The Politics of Women's Health

Promoting Breastfeeding Takes More than Exhortations

The following presentation was given by OBOS Executive Director Judy Norsigian at the Third Annual Breastfeeding and Feminism Symposium, September 25, 2007, Chapel Hill, NC.

I am so pleased to be at this wonderful gathering, where we can explore so many crucial dimensions of breastfeeding and its role in the lives of women, children, and the health of our communities. This meeting also offers the opportunity to continue the rich discussions begun at the National Summit to Ensure the Health and Humanity of Pregnant and Birthing Women held in Atlanta during January of 2007. Looking at reproductive health issues through the “reproductive justice” lens is enabling many of us in the women’s health and public health field to strengthen our efforts to establish more widespread support for breastfeeding.

We don’t have to look far to notice the trends that discourage women from breastfeeding. We regularly confront pervasive myths like “breastfeeding produces saggy breasts” or workplaces that don’t make even tiny accommodations for breastfeeding moms -- let alone encourage women through explicitly supportive policies. And when we are able to get the media to focus on this issue, it is not always the kind of attention we want – just think, for example, about how controversies regarding breastfeeding in public are often presented.

Back in August 2002, Nancy Solomon, a staff attorney with the California Women’s Law Center wrote an opinion piece for Womensenews entitled Breastfeeding in Public Is a Basic Civil Right.  It began as follows: 

Exposed breasts. They are all over the media: in movies, magazines, even television. But put a nursing infant anywhere near those breasts and suddenly some people are offended.

She underscored the challenges before us by noting examples like the following:

• In December 2001, a woman nursing in a restaurant at a Las Vegas casino was told that she would need to "go somewhere more private."
  
  
• In March 2002, a woman was denied entrance to a public zoo in Orange County, California, because she intended to breastfeed on a bench inside the zoo and the attendant feared that "children might see."
  
  
• In June 2001, a woman in San Mateo, Calif., was asked to stop breastfeeding at a public pool. She was told that her actions violated public health codes and constituted indecent exposure and nudity. Pool staff later informed her that they were afraid her breast milk "might infect the pool water."

And from www.breastfeeding.com we have the following example: In Boulder, Colorado, one mother was told by a staff member at a public pool that she would have to go to the restroom to nurse her baby. Knowing her rights, the mother staged a "nurse in," as she and other nursing mothers gathered at the pool and discreetly breastfed their children. The nursing mother had every right to breastfeed her child at the public pool and was later offered an apology by the pool staff.

In July 2002, the California Women's Law Center staged a nurse-in with more than 70 breastfeeding mothers at the Santa Monica Place Mall, after a mall security guard told a woman she was being "indecent" while nursing her infant in the food court.

One woman was asked to stop breastfeeding in the children's section of a Borders Books and Music store in Glendale, Calif. In 1999, the California Women's Law Center sued Borders on behalf of this nursing mother, and Borders settled, also agreeing to educate its employees about the right to breastfeed in public.

In 2003 a Kansas woman breast-feeding her 6-month-old daughter in a health club was told by a man that he didn’t want his son exposed to the sight. After that incident, lobbying by women led to the passing of a new bill in Kansas in early 2006 that reaffirms a woman’s right to breastfeed in public.

Earlier this year, an incident at an Applebee’s restaurant in Lexington, KY, led a woman to organize a nurse-in, get support from a state legislator, and demand an apology and training of restaurant workers regarding the state law.

Sometimes an incident leads to a more organized effort to eliminate obstacles to breastfeeding. Here is one story that led to the development of a wonderful website for activists (or “lactivists”): 

At a Maryland Starbucks store, a mother was asked to breastfeed in the bathroom or cover her child with a blanket. This was in violation of Maryland law, which protects the rights of mothers to breastfeed in public. When she protested, the store responded with an apology to the mother and by informing its employees about Maryland state law. Out of this incident has grown a whole movement to “Nurse your Baby at Starbucks” and to ask that the company publish a national policy allowing breastfeeding in its coffee stores.

The campaign urges us all to ask Starbucks:
1) To make a clear national policy that mothers have a right to breastfeed in their stores without being asked to move, hide, cover up, or leave.
2) To train all employees that breastfeeding is different from other behaviors that customers might complain about (such as loud music, offensive language, etc.), and that employees are not to ask a breastfeeding mother to move, hide, cover up, or leave.  Instead employees can advise the complaining customer to avert their eyes or move to another part of the store.
3) To make the public aware of this policy.
 
