Cultural Practices and Medical Beliefs in Pre-Revolutionary Russia Compared to Modern Textbook Advice: Did Russian Women Breastfeed the “Wrong” Way?

Abstract

Background and Aims:

Historical accounts of infant feeding practices can inform our understanding of current-day practices and the ways in which cultural traditions are incorporated into infant care. Pre-revolutionary Russian feeding practices have not previously been summarized, to our knowledge. The purpose of this study is to collect information about pre-revolutionary feeding practices. We may then be able to better understand the motivation for suboptimal practices and tailor feeding messages to the specific population.

Methods:

Materials were collected from libraries and from the Internet regarding medical, demographic, and ethnographic literature of the 19^th century and early 21^st century, primarily in Russian.

Results:

Breastfeeding was pervasive in pre-revolutionary Russia, but suboptimal patterns such as withholding colostrum and early introduction of other foods and liquids were common. Breast problems were treated with folk remedies and comfort measures, some of which are similar to modern-day treatments. Around 1906, child rearing and infant feeding recommendations were subsumed by male physicians espousing the “scientific approach.”

Conclusions:

Many of these medical recommendations were detrimental to the previously successful breastfeeding practices that, despite barriers, had allowed Russian women to continue breastfeeding for 2 years or longer.

Introduction

Pre-revolutionary Russian medical literature of the late 19^th and early 20^th century focused great attention on the issue of breastfeeding, especially the allegedly suboptimal feeding practices of Slavic mothers during the course of the 19^th century. This was of great concern because of the staggering death rates of children at the time. One-third of them died during the first year of life, and more than half did not live to the age of 6 years.¹

The lamenting of the medical profession at the inability of women to breastfeed “the right way” could be summed up by the quote from the book “Mat’ i Ditia” (Mother and Child) by Vladimir Zhuk, a prominent doctor and educator in pre-revolutionary Russia: “What could be easier than feeding a child? Mother's instinct should be enough to correctly do so as we see it in animals. In reality things turn out the opposite way. Every step of the way we see very incorrect feeding.”² This was the first book in Russia on the subject of hygiene and childcare based on scientific information. Another author, Pokrovskiy, a famous Moscow pediatrician and educator, described child rearing practices in Russia as “barbarian and reckless.” Based on medico-anthropological data included in his work, Pokrovskiy took upon himself “to condemn this folly and such traditions typical of uncultured barbarians even in cultured peoples.”³ The first author (N.G.-W.), a native Russian, became curious about these condescending descriptions of nursing practices of Slavic mothers. Did Russian mothers breastfeed the “wrong way”?

The Russian Empire spanned the modern-day territories of Russia, Ukraine, and Belarus. Russians, Ukrainians, and Belarusians were ethnically, historically, and culturally similar in their worldviews and living practices. Their historical practices and knowledge of breastfeeding are analyzed here in relation to current worldwide practices of breastfeeding and modern-day biomedical knowledge of breastfeeding, as outlined by textbooks widely used by lactation consultants.^4,5

Methods

Historical information was obtained from the University of North Carolina at Chapel Hill and Duke University libraries and from the Internet: Medical, demographic, and ethnographic literature of the 19^th century and early 21^st century, primarily in Russian. The primary author read all materials and provided the translated quotations used in this article. The search terms “breastfeeding,” “feeding,” “breast,” “mastitis,” and “nipples” in Russian were used for any descriptions of breastfeeding practices and knowledge among peasant women in the pre-revolutionary Russian Empire. Descriptions were limited to those of eastern Slavs during the 19^th century until 1917, including medical recommendations during those times. The information is compiled to provide a summary of breastfeeding practices of the selected historical culture, which is then compared with modern-day advice and knowledge.

