at UNC Greensboro, took a deep dive into some of the paradoxes around breastfeeding and the status of women and their children. I recently talked with her about her research and key questions from her talk.
Jeanette McCulloch: Why look at how breastfeeding impacts the status of women?
Paige Hall Smith: Because we hear the very real stories of the ways that many public policies – and some individual employers – are at odds with breastfeeding success, we think that breastfeeding may hold women back in professional and educational settings. This, presumably, could mean that breastfeeding results in lower economic and educational well-being for women and their families. Some would suggest that if we promote breastfeeding, we would not be advancing the status of women and in fact, we might harm it.
But when we look at markers that indicate women’s status, we find that states where women hold the highest status are also the states with the highest breastfeeding rates.
JM: How do you measure the status of women?
PHS: Our research used traditional measures at the state level – educational status, voting status (voter registration and regular voting), economic security (employment, income, holding managerial positions), autonomy (owning a business, access to health insurance, college education), and reproductive rights.
The Institute for Women’s Policy Research (IWPR) has been collecting these indicators of the status of women for decades for all of the states in the U.S. Research that has used these indicators has found is that women in states with higher status experience less suicide, less depression, less female homicide and also have better child health.
And – contrary to what you might expect – we found that women in higher status states are more likely to initiate breastfeeding, breastfeed exclusively, and breastfeed longer. This possibly leads us to the exciting notion that we can improve breastfeeding outcomes and women’s status simultaneously.
JM: What do these connections tell us about breastfeeding rates?
PHS: The connection between women’s status and breastfeeding leads to a number of interesting ideas. We know from other research that both education and income are positively associated with breastfeeding outcomes. More research on why this is the case would be useful, particularly given that higher income is also associated with women’s employment. We also learn in this study that in those states where women have greater control of reproductive choices, and those where they are more likely to vote, also have higher breastfeeding rates. Since none of these are indicators that are directly implicated in breastfeeding success, we have to conclude that something interesting is going on in the climate of these states that makes a difference for women.
It makes sense that women who have higher status have more ability to manage their own time and resources (such as adjusting break times at work, taking additional maternity leave, determining the flow and location of their work) which may lead to higher breastfeeding rates. They may also have more authority at home and at work, which translates into greater ability to actualize their own decisions. Breastfeeding, like the ability to control one’s fertility, can be seen as a form of reproductive autonomy.
The relationship between women’s status and breastfeeding remained even when we controlled for available state-level breastfeeding support, such as access to IBCLCs, peer support like La Leche League, and baby friendly hospitals. One possible interpretation for this is that the breastfeeding support measures we have in place are ones that provide more assistance to higher status women than they do to lower status women. We need to think critically how our measures are affecting different populations. In general we found that clinical indicators of breastfeeding support had more impact on breastfeeding than did policy measures. This could have been because currently there insufficient “trickle down” from policy to women’s lives.
JM: And what do these connections tell us about the status of women?
PHS: Several things. One is that women’s status — their income levels, educational levels, voting, autonomy and reproductive control — are powerful determinants of women and children’s health status and now we know that this includes their infant feeding behavior. One thing this tells us is that we can, if we choose to do so, find synergy between improving women’s status and breastfeeding promotion and advocacy. A second, but more problematic issue is that our findings also mean that lower status is associated with less breastfeeding. This is troubling since we do not want breastfeeding to become a class-based privilege. Hence, we need to continue to work to identify the structural barriers to breastfeeding experienced by lower income women.
A third, and very intriguing issue this study raised for me turns on the question of the adequacy of our current approach to measuring the status of women. None of the measures traditionally used –education, income, reproductive control, and voting — have anything to do with motherhood specifically. Perhaps this is because not all women are mothers. But I wonder what the implications would be of adding breastfeeding rates to our package of indicators of women’s status. The proportion of mothers breastfeeding tells us something different about the lives of women than do these other important indicators. Specifically, breastfeeding can be seen as providing unique information on how well women in a state are able to combine their work and family responsibilities.
Since policy makers as well as women’s advocates look at these indicators of women’s status as measures that we want to improve it is instructive to think about what it might mean if if we were to look at breastfeeding as a measure of status.
I think that this would point our attention to strategies and supports that are very different from those that emerge from considering how to improve women’s educational attainment or employment status. If we want most women to have the option to breastfeed according to public health objectives then we need to make some significant changes in the way work and family life are organized. Specifically in order for women to successfully integrate their mothering and occupational roles they need to be able to spend significant time with their babies (at least for the first 6 months), to have access to their babies at work, for work and breastfeeding to be flexible, and to have social norms that value mothering and women’s employment and breastfeeding and children; we need to have practices and supports in place so that women’s choices about motherhood and breastfeeding do not lead to employment discrimination or loss of economic status; and we need gender role norms that support and value paternal as well as maternal caregiving. Looking at breastfeeding as an indicator of women’s status could provide the leverage we need to advance the radical social changes.
JM: What are the most important takeaways from your research?
PSH: This research suggests that we can possibly increase breastfeeding by increasing the status of women. In addition I suspect that if we implemented strategies that supported breastfeeding for all women we might also see some significant increases in the status of women who are also mothers since these strategies would make it easier for women to combine work and motherhood.
Paige Smith Hall is the founder and co-director of the Breastfeeding and Feminism International Conference. Jeanette McCulloch, IBCLC, is a past speaker at the Breastfeeding and Feminism International Conference and the co-founder of BirthSwell, an organization devoted to improving infant and maternal health through changing the way we talk about birth and breastfeeding.