One sample letter suggested for those writing to Starbucks read as follows:

Dear Mr. Smith (CEO of Starbucks):

My name is ______ and I am ____ months old. I like to drink my mama's breast milk. It tastes good and it is so good for me. I like the fact that when my mama takes me places, she feeds me when I am hungry, which is a lot, since my tummy is so small. Sometimes she goes to Starbucks. When she does, I don't want to be hungry. I want to be able to nurse there, too. I don't like nursing under a blanket because I can't see my mama and my mama can't see me and it gets hot and uncomfortable under there. I really don't like nursing in the bathroom. That's gross. Do you like to eat your food in the bathroom?

Please make a policy so that no one will ever ask my mama to stick a blanket over my head or take me in the bathroom to nurse. Thank you. 

Sincerely,  _________

In a case against Wal-Mart, a district court in Ohio held that discrimination against breastfeeding women is not sex discrimination in violation of Ohio's public accommodation laws. In 2002 Ohio had no law protecting a woman's right to breastfeed in public, so it was not illegal for someone to harass the woman who ultimately brought this lawsuit against Wal-Mart. Ohio, which has one of the country’s lowest breastfeeding rates, now does have legislation protecting a woman’s right to breastfeed in public. The Ohio Lactation Consultant Association is also another key group promoting breastfeeding in the state.

Many people do not know is that breastfeeding in public is legal in every state, and thus women do not need to "cover up" or go somewhere more private. Now, more than half of states have laws specifically protecting this right. So we are making progress.

Breastfeeding laws fall generally into two categories. Some states simply exclude breastfeeding in public from the state's criminal laws regarding indecent exposure or obscenity, so that a woman cannot be charged criminally for nursing in public. In these states, a woman who is harassed for breastfeeding in public can sue under other laws, such as those prohibiting sex discrimination in places of public accommodation.

Other states, such as New York and California, offer stronger protection in the form of civil statutes protecting a woman's right to breastfeed in public. Under these laws, mothers may sue for civil rights violations if they are prevented from breastfeeding in public. As pointed out earlier, Federal law also protects nursing mothers, although it only ensures them the right to breastfeed in public if they are on federal property.

In May 2002 the American Medical Association adopted a resolution urging states to pass legislation protecting a mother's right to breastfeed in public. Thus, it should be easier to enlist MDs in helping with breastfeeding campaigns and lobbying efforts. But any legislation passed should not merely make nursing in public an exception to a state's obscenity or indecent exposure laws. Laws ideally should guarantee breastfeeding as a civil right.

Last May the Wall Street Journal blog reported on a survey by the National Women’s Health Resource Center and breast-pump maker Medela Inc. that found that 32% of new moms gave up breastfeeding less than seven weeks after returning to work. Women in retail settings, younger moms and those with lower-paying jobs were particularly inclined to quit, according to the study. The blog also referenced a 2005 article by Sue Shellenbarger, who wrote that, “After more than tripling from 1998 to 2002, the proportion of employers offering supports for breastfeeding mothers in the workplace has remained at about 19%, based on a 2005 survey of 367 employers by the Society for Human Resource Management, an Alexandria, Va., professional group.”

The blog posted a number of entries that demonstrated problematic attitudes towards nursing, for example:

• A woman speaking about her friend: “The company had a pro-lactation policy, but her co-workers did not. She actually had a co-worker who thought that my friend was “shirking her responsibilities” by pumping twice a day at work. She felt that if nursing mothers got to take these “leisurely breaks” then she should be entitled as well. It didn’t matter that my friend ate lunch at her desk and came in before anyone else in the office. It was the perception that my friend was just lounging in a room somewhere having a grand old time, rather than the reality that there was a machine pushing and pulling her boobs into submission so her child could eat. My friend gave up breast feeding shortly after this incident, feeling that she was putting her career in jeopardy. It’s sad that she had to put her career ahead of what was best nutrition for her child.”
  
  
• “…I worked in the restaurant business in NYC when my daughter was born. I managed to pump from six weeks until she was seven months but it wasn’t easy. I had to do it in the restroom (thank heavens there were two stalls). I ultimately had to stop because I changed jobs that didn’t allow me the breaks I needed to pump (both bosses were young guys which didn’t help). I always thought it funny that working in a business where the main job was feeding people didn’t allow for me to feed the most important person in my life.”
  
  
• “...In Minnesota companies of a certain size are required to have lactation rooms available. When my daughter was born, I worked at a company that had a lactation room in each building, with 4 cubes per room, as well as a sink and a fridge. The room locked, and you went down, grabbed a cube, plugged in your laptop (if you wished), and went to work. I was able to pump until my daughter weaned herself at 10 months."

Nearly 7 in 10 women with young children work outside of the home. While some workplaces make accommodations for women who are nursing, most do not. Many women, particularly those who work in the service industry, have little control over their time. Even if they could use the break or lunchtime to pump breastmilk, where would they do so? Some employers have outrageously suggested that women use the bathroom, so we clearly have a lot of educating to do here.

