Storm in a D cup

http://www.womens-health.org.nz/index.php?page=storm-in-a-d-cup
(Be sure to check out the photo, too!)

Women's Health Action

World Breastfeeding Week posters have developed a reputation for being controversial and edgy. As we work on our poster for this year, breastfeeding advocate Louise James looks at some of the issues raised by last years poster.

A simple beginning

A quiet morning in the park with a mother, her breastfeeding toddler, a banana and a top class photographer. Mother and daughter look fantastic and all is going well when the photographer asks the mother to take her breast out from the neck of her red top rather than lift it up from the waist. The resulting photograph is elegant, less clumsy and certainly less ungainly. All are pleased with the result. However, the repercussions of that decision were to reverberate again and again as the poster developed and ventured into the public domain.

The theme for World Breastfeeding Week internationally is set by the World Alliance for Breastfeeding Action (WABA). In 2005 the theme was Breastfeeding and Family Foods: Loving and Healthy. The focus was on the continuation of breastfeeding after solids have been introduced. Women's Health Action workshopped this theme with a small working group which grew out of an initial community consultation. The decision was to develop a poster which depicted a mother breastfeeding her toddler. It was agreed, though not unanimously, to have the toddler hold a healthy nutritious food to demonstrate that breastfeeding could happily co-exist with first foods. Across all cultures, the most common first food for young New Zealanders was a banana. It suited the theme beautifully, being easily recognisable, portable, non commercial and healthy.

The resulting photograph was great and mother, photographer and Women's Health Action were happy with the result. Off it went to the working group. These were all people who supported breastfeeding and the WHO Global Strategy supporting breastfeeding exclusively for the first six months and on up to two years and beyond. For some of these people the translation of the words into a real life image proved challenging.

There is one right way
Everybody loves a breastfeeding image when the baby is small and the mother is in a Madonna pose gazing adoringly at her progeny. An older child however is more challenging and the new poster was an affront to the set of unspoken rules and assumptions that many people carry unconsciously in their heads. The revelations started with the working group, but were confirmed by the wider community once the poster was released. The process uncovered a number of unwritten rules and assumptions that form real barriers to mothers breastfeeding older children and they are fascinating. We discuss some of them here.The unwritten rules for breastfeeding older children in public:

If the child being breastfed is not a baby then the child should be 'a little toddler', 'a younger child', 'a 9-10 month child', "I have a problem with a child breastfeeding when they can ask for it".

The act of breastfeeding needs to be: 'discrete', 'private', 'less exposed', 'top pulled up' and 'tasteful'.

The breastfeeding mother and child should be 'loving', 'arm wrapped around the child', 'a more likely feeding posture', 'baby on lap', 'motherly', 'held in mother's arms' the child cuddling up on mum's knees' and 'don't sit with legs apart'.

Everybody should breastfeed in the same way so the image has to conform to personal experiences of breastfeeding: "some of us have breastfed our own children through to toddlerhood but at no time found it necessary to pull our shirts down", "We have never in all our years, seen anyone breastfeeding their toddler in this position." "We are all mothers who have breastfeed our own babies and have nothing against breastfeeding in public if it is done in a sensitive and tasteful way".

Can't have the child holding a banana: 'the banana can be seen as a phallic symbol', 'a banana milk shake?'

Thanks for the mammaries
The reaction to the poster was indeed mixed: the 'Outstandingly Healthy' breastfeeding poster proved overwhelmingly popular with many: WABA from Penang wrote, "Thank you very much for sending us the posters. They are beautiful and the message comes out loud and clear". James Akre formerly of the World Health Organisation wrote, "Splendid new breastfeeding promotion poster. It superbly places the expression 'complementary feeding' into appropriate perspective." Positive comments came from far and wide recognising the great shot that it was, "I think this poster is just wonderful." "Beautiful photo", "looks good": and "She looks gorgeous".

However, given the high level of negative comment, the focus testing was important and would determine whether the poster saw the light of day. We took the image to numerous different places outside of the health profession and asked them what they thought the messages were. While some in the working group, and particularly health professionals, felt it "Could discourage rather than promote breastfeeding", "is not appropriate" and "would put many people off", the take home messages from the focus group were exactly what we were hoping for and more:
Breastfeeding is nothing to be ashamed of.

Fresh air, fresh food and fresh breast milk.
It is OK to feed in public.
The longer you breastfed the better.
Breastfeeding makes mother and child happy and healthy.
Breastfeeding is not difficult or problematic.
Should feed whenever the child needs to.
It's a normal and natural thing to do.
Breast milk is the best.
Doesn't matter where you breastfeed.
Breastfeeding doesn't have to stop with babies.
Women's breasts are put on their bodies to feed babies.
Breastfeeding is clearly part of a healthy diet.
Breastfeeding is just part of life.
We had a second picture up our sleeve for focus testing. In this one the child was on the mother's knee in the more traditionally seen Madonna pose. We ran this image through our focus groups as well: The 'safe' alternative "doesn't grab you", is a "friendlier image", is probably "acceptable to society" and "it looks more of an effort". Surprisingly, and happily, when choosing between the two, focus group participants liked the edgier, challenging version.

