#blkbfing, african american anthropology, african american breastfeeding, African American IBCLC, bell hooks, Cultural Anthropology, graduate school, IBCLC, medical, social inequity, social justice, U.S. History, white supremacy, women's health
Below is a paper that I just turned in and filed with my department. I had to submit a ‘research competency’ paper as part of the requirements for my graduate program for the MA (think thesis), and chose to extend the conversation I started about my views on IBCLCs, who I think are very problematic for several reasons as you may have already read and as you will further see. This is an introduction — a starting point. There is much more to this conversation that I will introduce.
This article is under review with Nothing to Lose But Our Chains: Black Voices on Activism, Resistance and Love as well as Transforming Anthropology. Do not cite without permission.
Acquanda Y. Stanford
Uncovering Imperialist White Supremacist Capitalist Patriarchy in Professional Breastfeeding Services: The Greater Complexities of IBCLCs
Black American feminist and cultural critic, bell hooks, coined the term imperialist white supremacist capitalist patriarchy to highlight a non-prioritized system of domination that originates within the United States. Imperialism, white supremacy, capitalism, and patriarchy, hooks argues, culminate, and work in unison with one other with the desire to ‘go out’ and dominate based upon a history of white rule, violence, and the subjugation of people and cultures and is what constitute the framework of this force. The United States with its reputation across all facets of imperialist white supremacist capitalist patriarchy has been used to fuel this scenario within the U.S. boundaries and abroad. Imperialist white supremacist capitalist patriarchy manifests in various ways, and especially with new establishments that are seen to promote breastfeeding via professional services.
Prior to the emergence of this phenomenon of professional practices within more medicalized contexts, breastfeeding had been a tradition that has sustained the human race, with overarching dominant sentiments that wavered between disdain and acceptance. For Black women, breastfeeding harbors a form of community autonomy as well as a distinct injustice and a complex narrative. Forced wet nursing during the colonial period, Black women were made to use their milk to feed a slaver’s baby during chattel slavery and is at the root of this history. This was done in order to alleviate the physical and social discomfort of more affluent white women, and many believe that Black women were most often only able to provide their milk to their own children surreptitiously and sporadically. But breastfeeding was also a primary component of autonomy Black women had while working as midwives both before and after the Civil War. The midwife, who was a prominent figure in communities, worked to ensure a woman was cared for and that her body produced proper milk for her baby. After emancipation, Women of Color from the U.S. and elsewhere gained employment via wet nursing, yet when anti-immigrant sentiments surfaced and stigmatized these women, the belief that a woman’s personality could be transferred from her breastmilk to the child led to the castigation of this practice (Boswell-Penc, 2006), essentially becoming a segue toward the acceptance and even favoring of artificial infant formula which was a nascent yet burgeoning idea. Though the picture remains complex when it comes to understanding the legacy of Black and African American women and breastfeeding, what is known is that this has greatly impacted the breastfeeding rates for generations.
According to various reports, including the Center for Disease Control and Prevention (CDC), Black women statistically rank lowest in all areas of breastfeeding. Racial and Ethnic Differences in Breastfeeding Initiation and Duration, a 2004-2008 National Immunization Survey, conducted by the CDC, highlighted these disjunctures, showing that in all stages of infant feeding from birth through 12 months, non-Hispanic Black women ranked lowest, with 54.4 percent breastfeeding at birth, 26.6 percent at six months, and just 11.7 percent at 12 months (MMWR). Lack of breastfeeding produces disastrous consequences. This gap means that in addition to a history of enslavement Black people in this country remained compromised and disproportionately impacted with maladies that an increase in breastfeeding can help thwart. Not only would more breastfeeding help counter physical ailments such as ear infections, gastrointestinal infections, upper respiratory infections, childhood diabetes, and help decrease Sudden Infant Death Syndrome (SIDS) by 50% (Milligan et al) among countless other positive outcomes, some believe that psychological damages stemming from a history of forced separation between Black women and their babies could be restored by the physical closeness breastfeeding requires. Other injustices could also be highlighted. For example, a Black feminist perspective looks at how Black women’s bodies have been castigated and maligned, and motherhood has been deemed inferior. Even though breastfeeding alone does not combat these stigmas, this and more could all be centered at this site, potentially creating a new narrative and frame of reference for Black women.