Results

Women in social context

Russians belong to the East Slavic ethnic group. Formerly the main population of the medieval state of Kievan Rus, they evolved into the Russian, Ukrainian, and Belarusian peoples by the 17^th century. East Slavs are followers of the Eastern Orthodox religion, a branch of Christianity. They were predominantly agrarian peoples. At the turn of the 20^th century, peasants constituted around 80% of Russia's population. In the mid-19^th century peasant birth rates were comparable to those of other social classes at approximately 51 births per 1,000 people. The peasants had the lowest death rate, highest marriage rate, and highest population growth of all social classes in the Russian Empire. By the end of the 19^th century, the infant mortality rate was 260 per 1,000 births. It is noteworthy that despite similar feeding practices among East Slavs, ethnically Russian children had the highest chances of dying before the age of 10 years compared with other ethnicities living in similar conditions in the Russian Empire.¹ The family structure was hierarchical, patriarchal, and authoritative. In essence, women were slaves in their husbands' families and had few, if any, rights: “A Russian woman was an eternal neif [serf] from birth till death.”¹ Considered stupid and soulless by nature, women were treated worse than horses or cows. Women typically worked until the time they gave birth and resumed work 3–5 days after giving birth. They gave birth an average of eight to 10 times in their lifetime.^1,6

Breastfeeding was never a choice

Breastfeeding/nursing was not and still is not a choice for most Russian, Ukrainian, and Belarusian women. It is a natural and expected continuation of the conception–pregnancy–birth–lactation cycle as well as expected social maternal behavior. Conscious refusal to breastfeed was considered sinful in the past and is still frowned upon today.⁷

Folk language representation of breastfeeding and breastmilk

Historically Eastern Slavs viewed the breast as a symbol of motherhood. It was synonymous with nourishment, existence, protection, and comfort (i.e., everything positive). Folk representation of the maternal breast, breastmilk, and breastfeeding strongly indicated that breastfeeding was an expression of a mother's love for her child. Ukrainians described something “as good as mom's tit,” meaning something very good. (Another term for “folk language” is “vulgar language,” so it is not a surprise to see words that may seem inappropriate for a scholarly publication today.) It was widely believed that during nursing a unique physical and emotional connection was formed between a mother and her child. Breastfeeding not only transmitted nourishment to the child but also non-material values, made the child “your own” (a social being, belonging to a particular family, etc.). One traditional Russian saying went “to take in with mother's milk,” meaning to learn from infancy and childhood. Another example of language extolling breastfeeding was when a beautiful person was described as “blood with milk,” referring to the prevailing notion that blood and milk literally mixed to form a new life.

All modern-day Slavic languages have a word to describe an infant as “breast-baby” or “breast-child” (Russian grudnoy, grudnichok). There is another term for infancy as the age “when milk hasn't dried” on the baby's lips. Today the original connection to the breast is lost because these words may just as well apply to artificially fed infants.

Despite all of the above, maternal milk was also viewed as a source of human sinful nature. Western Belarusians believed that the soul of a deceased child who did not have a taste of “sinful mother's milk” went straight to heaven, bypassing purgatory.⁸

The medical source of the time, Zhuk,² stated the scientifically established fact that feeding practices were related to overall health and survival of children—that artificially fed infants were unlikely to survive and were weaker than their breastfed counterparts if they did survive. This source also subscribed to the prevailing theory that the maternal psychological state influenced the composition of milk and was passed to the child through it, such that the act of breastfeeding transmitted love for the Motherland.²

Initiation of breastfeeding

Biological nursing (i.e., breastfeeding at the breast by a biological mother) happened only after social affirmation of the infant and purification of the new mother. In Ukraine it was a custom to postpone nursing until after the child was baptized, and the mother engaged in a ritual called “zlyvki” (“pouring off”) sometime around day 3 after birth. Until the ritual was performed the infant was pacified with honey smeared on his or her lips. If the child was fussy, another woman nursed the newborn until the mother was purified after giving birth. Zlyvki was an apparently pagan ritual that involved washing off the face and breasts of the new mother with the water that was brought by the midwife who had helped the woman during birth. The helper woman appealed to Water and Earth for help to recover from labor for the new mother and to bring in her milk to feed the newborn. Another purpose of zlyvki was to purify the midwife before she could go to deliver another baby. Later zlyvki were performed with the sole purpose of bringing in milk. If plentiful milk had not come in, more water rituals would be performed. If water rituals failed, they were strengthened by adding bread to the performance. Immediately before the first feeding the infant could be given a “chew,” a form of a pacifier, that was made from grated beetroots mixed up with sand wrapped in a piece of cloth. This chew was given to make sure the infant was not too fussy or finicky and to prevent hernia.^9,10 In all areas of Russia a similar ritual handwashing (Russian “razmyvanie ruk”) was performed in combination with a purifying traditional Russian bath, “banya,” for both mother and child.^3,11