What lies beneath?What was going on for many people? Even those who agreed it was a lovely photo and supported breastfeeding, said they would not display it. A childbirth educator said, "Cool, but I wouldn't put it up in my classes." And a nurse felt "it would be demeaning to even ask mums to look at the poster." Different people reacted to different aspects of the poster. For some, it was the size of the breast. With the growing popularity and acceptance of breast augmentation, with magazines and movies showing large breasts in skimpy clothing it is amazing that naturally full breast is seen as somehow remarkable and obscene. "What a big boob!" said some and "The exposed breast is obviously enlarged." And some accused us of digitally enhancing it to make our point. Just for the record, we didn't.

Some disliked the poster at some incoherent level and were then asked to say just what their problem with it was. The most violently opposed immediately seized on the age of the child and inflated that. With no evidence at all, they decided the child was at least three years old and maybe as old as four or five. Again, without any evidence they were also more likely to assume the child was a boy. In fact, the child is 20 months old and a girl.

Clearly the poster brought out some deep seated barriers in attitude that can't help but hinder the widespread freedom to breastfeeding with in our society. A couple of comments on an internet forum about the poster sums it up nicely, "it's important to realise that our discomfort is about US not about what that child is doing. Breastfeeding isn't a 'glorious act' it's a way to nurture a young child, both physically and psychologically. "I am guilty of feeling a little uncomfortable by the poster as it doesn't portray what I thought breastfeeding was about for me." It's a societal issue with women's bodies in Western culture being viewed as sex objects.
Breastfeeding Week 2005 presented New Zealanders with a new image of breastfeeding to begin breaking down the barriers of stereotypes that have been infiltrating us through the years. Taking a look back in history at the images of the Madonna breastfeeding her child, there has been a variety of images. Continuing to only portray breastfeeding in one way, the romantic Madonna look, does not help the acceptance of breastfeeding as a normal and natural function that has many different looks.

Getting Over it
From the amount of debate and dialogue that has occurred from the release of the poster it became apparent that the image presented challenges to some peoples' way of thinking about breastfeeding. "At least it has promoted discussion, which is very healthy for our Public Health Unit." "It has created a lot of discussion about breastfeeding which is a good achievement."
Many people who were first taken back by the image, on reflection came to see its value: "Well done, at first I thought too much breast was showing, but you can almost see that amount on some people so I say go for it." "Throws you back a bit at first, but hey it's natural, it's acceptable to show the breast." One mother of a young baby suggested that the image should have been more discrete then went on to ask, "any tips for being able to feed that long?"

Just like me!
There was a wonderful unanticipated reward from the release of the image - the validation that small talking breastfeeding children received. The image remains of one such child excitedly tugging her mother to see the poster and beaming at her as she pointed to it with a big smile on her face saying "like me". Another child was determined to know the name of the child in the photo - the little girl breastfeeding in the park was her hero. A mother related; "Two and a half year old Clayton (still breastfeeding) saw the toddler breastfeeding poster and immediately said Nana and Nan-na. He had no trouble seeing it as an advertisement for food with his breastmilk.
Getting On with itBreastfeeding is the biological norm. However success is at least as reliant on the many non-biological social factors in our modern society. One of those factors is people's views, expectations and tolerance for what is seen as normal. The focus on breasts as sex symbols and their extensive use in selling almost everything is seen as normal by most and desirable by many. At the same time, the tendency to hide breastfeeding away and portray it as normal only for babies who are held in a Madonna pose, creates a situation where breasts are seen as indecent when they are being used for their designated purpose and decent when their display is gratuitous.

Variety is normal. Some mothers' breastfeed by lifting their tops up, others by pulling them down, both are acceptable. Mothers breastfeed two year olds, two month old babies and sometimes tandem feed new babies alongside pre-schoolers. All are acceptable practices. Babies feed comfortably in their mother's arms. Toddlers however are active and curious. Many feed 'on the run' and most have a wandering eye - they just hate to miss anything! Many a mother breastfeeding a toddler will testify to the fact that few breastfeeding toddlers focus entirely on the job at hand. Mothers sometimes look adoringly at their infants when they feed. Other times they take no notice of the child at the breast as they talk freely to friends. In this they are not unusual - most animals with suckling young pay them little heed as they get older!

For breastfeeding to move from a biological norm to a widespread and accepted cultural norm, we all need to look at how we react to the different breastfeeding styles and images that we see. When it is no big deal or nothing out of the ordinary we will have made progress. While we still gape and uncomfortably shift and shuffle at the exposed breast or the feeding child (in any position), we still have a way to go. And while we still have a way to go, children miss being breastfed and gaining major health benefits. Every one of us has a role in creating a breastfeeding society.