Today, we are in a period where providing milk from a woman’s body to her baby is seen as the healthiest way to nourish an infant. Breastfeeding has become highlighted in multiple settings, with women ‘returning’ to this natural tradition. But there are still gaps in Black communities. Blacks and others alike say that an increase in African American professional services, adding more figures with those who have formal knowledge specifically related to breastfeeding, would provide crucial groundwork for a greater understanding of their culture, and consultants who ‘look like us’ would be around potential breastfeeders and produce positive outcomes, since African American women would be more receptive among those who they could relate to. Bolstering breastfeeding promotion are individual advocates as well as Non-Governmental Organizations such as the World Health Organization (WHO), UNICEF, and various hospitals who implement ways to encourage more breastfeeding education with the hopes that women will adopt this tradition. In 1991, for example, both the WHO and UNICEF launched the Baby-Friendly Hospital Initiative, with an effort to ‘improve practices that protect, promote, and support breastfeeding (who.int). A baby-friendly hospital is recognized by 10 steps that are part of the guidelines instituted by the WHO and UNICEF, and require hospitals to create an environment where breastfeeding becomes the primary method of feeding a newborn. This is done by training staff members, encouraging breastfeeding on demand – rather than nursing on a fixed schedule, discussing breastfeeding with pregnant women, and ‘rooming-in’ – keeping a baby in the same room as mother after delivery rather than moving it to a nursery (babyfriendlyusa.org). These, along with other steps will help ensure breastfeeding becomes part of the cultural norm. Baby-friendly hospitals are one facet of a larger endeavor to promote breastfeeding. In the past three decades additional efforts have been made to divert attention from manufactured infant formula and find ways to impart knowledge on individuals in order to promote more breastfeeding. Most notably this has been done with the eruption of International Board Certified Lactation Consultants (IBCLCs).
Towards the latter part of the 20th century, increasing awareness and so-called scientific data highlighting the various health benefits of human milk as opposed to artificial infant formula, which was greatly promoted instead of breastfeeding at the time, is what led to this newfound establishment (ibcle.org). To heighten this interest and encourage breastfeeding among pregnant women and those who recently birthed, medical professionals began working with local advocates with an effort to increase the population’s understanding of human milk as well as a mother’s desire to breastfeed and to offer hands-on assistance (iblce.org). In 1985 the International Board of Lactation Consultant Examiners (IBLCE) geared specifically toward breastfeeding education and promotion formalized and IBCLCs became the product of this initiative. A rigorous set of criteria, including enrolling in formal education classes in anatomy and physiology, nutrition, biology, cultural sensitivity and others, as well as taking lactation-specific courses and apprenticing for approximately one year to gain hands on experience is required. Once these requisites are completed the candidate then sits for a difficult and costly exam that is administered only one day per year around the world. Upon acquiring a favorable score, the individual is allowed to place ‘IBCLC’ behind his or her name for a certification that is recognized internationally, for period of five years. IBCLCs have been deemed the ‘Gold Standard’ in clinical breastfeeding support and lactation management. They have been viewed as adding a level of empowerment for women who make up the greatest majority of this enterprise, allowing them to participate socially and economically within the community. Their ability to effectively apply learned skills in latching a baby to a breast, offer information about infant nutrition, diagnose and treat women for ailments such as mastitis, engorgement, and other areas concerning breast health, including assisting women in reaching their breastfeeding goals is what has relegated these clinicians to the top of the lactation hierarchy. Mothers in large numbers, as well as some fathers and other advocates often rave of the help they have received. Many state that without this assistance initiating and sustaining breastfeeding would have been more complicated, if not entirely unsuccessful and this has been the overarching sentiment, as more and more breastfeeding professional services are on the rise. Worldwide there are more than 28,000 IBCLCs (IBLCE.org) and new certifications mean this number increases each year. The vast majority – over 50 percent – are located in the United States (IBLCE.org) with a notable amount in Australia and Canada. Lactation Consultants are employed in various sectors, and apply their specialized breastfeeding knowledge to their current work as registered nurses, dieticians, and obstetricians, while others work in government offices, non-profit organizations and private sectors, charging between $90.00 and $150.00 per consultation visit. In my own participation in breastfeeding advocacy I wanted to join the ranks of IBCLC. Once I learned of the severe disjuncture in Black breastfeeding, my desire to help curb the staggering amount of inequities caused by a lack of breastfeeding was at the forefront of this desire. I believed this avenue would not only provide an opportunity to have a literal hand in curbing social and health-related ills associated with the lack of breastfeeding, but I was also certain that since I grew up in an environment where breastfeeding was the cultural norm I would be able to recruit other people of African descent into this field, since the numbers of Black IBCLCs are few.
