When breast is not best: Opposing dominant discourses on breastfeeding

Introduction

The World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding up to two years of age or beyond (WHO/Breastfeeding, 2015) and this has become the optimal goal of policy and practice within health care systems around the world. Government health policies, antenatal classes and health care professionals, books, websites and magazines for expectant mothers all strongly promote breastfeeding as the superior infant feeding method (Knaak, 2010; Lee & Furedi, 2005). Breastfeeding is both a private bodily act and highly scrutinized gendered practice, governed by medicalized professionals and discourses that intersect with broader discourses on motherhood and ‘expected mothering behaviour’ (Andrews & Knaak, 2013, p. 89). This has made it an intriguing, but often neglected subject for feminists, as certain feminist discourses have been, as Crossley has noted ‘influential in promoting breastfeeding as a way of “resisting” the medicalization of childbirth and motherhood’ (Crossley 2009, p. 71). This celebration of breastfeeding can be seen as both liberating and simultaneously restrictive for women as it can reinforce some of the more essentialist tendencies within gender discourse (Wall, 2010).

Breastfeeding, like so many other mundane tasks of parenting, has increasingly become a moralized subject of heated debate and policy making, and this shift in meaning has been linked to a cultural expansion of parenthood, and motherhood in particular. A number of researchers have made links with this expansion of parenthood, with wider concerns about what Ulrich Beck (1992) has termed as ‘risk society’ and the shift in our perception of children (Faircloth, 2013; Lee, Bristow, Faircloth, & Macvarish, 2014). These researchers have helped to identify how parenting has become conceptualized as an activity that parents engage in, where a specific skill-set and level of expertise is required, revealing a deterministic view of parents as ‘wholly responsible for their children’s outcomes’ (Faircloth, 2014, p. 31).

Breastfeeding rates in Iceland and the other Nordic countries are among the highest in the Western world and almost all mothers initiate breastfeeding (The Directorate of Health, 2012). The cultural and societal expectations for women to successfully breastfeed are therefore very high as breastfeeding represents a strong moral and social norm. Iceland is an interesting setting for this kind of research as it has been portrayed as being a model for gender equality and feminism; policies on parental leave and day care provisions adhere to the dual-earner/dual-carer model and feminist rhetoric has been successfully incorporated into political discourse, at both national and individual levels.

Numerous studies demonstrate that mothers and health professionals are affected by discourses on breastfeeding and motherhood (Andrews & Knaak, 2013; Larsen, Hall, & Aagaard, 2008; Murphy, 2003), and importantly that there is ‘no mainstream discourse that directly challenges the supremacy of breastfeeding’ (Williams, Donaghue, & Kurz, 2013, p. 97). Discourse is commonly understood as language-in-use that reflects on social relations beyond a particular unit of text (Gee, 1996). Certain ways of understanding thrive in particular times and have been referred to as ‘master narratives’ (Bamberg, 2005) and ‘dominant discourses’ (Gergen, 1995). Dominant discourses make sense to us as they are familiar and easily understood and thus ‘are both more “tellable” and “hearable” than their marginalized alternatives’ (McKenzie-Mohr & Lafrance, 2014, p. 3). Foucault’s argument that one of the central functions of discourse is to render certain courses of action reasonable, and to make alternatives seem inappropriate is important when we examine the availability of counter-discourses. Counter-discourses or counter-narratives contest or challenge what is perceived to be ‘true’ and common sense, and can only be understood in relation to that which they are countering, and thus, ‘the very name identifies it as a positional category, in tension with another category’ (Bamberg & Andrews, 2004, p. x). In light of the powerful biomedical discourses on the health benefits of breastfeeding and the ‘common sense’ status they have acquired, it is important to examine breastfeeding from a socio-cultural vantage point by looking at the lived implications of breastfeeding for women and how they construct their infant feeding experiences.