In Belorussia an infant's first feeding consisted of chamomile tea with sugar. The tea was the main source of nutrition for the first 2 days. Frequently a child would not be pacified with just tea, so if there was a woman who had given birth recently, she would come in to nurse the newborn. Very often such a woman was not available; therefore the infant was given a dummy (Belarusian “suslo”) made of chewed-up bread with sugar wrapped in a piece of cloth. On the third day after giving birth, the mother's colostrum was expressed; only then did the first feeding at the breast take place. Breastfeeding coexisted with giving children bread and sugar dummies from birth on. Premature infants were put to the breast. If they could not suckle, they were fed drops or spoonfuls of chamomile tea or expressed mother's milk, whole or diluted with water.⁶

In Russia first feedings were also frequently postponed until some ceremonies that socialized the newborn were performed. For example, in some regions the first feeding took place only after the infant's first bath or after baptism on the third day. It was a celebratory event in the family. A mother washed her right breast before she offered it to her child. The right breast was offered to prevent the baby from becoming left-handed. In Slavic cultures left was considered to be synonymous with evil.^3,7,12

Zhuk, the medical expert, acknowledged but disagreed with the belief, previously accepted by the medical profession, that feeding must be postponed for 24 hours after birth in favor of sugar water, chamomile, or dill tea.² He recommended feeding a child for the first time after a bath 4–6 hours after birth. Washing of the breasts was suggested to remove all the oily substances from them. Mothers were cautioned against feeding too frequently, not more than two or three times a day. In case there was not enough milk in the first day, which according to the author happened very frequently, he recommended giving a newborn sugar water with several drops of cow's milk, insisting it was given only by bottle, as the child might choke on milk given from a spoon. In the following days more substantial artificial feeding was in order.

Frequency of feedings

In Ukraine peasant women never scheduled feeding, nursing all the time as work permitted—“as baby cries, then give him a tit.”⁹ In Belorussia mothers breastfed when the child would cry.⁶ In Russia infants were also fed at first demand—“if he's crying, he is hungry.” However, some people believed that too frequent feedings would cause the child to grow up a thief. There was no differentiation of feeding frequency for fasts, but devoutly religious mothers would not nurse during weekly Wednesday and Friday fasts and before communion, replacing feedings with bread dummies as well as restricting the frequency of nursing during fasts.⁷ During harvest time Russian mothers were often away from their children for 3–5 days at a time, coming back with bloody milk. They would resume nursing upon their return.¹³

Medical literature described demand feeding as lazy and careless on the part of the mother. Restricted feeding was suggested during the first day with eight to 10 feedings a day in the following days until the second week. Restricting feedings at night should begin at 2 weeks. At 6 weeks Zhuk recommended only seven feedings a day.²

Introduction of solids

During the baby's first months, primary nutrition came from breastmilk, but even in cases when mothers had enough milk, additional foods were introduced early—from the second to fourth months of life. In Ukraine liquid millet cereal, a soured, steamed, and baked mixture of malt, rye, and buckwheat flours, potatoes, and pumpkin were wrapped in a piece of old soft cloth, a so-called “dummy” (Ukrainian “kukla”), and stuffed in the infant's mouth. Fresh fruits and vegetables were also given before 6 months. Water was introduced later, after 8–9 months, as it was believed that angels were giving babies water up until that age.⁹

Russian women also practiced mixed feeding, using dummies and cow-horn bottles in addition to the breast. In this case dummies were made of chewed dark or white bread mixed in with sugar wrapped in a soft cloth and stuffed in a child's mouth. Bottles were made from a hollow cow horn with a cow's teat softened in salt water. They were filled with whole or diluted cow's milk or fermented bread drink (Russian “kvas”) and tea if milk was not available. It was not until the middle of the 19^th century that cow-horn bottles were replaced with glass bottles. Six-month-old children were fed buckwheat cereal with milk and a special preparation of rye bread boiled in water. Older children ate adult food and continued to nurse.^3,7,14