Other desires for more representation among groups of Color also brought along criticisms of the IBLCE and the International Lactation Consultant Association (ILCA). The grievance by Communities of Color has been that the criteria involved in becoming certified are unfair. They argue that the ways to secure this title are the for privileged and elite, which translates to the white middle-class woman, since money and access are needed to work toward this endeavor, and Women of Color are impacted by greater barriers and social circumstances that interfere with these. Black lactation advocates have criticized the certifying entity, stating that the requirements are too stringent: access to education, work, and the ability to obtain clinical apprentice opportunities are much more complicated for them, moreso, than others who do not face the consequences of racial and gendered marginalization. Black women are disproportionately impacted by a social environment that interferes with who is even in our homes and affords us the ability to obtain these credentials. Historically, Black women have been placed in predicaments where they have been the head of households, having to work and be away from family and have had greater difficulty accessing privileged endeavors such as volunteering for months without pay. Additionally, the predominantly white staff that makes up the administrative realm causes division in formal practices: these skewed perspectives influence how information appears on tests and what is relayed to clients. Many people who advocate for great diversity among IBCLCs suggest that increasing the numbers within this sector would allow more opportunity for groups to participate: more input and voices from these margins would assist with erasing health injustice. In response, there have been recent efforts on the part of the IBLCE and ILCA to examine their set of criteria, in order to create what they believe to be more equity within the institution. One way has been a formal summit to draw attention to these discrepancies. In August 2014, in Arizona, United States, the IBLCE and ILCA convened an ‘equity’ summit, asking for those who feel marginalized to highlight this and ways to restructure the curriculum. Various individuals came together to highlight ‘real-life experiences, obstacles, and challenges of underreprepresented people in the U.S. and across the globe’ (ILCA.org). In order to offer an opportunity toward certification for these communities, the IBLCE changed its criteria, reducing mandatory apprentice hours, and created different avenues toward reaching the education goals.
But breastfeeding professionalism is too often romanticized. It is too often seen as a facet of care, nurturing and community empowerment, rather than a site to trace domination and a U.S. attempt to expand the bounds of its desire for a global empire. At first glance professionals appear to work toward a positive outcome for promoting the breastfeeding tradition. Looking deeper into history, however, it becomes apparent that this newly coveted terrain in medicalization not only causes trauma at the local level by removing knowledge from the people, but is exceptionally problematic within and between various layers. This paper examines the infiltration of imperialist white supremacist capitalist patriarchy as it manifests with the rise of breastfeeding professionals. It looks specifically at the IBLCE and the proliferation of IBCLCs. I will examine how, on the surface this newfound establishment may reflect an avenue toward strengthening a bond between mother and child, helping women reach their breastfeeding goals and creating a culture of acceptance on all levels of human lactation. Layers beneath this veneer, however, expose ‘blind spots’ that harbor a lengthy legacy of domination that remains a part of all facets. IBCLCs appear to work at countering the disruption of the physiological function caused by the interference of infant formula milk, but they only cause an increase in social discord on a local and global context. This means that not only does the IBLCE produce more inequity within this profession, but also it encompasses a legacy of injustice in creating a hierarchy and inevitable oligarchy where breastfeeding knowledge becomes consolidated, available only to those who have access and privilege. For Black women, IBCLCs pose an additional layer of destruction. A history of state-sanctioned intervention directly related to the breast has been faced by this group, and the mainstream biomedical model of healthcare has been built upon the dispossession of Black women and dismemberment of a shared autonomy once held by Black midwives. This devastation continues to manifest via this facet of reproduction, and is damaging to those in the United States, and abroad. I suggest that it is only through community participation and sovereignty, highlighting ways to create more radical awareness about breastfeeding within their own everyday understanding, is how communities can shield itself, and return this natural, healthy tradition and power back to their community.
The roots of this contention trace itself back hundreds of years to the domination and subjugation of women via reproduction. The autonomy women exercised over their reproductive biology individually and collectively within their community came to a halt at the outset of the capitalist regime, a direct desire for economic gain. This pre-dated the colonization of America – its ‘discovery’ by Christopher Columbus or the transatlantic slave trade, both which are greatly influenced by this and crucial elements along this trajectory. Biological control was needed to increase the population of Europeans from decline that happened as a result of the Black Death; In just over five years in Europe it ‘killed one third of all the people’ (academic.mu.edu), and reproduction became the primary site of control. The attention to repopulation became centered on European women within the region, foreshadowing a marker of control that would reverberate across time and space, directly creating the framework that would later be seen in the Americas.
Sylvia Federici explores the ancient roots of what would be imperialist white supremacist capitalist patriarchy. In Caliban and the Witch: Women, the Body and Primitive Accumulation, Federici states that is was in the middle ages, during this pre-colonial period in history that set the stage for the control of women, eradicating autonomy they had over their reproduction – including suppressing it. Reproductive autonomy was a woman-centered avenue, where women relied on other female figures and elders in the community. Federici argues that ‘things changed drastically, however, as soon as women’s control over reproduction seemed to pose a threat to economic and social stability, as it did in the aftermath of the demographic catastrophe produced by the “Black Death,” the apocalyptic plague that, between 1347 and 1352, destroyed more than one third of the European population’ (Ziegler 1969:230, Federici 2004: 40). One of the repercussions of the plague’s death toll was that it created a labor crisis that needed to be filled. Federici highlights that it was within this time that ‘the main initiative that the state took to restore the population ration was the launching of a true war against women clearly aimed at breaking the control they had exercised of their bodies and reproduction (Pg. 88). In a drastic effort toward repopulation, new laws became the norm. New forms of surveillance were adopted to ensure that pregnant women did not terminate their pregnancies. ‘In France, a royal edict of 1556 required women to register every pregnancy, and sentenced to death those whose infant died before baptism after a concealed delivery, whether or not proven guilty of any wrongdoing’ (Pg. 89).