The objective of this article is twofold. The first is to extend theorizing about rhetorical agency (the ability of individuals to speak or to create rhetoric in the context of discourse) and resistance by demonstrating how Icelandic mothers who have struggled with breastfeeding oppose and challenge dominant discourses on breastfeeding and good mothering and what counter-discourses they draw upon, in order to make sense of their experiences. The second objective is to examine if, and how, narratives on shared parental responsibilities, gender equality and feminism influence the counter-discourses of mothers struggling with breastfeeding. The article starts by giving a brief overview of the Icelandic context. A description of the methods and methodology used in this study is then given. The following sections present the results and discussions, exploring how Icelandic mothers who have struggled with breastfeeding contest and negotiate scientific discourses on breastfeeding and ‘good’ maternal practice.

Icelandic context

Iceland has ranked as number one for seven consecutive years on the Gender Gap Index published by the World Economic Forum (2017). On most parameters Icelandic society has been moving towards gender equality in the last few decades. Women in particular have been strengthening their social position but there has also been some movement among men into more traditional female spheres. Similar to the other Nordic countries, Icelandic politicians have for decades subscribed to ‘the gender equality project’ and have used political measures to influence the social situation of the genders in order to increase equality. Among these measures have been extensions of publicly funded day care for children and later a parental leave which gave both parents the right to time off from salaried labour to care for their infants and guaranteed them re-entry into the labour market (Eydal & Gíslason, 2008).

Although there have been many changes in gender relations within the Nordic countries in the last decades, traditional ideas are still very strong when it comes to parenthood. The dominant rhetoric on parenting in the Nordic countries is that it should be shared. Still it seems that women are almost always regarded as mothers or potential mothers, regardless of their wishes and actual status (Kugelberg, 2006; Magnusson, 2008; Perälä-Littunene, 2007; Phoenix & Woollett, 1991). Qualitative studies in Denmark (Olsen, 2000), Finland (Lammi-Taskula, 2007) and Iceland (Gíslason, 2005) have revealed this tendency by showing that mothers who ‘allow’ the fathers to use (some of) the sharable parental leave time are stigmatized and their dedication and devotion to their young children is questioned. A qualitative study in Iceland showed that there is a tendency to bracket motherhood and mothers’ parental leave as unconnected to the broader idea of gender equality. The couples interviewed all stated that they were equal in all regards and that they were in favour of gender equality. Still they had not shared the parental leave equally, nor had they made similar arrangements in order to bridge the care gap from the end of parental leave to day care. On the contrary, the mothers, much more than the fathers, left the labour market during this period. That was seen as unproblematic because, it seemed, motherhood was so natural, almost holy, that it was above and unaffected by tedious realities such as gender (Ingólfsdóttir & Gíslason, 2016).

The prevalence of breastfeeding is traditionally very high in the Scandinavian countries, and we have witnessed an upward trend towards higher breastfeeding rates and duration (Thome, Alder, & Ramel, 2006). Almost all mothers initiate breastfeeding (Larsen & Kronborg, 2013) and both policy and practice are in line with the World Health Organization recommendations. In a Swedish context breastfeeding is the ‘cultural norm’ and synonymous with good mothering (Flacking, Ewald, & Starrin, 2007) and the high breastfeeding rates in Scandinavian countries should therefore be considered a direct result of those cultural expectations, as well as other supportive structural conditions.

Breastfeeding rates for children in Iceland born in 2004–2008 reveal that breastfeeding is common, as 98% of children were being breastfed at one week old and 86% exclusively breastfed at that age. Breastfeeding rates in Iceland remain at a high level as 86% of three-month-old children were breastfed and 67% exclusively breastfed. The breastfeeding rate for children who were six months old was 74% and for one-year-old children the rate was 27% (The Directorate of Health, 2012). The ‘natural childbirth’ movement has been influential in Iceland and has gained institutional approval and successfully challenged the medical hegemony. A study from 2016 on attachment parenting discourses on Icelandic parenting websites offering expert advice on pregnancy, birth, breastfeeding and care, revealed how Icelandic mothers are simply expected to breastfeed and the assumption that all mothers would want to breastfeed (for some length of time at least) is completely taken for granted (Símonardóttir, 2016a). A previously published paper from this study, on Icelandic women who have struggled with breastfeeding, demonstrates how dominant biomedical discourses on infant feeding and ‘good mothering’ discursively position women as powerless and unable to make decisions on breastfeeding cessation, while the surveillance that women who fail to breastfeed come to expect from other mothers and the general public results in them having to account for their ‘lack’ of breastfeeding in order to avert the hostile gaze of others (Símonardóttir, 2016b).

