Tasnim Nathoo, Aleck Samuel Ostry. The One Best Way? Breastfeeding History, Politics, and Policy in Canada. Studies in Childhood and Family in Canada Series. Waterloo: Wilfrid Laurier University Press, 2009. 260 pp. $24.95 (paper), ISBN 978-1-55458-147-4.

Reviewed by Heather Stanley (University of Saskatchewan)
Published on H-Canada (December, 2009)
Commissioned by Stephanie Bangarth

Limited Choices

Breastfeeding is a matter of personal choice; however, that choice is constrained by social, cultural, and economic factors. This is the central thesis of Tasnim Nathoo and Aleck Samuel Ostry’s new book The One Best Way? They argue that, despite the lessons learned from over 150 years of changing breastfeeding priorities and practices, contemporary discussions about breastfeeding policy lack a historical consciousness. To remedy this, their study, combining a synthesis of the major secondary source literature with some primary data, is meant both to provide a basis for future, more in-depth historical examinations of breastfeeding and to place current decisions about infant feeding in a historical context.

The One Best Way? is divided into four main, roughly chronological, sections that examine breastfeeding from colonial Canada in the 1850s to the present. The first section, entitled “Transitions,” spans 1850 to 1920 and uses Montreal as a case study to describe issues facing colonial mothers. Long-term breastfeeding was originally common across class and ethnic lines largely due to the lack of a viable alternative. However, Nathoo and Ostry demonstrate that industrialization slowly changed the pattern of infant feeding in Canada as women moved to work outside the home. The use of spoiled or tainted cows’ milk meant increased rates of tuberculosis, scarlet fever, diphtheria, typhoid, and cholera in infants; pure milk depots, based on those in Europe, quickly became part of the maternal feminist reform movement. Their claims about the need for pure milk were further reinforced by increased scientific knowledge and a general acceptance of germ theory. Reformers, especially Helen MacMurchy, concerned about the dangers of bottle-feeding made breastfeeding become part of a larger plan to counteract “race suicide.” Thus, in the early twentieth century, breastfeeding was framed as a patriotic duty. This was also the birth of blaming the mother as MacMurchy, herself single and childless, condemned mothers who bottle-fed as selfish.

Nathoo and Ostry trace the rise of bottle-feeding from the 1920s to the 1960s in the second section of the book, “Decline.” They argue that the medical profession, which was increasingly gaining prestige during this period, remained ideologically supportive of breastfeeding, but, ironically, the actions of the medical community often undermined women’s ability to breastfeed. Many doctors not only were uneducated about breastfeeding but also became involved in the development of patent baby foods and formulas. Such factors as increased understanding about the role of vitamins, the breakdown of traditional multigeneration families and lay knowledge, better refrigeration, and the removal of some of the dangers of bottle-feeding led to a highly ambiguous situation regarding infant feeding. Simultaneously, various baby formulas were being developed and aggressively marketed. For example, the Dionne quintuplets became the “spokesbabies” for Carnation despite the fact that they had actually been fed donated breast milk in infancy. One of the biggest factors in the decline of breastfeeding was the increase in hospital births. Women in the hospital did not have ready access to their babies to practice on-demand breastfeeding; overworked nurses and doctors would often substitute formula at the first sign of difficulty; and the authors note that, “by the 1960s, breastfeeding was almost forgotten” (p. 104).

In the third section of the book, “Resurgence,” the authors examine the factors that caused a repopularization of breastfeeding between the 1960s and 2000. Interestingly, Nathoo and Ostry argue that the medical community was not behind the resurgence. Instead, they point to the women’s movement, and the related natural childbirth movement, as well as international concerns about formula feeding, as the central forces of change. They note that lay organizations, such as the La Leche League, formed to disseminate previously lost breastfeeding information to mothers wishing an alternative experience. Hospitals, bowing to consumer pressure, began allowing “rooming-in” where the baby would spend increased amounts of time with the mother in her room, thus making breastfeeding a viable option. As rates of breastfeeding increased in the developed world, formula manufacturers shifted their attention to the developing world; the concomitant increased infant mortality there focused attention on the content of formula and the advertising tactics of the manufacturing companies. Concerned women and men participated in a worldwide boycott of Nestlé, a main producer of formula and the World Health Organization and UNICEF developed the Code of Marketing of Breastmilk Substitutes in 1981 to limit advertising. Nathoo and Ostry demonstrate that it was only after all these elements of the lay movement were well developed that both the government and medical profession “rediscovered” breastfeeding and gave it legitimacy. This led to the “Anytime, Anywhere” campaign by Health Canada to desexualize the breast and make public breastfeeding more acceptable.

Finally, in the last section of the book, “At Equilibrium,” Nathoo and Ostry begin their assessment of the current state of breastfeeding in Canada. They note that both the government of Canada and the medical profession have focused on education as the main strategy to promote breastfeeding, which is only a small part of women’s decision to breastfeed. They argue that the structural barriers to breastfeeding--including such issues as maternity leave, breastfeeding at work, understaffed hospitals, and the need for more breast milk banks--need to be addressed. They also warn that the increased importance of, and belief in, breast milk in our current time may lead to the commodification of breast milk, and they point to for-profit breast milk banks in the United States as evidence of this. Finally, Nathoo and Ostry argue that the culture of blame that has been a factor of infant feeding, whether breastfeeding or bottle-feeding, needs to be ended, and instead of measuring breastfeeding success via quantitative methods--how many women and the length of time before weaning--we need to measure it by maternal and infant satisfaction.

The One Best Way? does an admirable job in synthesizing the many disparate works that touch on the history of breastfeeding. Their central thesis and purpose--to draw attention to the structural barriers in breastfeeding throughout history and today--is admirable. The first section, and chapter 3 in particular, is strong and of interest to a historian, especially as a reference guide to the wider historiography. The book is, reflecting the expertise of its authors, written in a social science, rather than a historiographical, style, and this will discomfit many historian readers. For example, the last section of the book relies a great deal on statistical analysis and yet does not address the limitations of such a source base. The sources can also be problematic in the synthesis portions of the book as they limit the discussion to the available works and therefore the book lacks consistency in some areas. Aboriginal women, in particular, appear and disappear throughout the story, due, no doubt, to the paucity of sources regarding their health care issues.

In the classroom, The One Best Way? would be useful to assign to medical students completing history requirements as they will appreciate the social science framework. The first portion of the book would also be useful for introductory undergraduate classes, though established scholars might find its theoretical base, at least from a historical point of view, to be fairly basic. I found the last chapters to be dissatisfying as the voices and experiences of actual women, present in the beginning of the work, continuously fade throughout the narrative and finally almost totally disappear. Though I appreciate the authors’ desire to fill out the top-down history to make room for more bottom-up narratives, their thesis and purpose would be strengthened immeasurably by the inclusion of more mothers’ voices, especially in the latter half of the book where interviews could have been utilized. That being said, however, policymakers, analysts, and medical administrators, should they find their way to this book, will be interested in the historical lessons that the book has to offer. Hopefully they will pay attention to its central message of structural change as well as the need for education in all forms of infant feeding in order to give women a truly free choice.

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Citation: Heather Stanley. Review of Nathoo, Tasnim; Ostry, Aleck Samuel, The One Best Way? Breastfeeding History, Politics, and Policy in Canada. H-Canada, H-Net Reviews. December, 2009.
URL: http://www.h-net.org/reviews/showrev.php?id=26120

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