The interrogation of women and the removal of the midwife was a facet of control certain to happen, since the birth site would become scrutinized by male figures, inaugurating a new system by moving the self-governance out of the hands of the people in the community and into the hands of the state. The suspicion under which midwives came in this period – leading to the entrance of the male doctor into the delivery room—stemmed more from the authorities’ fear of infanticide than from any concern with the midwives’ incompetence (Pg. 89). Although it would not be until later in history where lactation became an explicit focal point, it operated as a facet of surveillance during this reproductive tyranny because ‘they also had to examine suspected local women for any sign of lactation when foundlings were discovered on the Church’s steps (Wiesner 1933:52, Federici 2004:89). The same type of collaboration was demanded of relatives and neighbors’ (Federici 2004:89).
In addition to efforts to increase the population after the Black Death, voyages by Europeans to the Americas was the culprit in colonization and the obliteration of Native populations on al large-scale quantity. ‘Within little more than a century, the Indian population declined by ninety percent and even ninety-five percent in Mexico, Peru, and some other regions (Gunder Frank 1978: Federoco 2004:86). Native genocide opened a additional avenue toward the implementation of European masculinist control in all facets of society. The forthcoming usurpation of African populations was to become a breeding ground for capitalism, and solidify markers of supposed inferiority based upon race, gender, and geographic location. Along with the slaughter of Native peoples, the spawn of the transatlantic slave trade beginning in the early 17th century claimed millions more lives, yet it varied only because although millions of usurped African men and women died, millions also lived, and for those who did they became components of the inevitable master-servant dynamic. This meant that the system built upon capitalist interest would become more solidified with ensuing racial categorization, placing people of similar phenotypes in particular social compartments. Racial categorization sprang up across time and space. This time period was shared with the ‘enlightenment’ era – the mid-1600s, influenced by thinkers who became interested in empirical evidence – and human biology became an instrument to measure and weigh superiority. This began the ‘scientific studies [that] extended the classification of humankind developed by zoologists and physical anthropologists by systematically measuring and describing differences in hair texture, cranial capacity in various races (Wander et al, 2008). African American historian and anthropologist, Nell Irvin Painter tells us that ‘all the prominent anthropologists of the time assumed that brain size correlated with intelligence’ (2010). White people consistently came out on top, a result of using their own culture and biology as the stick in which to measure others. This form of ‘scientific’ quantification meant that from then on, the human race would be judged in terms of skin color, and on cultural background, community, and ways of being. This became sedimented in society, transmitted across Europe and North America, eventually extending to other continents. This intellectual superiority, the result of scientific racism meant that African American men and women would become test sites in the quest for extending medical knowledge. African Americans faced the brunt of medical experimentation since enslavement meant legalized subjugation; they were treated like property, and could not resist these forms of control.
The desire for knowledge was practiced with efforts to explore and perfect procedures, with this growing interest in human biology being a facet of white male domination. Medical ethicist and author of Medical Apartheid: The Dark History of Medical Experimentation on African Americans from Colonial Times to the Present, Harriet A. Washington, tells us that ‘physicians were dependent upon slavery, both for economic security and for the enslaved “clinical material” that fed the American medical research and medical training that bolstered physicians’ professional advancement’ (Pg 26). The quest for newfound knowledge weighted heavily against Black women. Time and time again Black women were exploited via exclusive forms of experimentation because of their female anatomy, as gynecological information was sought, and its relation to women would emphasize male authority within medicalized contexts.
‘Medical experimentation was profitable in terms of recovered health and life for whites, who benefited once the medical process had been perfected. It was also a profitable source of fame, and sometimes fortune, for physicians’ (Washington, 2006: 56). This was an ongoing process. Washington states that ‘the experimental abuse of African Americans was not a cultural anomaly; it simply mirrored in the medical arena the economic, social, and health abuses that the larger society perpetuated against people of color, especially in the slaveholding states’ (Washington, 2006:56). But African Americans, however, were ‘weary because Western medical experimentation, with its mechanistic approach to the body, was philosophically inimical to the spiritual-community-based and holistic African systems of healing as practices by black healers’ (Washington, 2006:56). This is significant because folk healing and medicine, with lay midwifery as one of its facets, would also become a primary avenue of control and castigation based on the ideas that midwives lacked the intellectual prowess and newfound ‘knowledge’ necessary to tend to the mother-infant dyad – midwives would also be blamed for infant and maternal mortality. Marie Jenkins-Schwartz tell us that ‘in the antebellum South, slaveholders’ interest in slave women was matched by physicians struggling to assert their own professional authority over childbirth, and the two began to work together to increase the number of infants born in the slave quarter. In unprecedented ways, doctors tried to manage the health of enslaved women from puberty through the reproductive years, attempting to foster pregnancy, cure infertility, and resolve gynecological problems’ (2006). This would interfere with the breastfeeding relationship that the state, via biological medicine, would later work to intervene.