Zhuk recommended introduction of complementary foods at the eruption of the first teeth between 6 and 7 months of age. His choice of first food is animal milk.²

Treatment of common breastfeeding ailments

In Belarusia primary engorgement was often relieved by newborn puppies. If an infant died, fresh sage leaves were applied as well as poultice made with germander speedwell (Veronica chamaedrys) or common chickweed (Alsine media) to relieve swelling. Commonly used folk medicine diuretics such as parsnip, dill, caraway, and infusion of black elderberry (Sambuci nigri) were given to the mother to increase milk secretion. Cracked nipples were either not treated at all or covered with different substances such as fresh cream, unsalted butter, tallow candle, and sheep or goat fat. Sometimes the mother's own milk or urine was applied as well as a poultice of germander speedwell. Breast inflammation was treated first with an application of cold. For this purpose a grindstone or clay was put directly on the breast. Other methods were also popular: An inflamed breast was covered with blue paper used for wrapping sugar, soured milk, and cold grated potato with carrot as well as compresses soaked in barm, a yeast by-product of fermented drink making. At the same time milk was expressed from the breast if possible. If inflammation persisted, warmth was the next treatment. The most favorite measure was to apply hot poultice of flax seed and milk. Alternatively, warm butter was smeared on the breast and covered up with sheep wool.⁶

In Russia breast inflammation was treated similarly. A mash of grated carrots with cream and leaves of crushed sagebrush leaves was applied to the sore breast. If the breast was abscessed, dough of flax seeds with milk and honey or honey patty was applied. Various treatments for sore nipples included fresh butter, a mixture of plant oil with white wax, rye bread crumb softened with melted butter, flax seed boiled in milk, beetroot with butter, and tobacco leaves.⁷

In Russia women used a multitude of herbs to increase milk: Dill, caraway, aniseed, nettle, goat's rue (Galega officinalis), and cotton plant (Gossypium barbadense).⁷

Zhuk described treatment of mastitis with hot compresses, poultices, continued breastfeeding, and supportive bandaging. Sore nipples responded well to treatment of magisterim bismuth mixed with pork fat or a 2% solution of baking soda.²

Breastmilk substitutes

The lack of or complete absence of milk was a catastrophe. In this case the infant was fed half- or triple-diluted cow's or sheep's milk. When milk was hard to obtain, the above-mentioned solid foods were given with additional water-softened bread. Children often died from hunger or inflammation of the bowel if they relied on artificial feeding as the only source of nutrition. Chances for death increased even further if the infant's mother died.¹³

Zhuk debated the merits of different artificial concoctions (milk-based formulas with egg and grain additives or broths) with added sugar as a breastmilk substitute.² He was not in favor of imported formula products. His conclusion was that the only acceptable breastmilk substitute was cow's milk.

Duration of breastfeeding and weaning

East Slavic women nursed for the duration of three, sometimes six, religious fasts. It would amount to a year and a half to 2 years of nursing as only two out of many fasts were counted in this instance—Lent (40 days of fasting before Easter) and Dormition (also called the “Assumption of the Virgin Mary”). If her breastmilk was plentiful, a Russian woman would wean her children between the ages of 1 and 3 years. The decision to extend breastfeeding beyond the recommended duration was also influenced by the desire to postpone pregnancy or by lack of dairy cows in the region to facilitate weaning onto animal milk. In these cases women nursed up until their children were 7 years old. It is interesting that infancy by pre-revolutionary Russian definitions lasted for 6–7 years.^1,12 Women would breastfeed until the next pregnancy or rarely up until they felt fetal movements. Early weaning could be initiated in the wake of seasonal work or to avoid a more difficult weaning of an older “thinking” child. Ukrainians also nursed as long as possible, 2 years or until the new pregnancy—“an empty woman nurses for two years.” Belarusian women normally breastfed for 2 years or longer. New pregnancy did not preclude continuation of breastfeeding.^6,9