Methods

In order to explore the experiences of Icelandic mothers who had encountered problems with breastfeeding I, the first author, introduced the study on two popular Facebook groups for Icelandic mothers with the goal of recruiting participants to the study. The Facebook groups in question are mæðra-tips (tips for mothers), with 4241 members, and Brjóstagjafaspjall (Breastfeeding chat), with 1370 members. Following that initial request the daily newspaper Fréttablaðið published an interview with me on their website, where I explained the background and aims of the study and asked women to submit their written stories, and that particular interview was circulated and ‘shared’ widely on Facebook. I did not collect demographic information about the participants and the reason for this was my textual focus on meaning, experiences and discourses but not on ‘outcomes’ as such. I also wanted the participants to feel a sense of freedom in their storytelling by being able to structure their stories in whatever way they felt was important, without following a structured questionnaire format. The goal was to employ a study design capable of gathering a considerable number of participants while ensuring that the participants could reveal as much or as little about their feelings and experiences as they wished to. Over 90 women expressed an interest in the study and 77 women submitted their stories, in October and November 2015. Some of the respondents requested more information and were subsequently sent a list of questions that they could keep in mind when writing their stories (see Table 1).

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Table 1.

Questions for consideration.

How would you describe your views towards breastfeeding before you had children?

How did the breastfeeding go?

How did you experience breastfeeding?

What kind of reaction did you get from health care workers, your community, and those around you?

How did you feel?

What could have been handled better?

What kind of support would you have liked to have had?

How do you feel about the experience today?

The stories varied in length, the shortest comprising only of rather short answers to the questions, and the longest several pages of text. Altogether the data consisted of over 124 pages of text. All content that was analysed was in Icelandic and the quotes presented in this article have consequently been translated into English by the first author and the names of all participants in the results section of this article are pseudonyms. This particular study design proved to be extremely successful, as the data gathered were for many of the participants highly personal, very emotional and for some, the first opportunity they had had to share their stories with someone who was interested in what they had to say. The gratitude and appreciation expressed by many of the participants to me personally for taking on this particular project further convinced me of its urgency and need.

As with other qualitative studies, the data in this particular study cannot statistically represent any particular demographic group and the findings should therefore not be seen as representative of all Icelandic mothers who struggle with breastfeeding. It is quite possible that the women who had a particularly negative experience of breastfeeding would be more likely to want to take part in the study and others who have perhaps not been as affected by the experience would choose not to participate. Despite these possible limitations to the study, the sheer number of women who wished to take part in the study and the amount of common themes that were present in their narratives give weight to the reliability of the findings.

The goal of this study was to conduct a feminist analysis of what we see as dominant power structures imposed on mothers in order to help to break them down and rebuild in more equitable ways. This understanding has informed all aspects of this study. It has shaped the original research questions, as well as the conceptual and theoretical framework for conducting the research, and the methods and methodology used. For the purpose of this article I analysed the data that were coded as ‘resistance’: meaning instances of opposition where counter-discourses or discursive challenges to the dominant discourse on breastfeeding are made. My approach to analysis is situated within the Foucauldian theory of power and discourse, emphasizing how language actively plays a role in the construction and maintenance of reality (Cheek, 2004). In order to not only analyse what was being said, but also what remains ‘hidden’, ‘natural’ and ‘common sense’, I used discourse analysis to examine the discursive space that the participants inhabit. I paid special attention to how the mothers challenge dominant discourses on breastfeeding and what counter-discourses they draw upon to reconcile their own experiences of failing to breastfeed with their identities as ‘good’ and responsible mothers.