The biomedical model was an inevitable outgrowth of this desire for an increase in medical knowledge. This unnecessary aspect of attention to health was designed and has been used to regulate and control, situating knowledge, including that related to breastfeeding, into particular social sects. The biomedical model has both transformed and reshaped the way we view our bodies, and authoritative knowledge became one of its primary vehicles. Biomedicine is ‘the explanation of health in terms of biology’ (Open.edu). Dr. Cathy Lloyd tell us that:
‘With the rise of biomedicine came greater knowledge about the causes of infectious diseases. With greater urbanisation during the Industrial Revolution came widespread disease, which led to the public health movement. The key tenet of public health theories, of whatever type, was (and is) that health and disease arise from the relationship of individuals and populations with their natural or manufactured environment, and that the promotion of health and wellbeing requires intervention to modify or transform that environment.’
The biomedical model has been positioned as the dominant medical paradigm in the United States that overwhelmingly overshadowed traditional knowledge of health and wellness and folk medicines. It has placed everyone under the same homogenous category that is based upon theories of cause and effect, hypothesis, and “duplicates American class, racial/ethnic, and gender relations, and constitutes the standard by which all other medical systems are measured (Baer 1989, 1110; Sobo et all, 2012, 112). This version undermined traditional care and folk healing and ways ethnomedicine – alternative practices, were enacted – both ethnomedicine and alternative medicine which ‘refer to the similar process of seeking medical care that is not part of the mainstream or professional health care system (Bailey, 2000). The biomedical model of attention to health stemmed from the emergence of scientific data beginning with the ‘germ theory,’ which posits that disease origin could be traced to a specific germ – one for each disease (Sobo and Loustaunau, Pg 120).
The germ theory was ‘developed in a social, cultural, and economic milieu increasingly centered on the values of mass production, mass consumption, standardization, and efficiency, all of which were compatible with germ theory science and popularization’ (harvard.edu). This opened the floodgates to further research efforts to understand the spread of disease, which inevitably ‘brought about an elevation in the social status of physicians and of medical research and practice during a period of public skepticism about the value of traditional medical practice’ (harvard.edu). The significance of the germ theory is that it would become a focal point in centering the so-called shortcomings of midwives, when the state enacted new efforts to educate women with regards to proper hygiene techniques to avert sickness. In addition to this then nascent theory, specialized knowledge became fixed with the eruption of the American Medical Association (AMA), a primary purveyor of social dominance regarding race, gender and class, and a key step to the professionalization process of knowledge. The establishment of the AMA drastically changed information about health and wellness since it meant that those seen as not conforming to the set of higher standards of medical knowledge would not be able to participate in this newfound establishment. Elisa Sobo and Martha Loustaunau, in The Cultural Context of Health, Illness and Medicine, explain that ‘the power of the AMA was used to raise and maintain academic and scientific standards, but it was also used to consolidate power and further its own interests, including the economic position of the medical profession’ (Pg 121). The AMA consisted of a conglomerate of white men who would create the standard on what constitutes physical health. Sobo and Loustaunau elaborate on these, including their complications stating that they ‘also helped to secure the autonomous right to define and enforce the restraints, as well as the standards of practice’ (Pg 121). Additionally, this situated knowledge became solidified with the emergence of the Flexner report of 1910, in that it worked to ‘reform’ medical education.
The Flexner report has been called the ‘most important event in American and Canadian medical education’ (medicinenet.com). The originator, Abraham Flexner, published a report that created a standard in American practices, upon visiting the 155 U.S. medical institutions of the time and determining they were lacking in standards and efficiency that were in accordance to the new reliance on scientific data. Abraham Flexner was influenced by the German model of medical protocol, in ‘which physician scientists were trained in laboratory investigation as a prelude and foundation for clinical training and investigation in university hospitals’ (nbci).
Flexner’s report placed control of what had been constructed as medical knowledge in the hands of white males, expelling the nominal amount of Black male and some white females from the burgeoning establishment. It also created a legacy that helped to ‘solidify the alliance between the capitalist class and the AMA and to establish the dominance of the researcher over practitioner’ (Sobo and Loustaunau Pg, 123). Moreover, ‘professional medical reformers were well aware of the need for a strategy consistent with current historical forces. This meant offering investment opportunities in conquering disease and the promise of international status and leadership to investors (E. Brown 1979, 141). In keeping with the new scientific discoveries and inventions in the industrial sector, which promised growth and profits, the time had come to promote “scientific medicine”’ (Sobo and Loustaunau Pg 122). Another facet meant that this racialization and exclusion of Blacks who would eventually wish to study medicine were permitted to do so only to care for whites via servitude and in emergencies, other Blacks because of segregation. The results of this was that Blacks, and undoubtedly other People of Color, were provided with a framework of healthcare based only on the needs, ideology, and socio cultural functioning of the white population. These viewpoints continued to be attached to the overall social climate today. Another facet of the induction of mainstream medical knowledge greatly impacted birthing practices and midwifery. This is significant not only because it would mean more regulation of women’s bodies, but it also foreshadowed this new avenue of imperialist white supremacist capitalist patriarchy and its impact on breastfeeding and how this would reverberate on a large-scale basis. Just as birth came under scrutiny in centuries earlier in a desire to control the population, it was again at the forefront when regulations on lay practices emerged, especially altering the way Black women participated, seen most profoundly among midwives.