Weaning during religious fasts was avoided to prevent the child from experiencing hunger as he grew up. Instead women preferred to wean right before fasting, especially the strict Dormition fast on August 1–14. Weaning in Russia often happened on St. Elijah Friday (the last Friday before St. Elijah's Day) in July or on the eve of the Baptism of Jesus (the equivalent of Western Epiphany) in January. Russians in the southern regions of Russia weaned in spring or autumn. Summer was a dangerous time for weaning because of the diarrhea threat. It was thought that winter weaning would make a child's hair become gray early when he grew up. Some mothers used their child's birthday as a weaning guideline.^12,13

Traditional weaning happened in the following manner. The mother offered her child bread and salt, occasionally an egg, over her shoulder while saying “Here is your bread and salt, don't count on a tit.” This ritual symbolized the end of easy and worry-free life for a child. Additionally, mothers wore blouses backwards to prevent access to breasts, smeared soot, mustard, salt, and pepper over breasts, or hid a bristly brush or a piece of fur on the chest. Leaving a child with other relatives for a couple of days was a widespread practice. A weaned child was fed water-softened bread with sugar for a week to prevent return to the breast.^7,14

Returning to the breast was avoided to prevent dumbness (i.e., lack of intelligence) in a child. It would also mean that the child had abandoned the society, thus making him dangerous for it. Going back to the breast was thought of as a return to a previous social status, which was unacceptable in this archaic worldview. Re-creation of the connection with the mother was believed to endanger people around the child as well as the child himself. Ukrainians and Belarusians believed that a child who returned to the breast would possess an evil eye.¹⁵

Zhuk recommended gradual weaning of a child when six to eight teeth had erupted, around 10–11 months of age. He viewed the return to the breast as an unnecessarily burdensome event. He recommended weaning from the breast onto cow's milk to ensure adequate nutrition.²

Discussion

Analysis of this literature search has shown that some medical recommendations on breastfeeding in the early 20^th century mirrored the actual practices and customs of uneducated peasant women. Medical recommendations and maternal practices of delayed first feedings, washing of the breasts, early supplementation, and early introduction of solids go against our current biomedical recommendations (Table 1). Maternal practices of demand feeding, breastfeeding for years, and knowledge of health and contraceptive effects of breastfeeding closely matched modern scientific knowledge as described in current textbooks.^4,5 Mastitis management, such as breast emptying and application of cold and heat, was partially compatible with current guidelines, taking into account that antibiotic therapies were not available in the 19^th–early 20^th century. Medical recommendations of 1906 introduced the erroneous ideas of premature weaning and scheduled and restricted feedings. They contradict modern scientific information.

Table 1.

Summary of Maternal Breastfeeding Practices, Pre-revolutionary Medical Breastfeeding Beliefs, and Modern Scientific Information About Breastfeeding as Outlined by Riordan and Wambach ⁴ and Lawrence and Lawrence ⁵