Challenges, opposition and counter-discourses on breastfeeding

All the Icelandic mothers in the study wanted to breastfeed and they all experienced severe difficulties such as mastitis, damaged nipples, yeast infections or great pain. For some, the milk supply was low or non-existent and for others, the milk supply decreased over time. Some mothers were not able to establish any breastfeeding; others were able to breastfeed for a short period of time and a number of mothers encountered problems (for weeks and even months), but were able to carry on with breastfeeding despite those obstacles. The women invested a great deal of physical and emotional energy into trying to establish breastfeeding and when they encountered problems with their milk supply/production they were encouraged to increase the number of feeds dramatically and, additionally, use an electric breast pump to enhance milk production. As Ryan, Bissell, and Alexander (2010) have asserted, when a woman has had a less than joyous experience of breastfeeding ‘she has few other discourses to call upon but the one that says “I failed, I feel guilty, I’ve let them down” which causes a crisis in her sense of self’ (p. 957). It is therefore important to keep in mind Foucault’s (1980) view of the interplay between power and resistance when we examine the possibilities for women to construct competing discourses and subjectivities, as there are:

No relations of power without resistances; the latter are all the more real and effective because they are formed right at the point where relations of power are exercised; resistance to power does not have to come from elsewhere to be real, nor is it inexorably frustrated through being the compatriot of power. It exists all the more by being in the same place as power; hence, like power, resistance is multiple. (p. 142)

In the following sections we present analyses of extracts from the participants to demonstrate key analytical points where mothers contest or challenge dominant discourses on breastfeeding and ‘good’ mothering, or construct counter-discourses of their own.

Conclusions

Foucault’s understanding of power relations is based on the premise that they are inherently unstable and always accompanied by, and even generating, resistance. Nevertheless, as Lupton (1995) has pointed out, even though individuals can resist or oppose dominant discourses and produce counter-discourses of their own, the availability of such discourses is always limited by social and cultural context. In this article we have demonstrated how the experiences of Icelandic mothers struggling with breastfeeding reveal instances of opposition and contradictions to the dominant medical hegemony of breastfeeding discourse.

Breastfeeding in an Icelandic context represents a strong moral and social norm and is not presented as a decision, rather as an obligation and a duty that all women should take on. This overall assumption is not challenged in the women’s narratives as breastfeeding, or at least a serious effort to breastfeed, is still expected. Nevertheless, through their narratives, the mothers contest certain aspects of professionals’ infant feeding advice by constructing counter-discourses of their own, where they present themselves and their infant’s feeding experiences as legitimate.

The cornerstone of all dominant medical discourse on breastfeeding states that breastmilk offers considerable health benefits over formula. Even though the women do not directly challenge this overall assumption, some of them do contest the universality of such claims, contrasting their own happy, healthy and smart children with the image of formula fed children as deprived and less healthy. The very real fear that the women have of their children being lesser than because of not being breastfed suggests that the message of ‘breast is best’ has been internalized by the mothers.

Another example of dominant breastfeeding discourse that the Icelandic mothers challenge is the idea that bonding between mother and child primarily takes place through breastfeeding. This is refuted by presenting their negative experiences of breastfeeding as a counter-discourse, where breastfeeding is stressful and painful and leads to postnatal depression or anxiety and does therefore directly interfere with bonding. Some mothers reject the notion of bonding through breastfeeding by constructing their experiences of breastfeeding as uncomfortable and unenjoyable. These women can run the risk of being pathologized and certainly vilified for their feelings in a culture that claims that breastfeeding is a mother’s duty, which makes their resistance to the normalizing discourse of motherhood quite significant.