The significance of the Black midwife cannot be overstated. More than simply a fleeting and indifferent figure appearing moments before active labor in time for a woman to push, and disappearing moments into the postpartum period, Black midwives, often labeled with the misnomer ‘Granny,’ since they varied in age, were invested in the care and well being of women. Granny midwives’ tradition encapsulated a holistic framework that encompassed more than just physical health, but mental health, as well as community, and spiritual beliefs were all equally important components in practicing and tending to women. In terms of numbers, midwives were affluent. Valerie Lee, author of Granny Midwives and Black Women Writers: Double-Dutched Readings, tell us that: ‘A federal public health survey in the early 1920s estimated a total of 43,627 practicing lay midwives, most of whom were black, serving primarily black communities’ (Lee, 1996, Pg. 6). These women, many with limited or no formal education, practiced for decades, conjuring community respect for a tradition in which they felt called by God. In In the Way of Our Grandmothers, Debra Annie Susie explains that ‘birth among women’ was a communal event that connected each other across generations:
The birthing chamber was the focal point of a variety of deep female attachments: there was the relationship between the laboring woman and her midwife; the midwife and former “clients”; the laboring woman and her mother, grandmother, sister, or other supporting female relative(s); and the laboring woman and her friends (16).
Black midwives provided a comprehensive realm of support for women and their families and rarely suffered reproductive tragedies. On the other hand, midwives who ‘caught’ babies, sometimes numbering into the thousands, can be seen in such stories as Margaret Charles who practiced for over 50 years and never lost a mother (Smith, Holmes, 1996), and Onnie Lee Logan (1989). Black midwives’ methods to ensure the interests of the newly-oriented mother-infant dyad was to provide support during all phases of pregnancy, administering traditional remedies of herbs and food to comfort laboring women, and then stick around – sometimes up to two weeks after the birth, ensuring the new mother knew about provisions for herself and her baby, in terms of proper nourishment and physical care. ‘As one retired midwife from Halifax County, North Carolina described her duties’: ‘You teach them how to take care of themselves, to keep the house clean and proper for the baby, ‘bout good food to eat so they’ll have good milk’ (Matthews, Pg. 62). Breastmilk, in this sense, was a normalized function that though sometimes explicitly discussed, was mostly implicit in it social acceptance.
The history of breastfeeding for Black people must be understood within its cultural manifestations. Although written accounts are few, and oral accounts are not always discussed to larger public audiences what is most notable is how breastfeeding is highlighted (but, in many cases, how it is not highlighted) with in these contexts. The retired midwife from Halifax County, as seen in the previous example, speaks explicitly about breastmilk. This story is rare, however, as many previous narratives about infant feeding among Black midwives are not so easily discernable. Their conversations about birth and care-taking allow us to glean the significance of breastfeeding as they operate with a larger cultural context – as the accepted social norm. A recent facebook caption from the image below taken from Time Life magazine in 1937, of an African American women in Greenville, Mississippi, USA, which currently has the lowest rates of breastfeeding among any group in the country, nursing in a health department waiting room, states: ‘we all know breastfeeding rates among black women is the lowest in the country, but it wasn’t always this way’ (2010).
Although it may seem simplistic in its presentation – an African American woman breastfeeding is quite profound within a larger context. A woman who is breastfeeding fully exposing her breasts speaks the social climate and attitudes regarding nursing, since it could be argued that breastfeeding was something that was quite accepted as the norm during this timeframe since such an act could not have happened without a culture of acceptance. In my own visits to the Mississippi Delta, and Greenville specifically, through talking to participants and observing the climate around exposure during breastfeeding, it is clear that not only would such a display not be visible today, it would be severely reproved, seen as obscene.
But the decline of the midwife was inevitable. Birth became regulated and imbued with scientific practices and those who were not official were castigated and later even prosecuted. Several reasons, including blaming midwives for maternal mortality, without regard for social and political racism and discrimination contributed to this. Valerie Lee explains additional factors:
‘Other contributory explanations for the decline of midwifery include: 1) weekly organized midwifery organizations compared to aggressively organized professional medical organizations, such as the coalitions that the American Medical Association built: 2) establishment of all-male medical schools, barring women from access to medical knowledge; 3) increasing infant mortality rates, which were always a locus for scapegoating midwives and grannies in particular’ 4) new surgical childbirth instruments which only doctors could use; 5) doctors’ alliances with upper-class white women (1996: 27).