Component of breastfeeding management	Maternal practice	Pre-revolutionary medical beliefs	Breastfeeding and Human Lactation ⁴	Breastfeeding: A Guide for the Medical Profession ⁵
First feeding	Delayed up to 3 days; prelacteal liquids and solids were used	Delayed 4–6 hours	Early and frequent feeding encouraged immediately postpartum (p. 216)	“Putting infant to the breast within the first hour is optimal…” (p. 272)
Frequency of feedings	Unrestricted feedings: Primarily infant-led	Restricted feedings; prescribed number per day depending upon age of baby ranging from 8 to 10 as a newborn and 7 times at 6 weeks of age	Cue feeding encouraged based on signs such as wiggling, rooting, fussing, restlessness, etc. (p. 221)	“Feed when showing signs of hunger” (such as stirring, bringing hands to mouth, efforts to root, etc.) (pp. 274–275)
Washing of the breasts	Yes, this was practiced	Yes, this was recommended	No mention of breast washing in preparation to feed	Bathing as usual; persistent removal of natural oils of the nipple and areola potentially damaging (pp. 268–269)
Early supplementation	Prelacteal feedings; common use of bottles and teats to supplement using teas or animal milk	Supplementation routinely recommended. Sugar water mixed with cow's milk, by bottle, in case of little milk during the first days	Exclusive breastfeeding is recommended for the first 6 months of life (p. 605).	Exclusive breastfeeding recommended for 6 months (pp. 361–362)
Introduction of solids	2–4 months of age	6–7 months or earlier in cases of “not enough milk”	Introduction of solid foods between 4 and 6 months of life (p. 605)	Recommended at 6 months (pp. 361–362)
Duration of breastfeeding (age at complete weaning)	Commonly 2–3 years, but up to 7 years	After eruption of 6–8 teeth (approximately 10–11 months of age)	At least 1–2 years of breastfeeding recommended (p. 605)	At least 1 year of breastfeeding recommended. No restriction on duration (pp. 361, 363)
Mastitis management	Milk expression; cold compresses; hot compresses; poultices	Hot compresses; poultices; supportive bandaging; continuation of breastfeeding	Continued breastfeeding, application of moist heat, increased fluids, bed rest, pain medication, and judicious use of antibiotics (p. 295)	Continued breastfeeding, bed rest, antibiotic therapy (p. 566)
Knowledge of health and contraceptive effects	Well known and ingrained into cultural practices	Recognized by scientific evidence and incorporated into medical recommendations	A variety of health advantages to mother and child, contraceptive effect documented (pp. 134–150, 706–708)	A variety of health advantages to mother and child, contraceptive effect documented (pp. 237–244, 742)

Medical beliefs in the pre-revolutionary Russian Empire were viewed through the lens of medical observation based on a scientifically prescribed world outlook of the times. Maternal knowledge was based on observational experience and socially and culturally prescribed worldviews. McKenna¹⁶ has argued that neither medical and nor scientific views are free of cultural biases. The historical and cultural context within which scholarly research takes place has explicit and implicit influence upon the findings of the research, as well as the recommendations that are based on it. Instances in which medical advice and maternal practices are similar highlighted this truth for pre-revolutionary Russia (Table 2). The higher societal value placed on scientific medical knowledge became very apparent in pre-revolutionary Russian medical and demographic literature. The condescending language used by learned male authors and decrying maternal practices as unscientific gave rise to the trend of undermining maternal experience and authority in making decisions regarding infant rearing, including feeding.

Table 2.

Summary of Maternal Breastfeeding Practices and Pre-revolutionary Medical Breastfeeding Beliefs

	Maternal practice vs. pre-revolutionary medical beliefs
First feeding	+
Frequency of feedings	−
Washing of the breasts	+
Early supplementation	+
Introduction of solids	+
Duration of breastfeeding	−
Mastitis management	+
Knowledge of health and contraceptive effects	+

(+) indicates an agreement between maternal practice and pre-revolutionary medical beliefs, and (−) indicates differences between maternal practice and pre-revolutionary medical beliefs.

Specific elements of breastfeeding that were practiced by Russian, Ukrainian, and Belarusian peasant women were a mixture of those that would be considered “medical advice” for their times (late 1800s to early 1900s) and those that would follow modern-day medical recommendations (late 1900s to early 2000s). Both maternal practices and medical beliefs of the early 1900s had discrepancies in comparison to our modern scientific understanding of breastfeeding, as shown in Tables 1 and 3.

Table 3.

Summary of Maternal Breastfeeding Practices and Pre-revolutionary Medical Breastfeeding Beliefs Compared with Modern Scientific Information as Outlined by Riordan and Wambach ⁴ and Lawrence and Lawrence ⁵

	Maternal practice	Pre-revolutionary medical beliefs
First feeding	−	−
Frequency of feedings	+	−
Washing of the breasts	−	−
Early supplementation	−	−
Introduction of solids	−	±
Duration of breastfeeding	+	−
Mastitis management	±	±
Knowledge of health and contraceptive effects	+	+

(+) indicates a match with modern scientific information, (−) indicates a discrepancy with modern scientific information, and (±) indicates a partial match with modern scientific information.