Dominant discourses present breastfeeding as the optimal feeding method with formula constructed as a lesser choice. The idea that formula feeding is inherently shameful or constructed as a failure on the mother’s part is contradicted in the narratives of the women, many of whom experience intense relief when they start formula feeding or supplementing with formula. That being said, constructing formula as a good option is only possible if breastfeeding no longer seems possible and this discursive shift of formula from second rate to the best option can only be achieved if the mother has truly tried and failed to establish breastfeeding. Thus, we can see how presenting formula feeding as positive and freeing the women disrupts disciplinary power without ever evading its constraints.

When it comes to fathers’ involvement in infant feeding through the use of formula, the mothers need to negotiate two positions at once: on the one hand, feeling happy to share the responsibilities more equally, and on the other hand, adhering to the dominant discourses of ‘good mothering’ that proclaim that infant feeding and care is primarily the mother’s domain. The mothers’ narratives also reveal how certain aspects of the intensive parenting culture prevail as the father bottle feeding is constructed as a means for him to ‘bond’ with the baby. This in fact shows us how women’s ‘accountability’ about not breastfeeding goes beyond their own actions and becomes a more encompassing argument about benefits to the family as a whole.

It has been argued that the subject can reflect upon the dominant discourses that constitute himself or herself and not simply accept them as uncontested truths (Weedon, 1987), but instead ‘position themselves within these, variably taking these up, resisting, negotiating and tailoring them to achieve a desired identity’ (Day, Johnson, Milnes, & Rickett, 2010, p. 238). The overall findings of this study reveal that women do just that: they resist, contest, renegotiate and tailor existing discourses to suit their own subject positions. Nevertheless, it would be far too simplistic to argue that this is a scenario where there is either a pure expression of agency or a simple reproduction of dominant discourses. Instead, the two often work simultaneously, and are mediated by cultural context in each instance, as well as the availability of counter-discourses.

Foucault describes silence or silencing as an integral part of the strategies that underlie and permeate discourses. Silence is therefore always meaningful as it is accompanied by social and political judgements about what is acceptable and unacceptable. Even though several counter-discourses can be identified in the women’s narratives, somewhat surprisingly almost none of them utilize feminist rhetoric to refute dominant discourses on breastfeeding or motherhood, and notions of equality and shared parental responsibilities do not feature as themes in their narratives. This was surprising to us as feminist discourses are common and pronounced in Icelandic society, ranging from the political to the personal. We wonder if this can be viewed as an apparent failure of feminism and feminist discourse; that has been unsuccessful in addressing and providing women with counter-discourses that challenge the highly gendered and oppressive elements of infant feeding and its link to idealized versions of motherhood. Feminist theorists can and should therefore continue to engage with this discourse by offering their insights into the complex issues surrounding infant care as well as the ways in which women as mothers are discursively constructed. Counter-discourses challenging the dominant discourses on infant feeding could for example help to identify how the demands made on mothers are made on the basis of their biology and other essentialist understandings. These counter-discourses could also be constructed around the need for equality between the sexes when it comes to caring for infants; resulting in shared parenting, right from the start. They could also address how this excessive focus on getting mothers to breastfeed hinders the mother from being a truly autonomous person as she is required to stay constantly close to her child, as well as pointing out how breastfeeding has become a ‘signal issue’ which assigns women into different parenting camps (Kukla, 2006) and thereby promotes and directly causes conflict and competition between mothers.

Some would argue that it is not the role of social scientists to necessarily champion certain discourses over others. We, on the other hand, agree with Willig (1998), who argues that it is indeed a political decision for the discourse analyst to choose which discursive objects to deconstruct and it is within his or her power to champion practices and possibilities that increase freedom and choice for individuals. What the findings of this study do is to make visible certain discursive constructions and power relations that have remained hidden or simply taken for granted. Once they have been identified, we are much better equipped to disrupt and untangle these constructions and power relations and critically engage with the normalizing discourses on infant feeding within the context of the Nordic countries.