Midwives who relied on God for their guidance, were now forced out when birthing was the object of sinister intervention and state-regulated control. Black feminist anthropologist and author of African American Midwifery in the South, Gertrude Fraser, tell us that ‘the regulation of the midwife in the first four decades of the century took place against the backdrop of a national “search for order”’ (Pg. 49). Most significantly, Fraser states that ‘with industrialization, it became increasingly important for the state to monitor the life process of its citizens and to install a regimen in which women expected to have their bodies monitored (Pg. 49). This search for order and industrialization can be explained with the implementation of birth certificates, fetal monitoring devices, and closer attention to the prenatal process, eventually extending to infant feeding.
In just the same way that birth became victim of the medicalization process, it is undeniable that breastfeeding has also been placed into this same context. This tradition that has historically been one where women relied upon elders and support from community members, has been inaugurated into a new realm of governance, supervision and influence. Infant feeding has become a topic where debates have rested upon what has been deemed to be the best practices, all while centering the perspectives of those who are in positions of power and have the ability to shape popular opinion. When wet nursing came under scrutiny because of anti-immigrant sentiments and fear of bad gene transmissions giving leeway to other feeding practices, which Maia Boswell-Penc says can be attributed to ‘attitudes toward science, toward motherhood, and toward the burgeoning medical profession (2006). The medical process impeded breastfeeding. It became a site to apply the concepts of scientific research to this area of the body beginning in the mid-20th century. Boswell-Penc further explains:
During this period, a developing confidence in science, medicine, and technology, discoveries in bacteriology, anatomy, physiology, and nutrition, as well as changes in public health and hygiene and innovations in advertising and marketing spawned a new addition to infant feeding. Increasingly, analyses of infant morbidity and mortality – in particular those launched by the burgeoning baby food industries, many of which had close links with scientists and medical people—pointed to the inadequacies and deficiencies in human milk (Pg 36).
The impact of the attention to this natural substance ravished the desire to breastfeed. More and more of the country shifted their attention on ways to shield the population from the detriments of human milk. The desire for economic gain by burgeoning consumer entities and the impact of advertising showcased manufactured milk that would be safer for babies and communities and would become the standard. Hospitals, with their newfound interest in milk became the purveyors of this additional monitoring, and the conduit of the commoditization of infant feeding, receiving stipends from formula companies for promoting their artificial milk. Also at this time ‘mothers began to see the medical professional as the expert, and to abandon advice from their own mothers, neighbors, and relatives – traditional advice – that had defined infant care in the past (ibid).
Anthropologist Penny Van Esterik explains the process of medicalization of infant feeding when she refers to it as: ‘the expropriation by health professionals of the power of mothers and other caretakers to determine the best feeding pattern of infants for maintaining maximum health’ (1989). Medicalization of infant feeding has become the primary marker of care, and has a list of consequences that are not always immediately visible. Most significantly it means a reconstitution on how we see our bodies, experience health and it creates a new configuration on natural life processes. Ivan Illich explains some of the consequences that he refers to as iatrogenic disease by stating that ‘medicine undermines health not only through direct aggression against individuals but also through the impact of its social organization’ (1976). Illich argues that natural human phenomena such as birth, sickness and death have now been placed within a context that is overseen by healthcare professionals and the medical establishment, creating a new form of reference that becomes embedded within the cultural norm. Illich refers to this shifting phenomenon as social iatrogenesis, and further argues that ‘when cities are built around vehicles, they devalue human feet; when schools pre-empt learning, they devalue the autodidact; when hospitals draft all those who are in critical condition, they impose on a society a new form of dying’ (1976). Placing a new form of reference on infant feeding in general, and breastfeeding in particular is and how this has the ability to imbricate itself within communities on a local and larger – even a global context. In this way, the medicalization of infant feeding is complicated in that it interferes with the ability of groups to self-manage and disrupts locally produced knowledge that stems from within the community. Also, it is possible that instinct that is manifested via an interdependence of a mother and her child is disrupted. Evidence of this interdependence can be seen in the breast crawl, a baby-led breastfeeding technique, where a newly-birthed infant is placed on its mothers abdomen and makes its way to her breast with minimal assistance, whereas IBCLCs intervene and position mothers and babies with a set of structured feeding techniques. Illich goes on to say that:
In primitive societies it is obvious that in the exercise of medical skill, the recognition of moral power is implied. No one would summon the medicine man unless he conceded to him the skill of discerning evil spirits from good ones…The medical profession is a manifestation in one particular sector of the control over the structure of class power which the university-trained elites have acquired. Only doctors “know” what constituted sickness, who is sick, and what shall be done to the sick and to those who they consider at a special risk’ (1976).