The trend of authoritative medical influence and surveillance of women's nursing experiences started more than a century ago and continues to this day in Russia. Increasing medical influence did not have much success in changing breastfeeding practices for the better in terms of modern-day definitions, such as breastfeeding exclusively for 4–6 months and breastfeeding with additional solids until 1 year by Russian cultural and medical definitions or until 2 years by World Health Organization guidelines for this region.^17,18 In the mid-1990s the average duration of breastfeeding in Russia was 3.4–4.2 months, and exclusivity rates were a mere 2.5% at 6 months. In 2005, only 35% of women were breastfeeding at 6–12 months. Medicalization of breastfeeding did not substantially improve exclusivity rates and contributed to the severe decline in duration of breastfeeding despite social engineering that is supportive of breastfeeding (maternity leave, daycare, and breastfeeding breaks at work) in the Union of Soviet Socialist Republics.^19–21 This phenomenon could be described as “retribution of Breastfeeding Nemesis.”²² (Nemesis in Greek Mythology was the spirit of divine retribution against those who succumb to hubris [arrogance before the gods].) Based on the seminal work by Ivan Illich, Limits to Medicine: Medical Nemesis, the Expropriation of Health,²³ Colson²² argued that medicalization of the activities of daily living normally accomplished alone or through experience, or through mimicry or help from friends and family, inevitably leads to punishment in the form of the ever-increasing number of therapeutic side effects caused by iatrogenesis.

High infant mortality rates could be mostly attributed to East Slavic women's low social status, not suboptimal feeding practices.²⁴ Lack of reproductive autonomy, limited access to economic resources, and low economic status were all found to be contributing to higher infant mortality rates. Mortality rates were not indicative of maternal failure in achieving her personal goals that a certain number, not all, of her offspring would survive and prosper.²⁵ Mothers' goals could be very different from the goals of males (in society in general) and the historically male medical and political establishments of the times. Women aim for quality, men for quantity, which would explain why Russian women took really good care of their first two to three children and invested fewer resources for subsequent children.^1,25 Children who reached the age of 11 years were “the healthiest, smartest, most capable of withstanding harsh realities” of life in the 19^th century.¹ Biomedical and demographic approaches offer limited understanding of breastfeeding practices because they usually fail to give due credit to the social, cultural, geographic, religious, personal, and evolutionary meanings of breastfeeding.²⁶

Conclusion

We can safely conclude that in spite of the extremely hard socioeconomic circumstances of women's lives in pre-revolutionary Russia that were often prohibitive of breastfeeding for days at a time, women were highly successful in maintaining lactation for many years, despite mixed feedings from bottles. The study and analysis of breastfeeding practices of Russian, Ukrainian, and Belarusian women in pre-revolutionary Russia showed that they possessed accurate knowledge to enable successful lactation and breastfeeding practices to achieve their personal and evolutionary goals. They knew how to breastfeed the right way despite widespread criticism by the medical authorities of their time.

Footnotes

Disclosure Statement

No competing financial interests exist.

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. Kormlenie i Otluchenie ot Grudi. Rossiyskiy Etnograficheskiy Musey. www.ethnomuseum.ru/section66/126/2822/4520.htm. 2010 September 30.

Volodina

. “Nahryshchanaye mystsa”: Zhenskaya grud i grudnoe vskarmlivanie v belorusskih traditsionnyh predstavleniyah i yazike (na obscheslavianskom fone) Antropologicheskiy Forum, 2006; 4:264. http://anthropologie.kunstkamera.ru/files/pdf/004/04_09_volodina.pdf. 2010 October 15.

Sbornik Kharkovskago Istoriko-Filologicheskago Obshchestva. Tipografiya gubernskogo pravleniya, Kharkov. 1897; 10. http://books.google.com/books?id=pbcWAAAAYAAJ&pg=RA1-PA24&lpg=RA1-PA24&dq=%D0%97%D0%BB%D1%8B%D0%B2%D0%BA%D0%B8&source=bl&ots=YOp_L1-Pyg&sig=kVzEjiuesdQ8gOIarKGqXWmNYZY&hl=en&ei=qwTbTMXxM8H38AamhLmJCQ&sa=X&oi=book_result&ct=result&resnum=2&ved=0CBoQ6AEwAQ#v=onepage&q=%D0%97%D0%BB%D1%8B%D0%B2%D0%BA%D0%B8&f=false. 2010 October 16.

