Abstract
Breast or Bottle? provides a rhetorical history of the shifting debates surrounding the feeding of infants since the 1940s. Focused on the American case, the book draws on a wide set of data sources including official policy documents and organizational statements, public health posters, medical and scientific texts spanning a period of more than 70 years, as well as fieldwork interviews and focus groups with mothers and breastfeeding activists. Koerber’s analysis shows how scientific and medical discourses about breastfeeding have shifted from a position of uncertainty about the benefits of breastfeeding, dominant until the 1990s, to the current view of breastfeeding as unequivocally the best mode of infant feeding.
The book is organized into six chapters. Chapter 1 provides an overview of the three key rhetorical commonplaces (topoi) that Koerber identifies in debates about infant feeding: breastfeeding as a foundation that can be improved upon by infant formula, breastfeeding as norm and infant formula as risky. For most of the 20th century, the benefits of breast milk were uncertain, and the topos of breastfeeding as foundation dominated medical practice and recommendations until the 1990s. Chapter 2 provides a rhetorical analysis of 59 scientific articles on infant feeding and immunity published between 1940 and 2005. This chapter shows a shift in the metaphor governing scientific understandings of the immune system, from hierarchical machine to complex system, which allowed breast milk to be rearticulated as a part of this system rather than a unique feature of women’s bodies. This effectively degendered breast milk, while inaugurating a new respect and valorization of its benefits.
Chapter 3 provides an in-depth look at three key policy statements issued by the American Academy of Pediatrics (AAP) in 1982, 1997 and 2005 and shows how these policy documents functioned as key rhetorical events or ‘communicative acts’ (p. 54) forging new articulations between science and medical practice. The 1997 statement in particular marked a critical shift away from the notion of breastfeeding as foundation to a position that rearticulated breastfeeding as normative on the basis of the unique health and immune benefits it provides to infants. This chapter also documents the discursive struggles behind the AAP policy statements, providing important illustrations of social change in action through the discursive work of activists. Chapter 4 looks at the breast/bottle controversy as played out in promotional discourse, drawing attention to the tendency of discourses to borrow or ‘strategically replicate’ (p. 82) information, catchphrases, images or rhetorical positions from other discourses, which are appropriated for their own ends. Pro-bottlefeeding promotional materials, for example, are shown to draw on the rhetoric and imagery of immunology to promote the (untested) immune-boosting qualities of their own products.
Chapter 5 moves the analysis to the perspectives of American mothers and breastfeeding activists, employing focus group and interview data collected during 2000 to 2008 from participants of a range of ethnic and racial backgrounds. Arguing that individuals are subject to complex ‘disciplinary rhetorics’ (p. 105) which shape their actions and their bodies, the chapter discusses ‘rhetorical agency’ as a choice between pre-existing discursive positions; however, Koerber argues that the effects of acts of resistance such as breastfeeding in public are unpredictable and can engender change in the broader disciplinary rhetorics of infant feeding. This chapter is critical because it shows that official pro-breastfeeding medical policy and clinical recommendations do not always translate into everyday realities: women are shown to be in a ‘troubling position’ (p. 108), where ‘breast is best’ on paper, but women’s efforts to breastfeed are often actively discouraged and even sabotaged by sociocultural dynamics. Koerber argues that society and healthcare professionals often do not value breastfeeding, nor expect women to be successful at it. This functions as a form of disciplinary rhetorics whereby many women expect to fail at breastfeeding and which actively ‘circumscribes what the breastfeeding body can do’ (p. 115).
Chapter 6 focuses on feminism in relation to infant-feeding controversies, arguing that a feminist voice on breastfeeding is ‘barely audible’ (p. 131). Koerber is largely critical of those feminists who have entered the debate, particularly those who have questioned the validity of the scientific evidence behind the current pro-breastfeeding position and linked it to an anti-feminist backlash that wishes to put women back in the home and reinstate traditional forms of motherhood. She notes that feminists have oversimplified the history of breastfeeding controversies by ignoring historical shifts and thus have failed to appreciate that ‘today’s pro-breastfeeding discourse is responding to a long history of battles against breastfeeding’ (p. 139). Koerber thus argues that, far from representing a regressive move to tie women to biological modes of essential mothering, today’s pro-breastfeeding discourse is founded on a profound disarticulation in which human milk is degendered by the scientific vocabularies of immunology, a view which seldom acknowledges the specificity of female reproductive bodies. Koerber also stresses the conflict that women experience between official pro-breastfeeding messages and informal societal messages construing breastfeeding as difficult, problematic and inappropriate for public view: while breast milk is valued as uniquely beneficial to infants, women’s breastfeeding bodies are not well accommodated or respected in social spaces. Koerber thus hopes to contribute to a ‘feminist discursive space for breastfeeding’ (p. 145) and calls for the development of an embodied feminist rhetoric of breastfeeding which returns the maternal body and the fleshy realities of breastfeeding to centre-stage.
A key limitation of Koerber’s argument is its failure to recognize, let alone engage with, the plurality of feminist positions on breastfeeding. Despite her claims, there is by now a fairly large body of feminist scholarship (including names such as Iris Marion Young, Alison Bartlett, Cindy Stearns and Linda Blum) that has attempted to theorize the embodied aspects of the breastfeeding body. Even while stressing the importance of developing an embodied feminist politics of breastfeeding, Koerber’s engagement is limited to authors such as Joan B. Wolf who are sceptical of current pro-breastfeeding rhetoric. A sustained rhetorical analysis of the shifting feminist positions on the topic is yet to be accomplished. But despite this, Koerber’s work underlines the importance of rhetorical histories as a form of discursive analysis which can interrupt and reframe our understandings of particular social issues. The book makes superb use of multiple sources of evidence and strives to reconcile textual analysis with the lively voices of everyday rhetoric and embodied realities. Amy Koerber is to be commended on a fine piece of scholarship which deserves to be widely read by scholars and graduate students in gender studies, public health, medical sociology, rhetorical studies and discourse analysis.