It may come as no surprise that in 1985 – the year the last lay midwife to practice at the end of the era in the United States where traditional midwifery was systematically dismantled was also the year of the rise of the IBCLC. This was after the efforts of the certifying entity, the IBCLE worked with advocates from La Leche League International, a mother-led breastfeeding support organization, that a began with a small group of white women in the USA. Consultants were the product of the efforts to not only highlight the benefits of human milk, but to encourage breastfeeding and offer hands-on assistance in latching, diagnosing and treating ailments, discuss nursing concerns, weaning, and many other areas that are closely related. IBCLCs erupted during a moment in time when the sentiments on infant feeding once again began to favor human milk, yet public sentiment maintained its adherence to scientific knowledge. Therefore, the burgeoning institution concentrated on breastfeeding and constructed a formula that maintained that successful breastfeeding was a concoction of ‘consumer demand, scientific evidence and practical clinical skills [which would work to] create an ideal climate for the new profession and for standards that demonstrate the practitioner’s knowledge and skill to practice in the field of lactation consulting’ (iblce.org). The ideal climate would mean that there was certain criteria that would need to be met in order to prove one was capable of thoroughly understanding breastfeeding. Basic instinct and community involvement was insufficient. On the other hand, success required enrolling in lactation-specific courses on nutrition, and apprenticing for the required hours which vary from 300 to 1,000, the sum of which totals thousands of dollars in educational expenses.
Worldwide there are more than 28,000 IBCLCs (ibcle.org) and this number increases each year. This figure may seem insignificant given the global population, but what is most profound is that with headquarters located in Virginia, USA, the highest numbers of consultants –15,144 – are located in the United States. Next, a notable amount are in Australia and Canada (iblce.org), and other IBCLCs are located in 107 out of 196 countries around the world. These numbers rise each year after successful certifications, and are even in places where breastfeeding has historically been the cultural norm. In Peru, for example, the current numbers of IBCLCs are 50. This may be seen as if it is a small figure, but the implications are significant. One resident discussed the interesting dynamic, stating that women in Peru just do not seem to have the ‘problems’ that appear to be rampant in the United States, implying that the hardships and breastfeeding issues are not from a lack of knowledge but are manufactured and culturally constructed. Further implications can be seen in the delivery room, where consultants show up uninvited in most instances, placing their hands on women, their breasts, and their babies, in an attempt to connect the dyad.
IBCLCs and proponents of breastfeeding professionals would argue that this new realm of what they state is ‘promotion’ is not a marker of harm – a desire for economic gain or a way to disempower women. On the other hand, they would support the claim that professionalization is a way to counter the tragedy of women being unfairly marketed by companies, losing the intergenerational knowledge about breastfeeding and those with academic achievements assist in restoring a sense of agency to these groups helping them reclaim their bodies. They would argue that it helps curb injustices on a vast scale by countering health, social, and environmental injustices. Yet these claims fail to take into account the legacies of imperialist white supremacist capitalist patriarchy – the U.S.-centric, white male-dominated scientific establishment that underscores these frameworks that infiltrates nations, consolidate knowledge, radically dispossessed communities by creating a path toward profiting from a natural, innate function, where human milk has now become a primary commodity that is being sold to the bodies that produce it.
Given the history of medical interference in stigmatizing lay knowledge and ethnomedicine, it is only a matter of time before women around the world become dispossessed through the usurpation of instinct, grassroots engagement, and knowledge that has been and can continue to be transferred within and between generations. The historical account will also mean that in just the same way wet nursing and infant formula were once viewed as a sign of privilege – since being able to have these reflected a certain level of wealth, it will only be a matter of time before the ability to hire an IBCLC will resemble this legacy. What will also become the legacy is that women, rather than relying on their bodies, will become dependent on the ever-increasing amount of scientific data, which will lead to a host of other injustices, including environmental, physical, communal and more.
In theory, method, and practice, the politics and controversy has been the same; in order to keep infant feeding within this realm means it must be maintained by the overarching medical institution that admonished midwives, dispossessed Black women and strengthened a multitude of interests based on the primary tenants of consumer commodities, and will essentially spread the net of imperialist white supremacist capitalist patriarchy around the globe. In the U.S. it was Black women who faced the brunt of disempowerment. In places around the world it will undoubtedly be those most viewed as socially marginalized who have built autonomy within their community when dealing with ways they understand health, wellness and creating and maintaining ties among each other.
It is without a doubt that the surge of International Board Certified Lactation Consultants conceals greater issues, by treating symptoms of problems while simultaneously creating greater areas of dominance, control, and the maintenance of the breastfeeding pecking order. Though IBCLCs at the individual level may only be interested in creating a more nurturing relationship between a mother and her infant, it is undeniable that the complications from this new-found establishment raises concerns for past, present and future generations on a local, national and larger context. This requires a radically reconstructed perspective and ways of participating, which must be done at the local level, where all who are impacted can help learn and help out. Returning power to the community is much more than simply attaching a baby to a breast. It also recognizes that a decolonial process must be enacted, lest we reinscribe a multitude of new ways to dominate.
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