The Department of Health and Human Service Ad Campaign

The recent government ad campaign with which we are all familiar bears mentioning here as one of the major efforts to promote breastfeeding in the United States. It was funded largely by the Advertising Council, with a much smaller contribution from the Federal government. The June 2004 press release that announced this campaign began with the following statement:

The U.S. Department of Health and Human Services’ Office on Women’s Health (OWH) and the Advertising Council announced today the launch of a new national campaign that encourages first-time mothers to breastfeed exclusively for six months. “Babies were born to be breastfed,” the campaign tag line, memorably summarizes the clear recommendation contained in the new public service announcements (PSAs).  “Like our campaign says, ‘Babies were born to be breastfed,’” Secretary Thompson said. “Breastfeeding exclusively for six months is a powerful way to get a newborn off to a healthy start in life. Hopefully, this campaign will provide mothers with the information and the motivation to breastfeed.”

Two of the television ads for this campaign had the same theme. One ad showed a woman late in pregnancy riding a mechanical bull; the other showed two very pregnant women in a log-rolling competition. The narrator is silent as the viewer watches the women and several seconds later says, “You wouldn’t take risks before your baby is born, why start after?” She goes on to say “Recent studies show babies who are breastfed are less likely to develop ear infections, respiratory illnesses and diarrhea. Babies were born to be breastfed.”

The ads raised a storm of controversy, especially because many viewers took the ads quite literally (others appreciated the irony and humor, understanding that the exaggeration was for effect). Some asked “Is feeding your infant formula really as risky as riding a mechanical bull? Are women who don’t breastfeed being reckless with their baby’s health?” Others were concerned that the ads did not give enough attention to the obstacles women face when they DO try to breastfeed.  But the most important aspect of this campaign is the concerted effort by the formula industry to stop some of the ads and otherwise interfere with the work of knowledgeable public health officials and advertising experts who had conducted many focus groups across the country prior to the campaign’s launch.

New Resources and Suggested Actions for Current Breastfeeding Activism

We each have been given a copy of the excellent AHRQ report on breastfeeding, and just the story of its suppression deserves much greater media attention, so that the public will better understand the continuing and sometimes insidious role of the formula industry. The recent Washington Post article about this report ("HHS Toned Down Breast-Feeding Ads: Formula Industry Urged Softer Campaign”) certainly deserves much more widespread circulation.

We also have the “toolkit” of the National Business Group on Health, another excellent resource to share widely. The toolkit, Investing in Workplace Breastfeeding Programs and Policies, includes information on how employers can implement cost effective programs to encourage breastfeeding.

Other things we can do include:

• Asking presidential candidates how they will promote breastfeeding in this country.
  
  
• Calling members of the media to task when they undermine our national breastfeeding agenda. For example, we could craft a letter to Bill Maher about his September 14 rant against breastfeeding in public, where he equated it with masturbating in public. To quote him: “there's no principle at work here other than being too lazy to either plan ahead or cover up…." and “I don’t want to watch strangers performing an intimate act...at least not for free!"
  
  
• Call attention to and seek support for the Breastfeeding Promotion Act of 2007 – HR 2236, introduced by Congresswoman Carolyn Maloney. [Note:  In 2009, this bill was re-introduced as HR 2819.] This proposed legislation would accomplish the following:

                 - Amend the Civil Rights Act of 1964 to protect breastfeeding women from discrimination in the workplace, and would include pumping in the definition of lactation

                 - Give employers with a tax credit of up to $10,000/year if they provide employees with access to qualified breast pumps, lactation consult services, and/or dedicated lactation space.

                 - Establish performance standards for breast pumps and identify those approved for the workplace credit "based on the efficiency and effectiveness of the pump and on sanitation factors related to communal use." The Department of Health and Human Services would also produce a guide to the evaluated pumps.

                 - Create tax breaks for women purchasing qualified breast pumps or lactation consultation services.

Now a word about creating a larger pool of activists working on these issues.  These days, I believe that feminists are not that different from other women in their susceptibility to marketing ploys.  It is quite challenging to help women see and deconstruct rather sophisticated efforts to undermine their confidence in themselves and to make them think that they are likely, for example, to have trouble breastfeeding. I think “lactivists” are far more politically savvy about the formula industry than feminists in general.  But with all the blogging and sharing on the internet, it doesn’t take long to educate feminists and others who may not have understood the crass economic motives that drive public and private policies that undermine breastfeeding.

Promoting breastfeeding will take political action, as well as educating members of the media as a key means to educate the public. Our cultural discomfort with breastfeeding in public – unique among industrialized countries – will be an ongoing challenge, but if the influence of the formula industry can be minimized, this is a challenge I think we can meet.

Written by: Judy Norsigian
Last revised: July 2009

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