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. Rodyny i khrestyny. Kievskaya Starina, 1898; 5. http://library.kr.ua/elib/malinka/malinka1.html. 2010 October 16.

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. Ritual v Traditsionnoy Culture. Struktorno-Semanticheskiy Analyz Vostochnoslavianskih Obriadov. Nauka: St. Petersburg, 1993. www.cultinfo.ru/arts/folk/demo/books/baybur/baybur9.htm. 2010 October 12.

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. Russkie Deti i Ikh Igry. Iskusstvo–St. Petersburg: St. Petersburg, 2000.

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. Smertnost detey. Issledovanie o rozhdenii i smertnosti detey v Novgorodskoy gubernii. Artemiev

. Zapiski Imperatorskogo Russkago Geograficheskago Obschestva po Otdeleniyu Statistiki, 1896. http://books.google.com/books?id=__gWAAAAYAAJ&pg=PA427&dq=%D0%BE%D1%82%D0%BB%D1%83%D1%87%D0%B5%D0%BD%D0%B8%D0%B5+%D0%BE%D1%82+%D0%B3%D1%80%D1%83%D0%B4%D0%B8&hl=en&ei=79fiTKqvC8P68AaJg5TRDw&sa=X&oi=book_result&ct=result&resnum=5&ved=0CDkQ6AEwBA#v=onepage&q&f=false. 2010 October 13.

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. Vostonchnoslavianskaya Etnografiya. Nauka: St. Petersburg, 1991.

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. Semantika i symvolika vtorogo u bolgar (s nekotorymi slavianskimi paralleliami) Tolstaya

. Priznakovoe prostranstvo kultury. Indrik: Moscow, 2002; 209–224. http://ec-dejavu.ru/c/Cherta_s_dva.html. 2010 October 10.

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. Cultural influences on infant and childhood sleep biology and the science that studies it: Toward a more inclusive paradigm. Loughlin

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. Lung Biology in Health and Disease, Vol. 147: Sleep and Breathing in Children: A Developmental Approach. Marcel Dekker: New York, 2000; 99–130.

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, Granat

. Zabota o Zdorovye Materi i Rebenka v Sovetskom Soyuze. Medgiz: Moscow, 1957. www.detskiysad.ru/gigiena/kurs01.html. 2010 September 29.

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. Epidemiologiya grudnogo vskarmlivaniya. Okhrana, Podderzhkai Pooschreniye Grudnogo Vskarmlivaniya v Lechebno-Profilaknicheskih Uchrezhdeniyah Rodovspomozheniya i Detstva, 2005. www.ourbaby.ru/articles/article.aspx?id=47. 2010 November 28.

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Dinamika grudnogo vskarmlivaniya v subyektah Rossiyskoy Federatsii sredi detey 6-12 mesiatsev. Obschestvennye gruppy materinskoy podderzhki i ikh rabota po okhrane i podderzhke grudnogo vskarmlivaniya. Expressprint-IK: Moscow, 2006. http://akev.ru/content/view/20/56/. 2010 October 28.

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. Breastfeeding Nemesis. Midwifery Today, 1998. www.midwiferytoday.com/articles/breastfeednem.asp. 2010 December 2.

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. Limits to Medicine: Medical Nemesis—The Expropriation of Health. Penguin Books: New York, 1997.

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, Williamson

. The impact of women's status on infant mortality rate: A cross-national analysis. Social Indicators Res, 1996; 37:333–360.

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. Mother Nature: Maternal Instincts and How They Shape the Human Species. Ballantyne Books: New York, 2000.

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. Cross-Cultural Perspectives on Women Series, Vol. 2: Anthropology of Breast-Feeding: Natural Law or Social Construct. Berg Publishers: London, 1992.